Musculoskeletal conditions in childhood Flashcards
Changes in lower limb alignment
As the child grows the long bones change in length and girth
rotational, torsional or angular changes may occur at the hip and knee (eg. genu varum or genu valgum)
Changes in lower limb alignment : gait
infants have a high gait. a lot of hip and knee flexion.
1-4 years= a lot of gastrocnemius use
Changes in lower limb alignment: hip
LL alignment = largely due to the femoral head in the acetabulum.
toes pointing in = femoral anteversion
(notable at age 3- 10)
changes in the LL alignment: knee (torsional)
tibial torsion:
- internal
(looks like ‘bowing’ of knees)
changes in the LL alignment: knee (angular)
- genu valgum
(knocked knees) - common after 2 up to 5 yrs
(can look severe but is normal )
By 7 years how do changes in LL alignment appear similar to adults?
- kinematic features similar to adults
- joint torque and propulsion patterns in walking similar to adult
- adult level of femoral head coverage achieved by 8yrs
- tibio-femoral angle and heel position = neutral
- COM still slightly higher than adult at approx L3
What are ‘atypical’ features of musculoskeletal developent we need to be aware of?
the five S’s:
- Symmetry - assymetry is usually a sign of anomaly
- Symptoms- children may often have MS differences without symptoms
- Stiffness- joint stiffness is not normal in a growing child.
-Systemic -
inflammation/metabolic conditions can have affect on growth
-Skeletal dysplasia - importance of height to weight ratio
Juvenile arthritis characteristics
many types:
oligoarthritis (F 3x>M)
rheumatoid factor (+ve polyarthritis) - will see systemic signs (heat +pain)
undifferentiated (unsure diagnosis)
signs:
- swollen joints
- red eyes
- fatigue
- decreased exercise tolerance
Osteogenesis imperfecta
‘brittle bone disease’
different types (12 types) common:
- congenita
- tarda
- blue sclera
SandS’s
- multiple #’s at birth (severe case)
- weak muscles
- diffuse osteoporosis
- deafness
- hernias
- easily bruised
- bowing of long bones
limb deficiencies
symbrachydactyly
- did not grow fingers properly
polydactyly -
extra fingers
amniotic banding
-parts of amnion strands wrap around limbs- part of the limb below won’t form properly
syndactyly
- joined digits
leg length discrepencies
2.5 cm or more
having a slight = not abnormal.
Lizarov technique = breaking the bone and external fixation with adjustments to widen each day (1-2 mm per day depending on what they need).
fractures
greenstick
- incomplete # (half of the bone fractured horizontally)
- can bow the long bone
- need cast for 6-12 weeks
growth plate (epiphyseal- is common because not developed/is softer)
stress fractures
Generalised joint hypermobility
- hyperflexibility in multiple joints
- may be associated with syndrome (eg. downs syndrome)
- pain in multiple jts, muscles, or fatigue known as Joint hypermobility Syndrome (JHS) (same as Ehlers-Danlos Syndrome)
- in JHS, important to look after joints and maintain fitness
- measure with Beighton Hypermobility Score
idiopathic toe walking
- usually no history of other issues
- normal ROM around ankles and knees
- consistantly walking on toes
- secondary changes of stiffness (eg. calf)
short term Rx:
- serial casts
- foam splints to keep feet down
Score on Beighton scale that is hypermobile
5 or more
