Peadiatric MSK condition

Question 1

Osteochondritis dissecans background

Answer 1

Age:
~10-20 years old (highly active)

Etiology:
Disruption of blood supply –>subchondral necrosis of bone
–>Results in cracking/loosening of the bone and cartilage
–>float within the joint

Presentation:
- Painful, swollen joint which increases with activity
- Joint may lock/catch
- Giving away
- Decreased joint ROM

Cause:
-unknown
-may related to trauma/abnormal bone stress

Question 2

Osteochondritis dissecans treatment

Answer 2

may need surgery to remove fragment

PT Rx:
-Pain Mx
-Activity modification
-Stretching, strengthening(OKC)
-Bracing

Question 3

Legg-calve-perthes background

Answer 3

Age:
Most common: 4-8 yo
Can occur between: 2-15 yo

Etiology:
-An inadequate blood supply to the head and neck of femur (from middle of the round ligament)–>
vascular necrosis–>
abnormal shape of the femoral head–>abnormal acetabulum
Increased risk of hip OA

Presentation:
-Mild hip, knee or groin pain (Usually unilateral)

-Pain exacerbated by hip/leg movement and activities such as running, walking, jumping

-Decreased ROM into internal rotation/abduction

-Limpping

Cause:
Unknown

Question 4

Legg-calve-perthes Rx

Answer 4

Goal: minimize femoral head deformity to decrease risk of OA

Decrease pain
Maintain hip ROM
Positioning
Stretching
Limit mechanical stressors on joints (e.g. encourage swimming)

Question 5

Slipped capital femoral epiphysis
Background

Answer 5

Age: 10-16 yo (rapid growth)
Most common

Etiology:
*Slippage of the overlying epiphysis on the growth plate of the femur
*Hip joint heals abnormally
*If untreated –> severe hip OA

Presentation:
*Hip, groin, medial thigh and/or knee pain
*Pain increases with activity
*Acute or insidious onset of a limp
*Decreased hip ROM

Question 6

Slipped capital femoral epiphysis
PT Rx

Answer 6

Almost all children require surgery
-Epiphysis is screwed into place

Post-op:
Stable slips = partial weight bearing to tolerance x 6 weeks
Unstable slips = feather weight bearing x 6 weeks

Question 7

Developmental dysplasia of the hip

Answer 7

Age:
Present at birth/later if walking is delayed

Etiology:
Abnormal growth of hip–>shallow acetabulum

Presentation:
*Asymmetry of the gluteal or thigh skin folds
*Decreased ABD on the affected side
*Standing or walking with ER
*LLD (shorter on affected side)

Testing:
*Barlow (subluxes the hip)
*Ortolani tests (relocates the hip)

Question 8

Developmental dysplasia of the hip
Treatment

Answer 8

-Good prognosis
-Surgery (older than 6 mo)
-Pavlik harness: younger than 6 mo
hips positioned into abduction
-worn 24 hours per day
-re-evaluated with ultrasound every 2-3 weeks

Question 9

Salter-Harris Fractures Types

Answer 9

SALTER
I – S = Slip (separated or straight across)
o Fracture of the cartilage of the growth plate

II – A = Above
o The fracture lies above the growth plate, or away from the joint

III – L = Lower
o The fracture is below the growth plate in the epiphysis

IV – TE = Through Everything
o The fracture is through the metaphysis, growth plate and epiphysis

V – R = Rammed (crushed)
o The growth plate has been crushed

Question 10

Salter-Harris Fractures Treatment

Answer 10

• Restore ROM and strength once fracture has healed.
  *Approximately 85% of growth plate fractures heal without any long-term deficits.
  *Most common complication: LLD