Pediatric MSK conditions

Question 1

Brachial plexus injury is usually due to traction on ______ during breech delivery of forceful traction and rotation of _____ during difficult delivery

Answer 1

shoulder; head

Question 2

What is the most common brachial plexus injury?

Answer 2

Erb’s palsy

Question 3

What nerve roots are involved in Erb’s palsy?

Answer 3

C5-C6

Question 4

What position is the arm in Erbs palsy?

Answer 4

Waiter's tip - 
Shoulder - extension, internal rotation, adduction
Elbow - extension
Forearm - pronated
Wrist and fingers - flexed

Question 5

Grasp is (lost/intact) in Erb’s palsy

Answer 5

intact

Question 6

Is there sensory loss in Erb’s palsy?

Answer 6

YES

Question 7

Klumpke’s palsy = injury to the ____ _____

Answer 7

lower plexus (C7-T1)

Question 8

What are 3 major impairments in Erb’s palsy?

Answer 8

1. paralysis or weakness
2. muscle imbalances
3. learned non-use - delay in motor milestones

Question 9

____ encompasses a spectrum of pathologic hip disorders in which hips are unstable, sublimated or dislocated, and/or have malformed actabla

Answer 9

DDH

Question 10

Normal development of the femoral head and acetabulum are _________

Answer 10

co-dependent

Question 11

The head must be stable in the hip socket for both to form _______ and _______

Answer 11

spherically; concentrically

Question 12

What are 2 large risk factors for developing DDH?

Answer 12

1. breech position

2. + family history

Question 13

DDH is clinically ______ in infancy/early childhood

Answer 13

silent

Question 14

There is poor prognosis of DDH if unstable and morphologically abnormal by __-__ years of age

Answer 14

2-3

Question 15

What are 4 tests to do in the screening exam for DDH?

Answer 15

1. LLD
2. asymmetric thigh or gluteal folds
3. limited or asymmetrical hip abduction
4. Barlow/Ortolani

Question 16

In the Ortolani maneuver, a subluxed or dislocated femoral head is reduced into the acetabulum with gentle hip ________ by the examiner

Answer 16

abduction

Question 17

In the Barlow maneuver, a reduced femoral head is gently _______ until it becomes sublimated or dislocated

Answer 17

adducted

Question 18

The _______ maneuver is a test of laxity or instability

Answer 18

barlow

Question 19

What is the most important clinical test for detecting newborn dysplasia ?

Answer 19

Ortolani

Question 20

3 management strategies of DDH?

Answer 20

1. observation
2. bracing
3. Sx

Question 21

6 long term implications of DDH?

Answer 21

1. degenerative arthritis
2. LLD
3. limited hip abduction
4. pain and disability
5. premature hip replacement
6. avascular necrosis

Question 22

_______ ______ = congenital disorder of collagen synthesis

Answer 22

osteogenesis imperfecta

Question 23

OI effects all _______ tissue

Answer 23

connective

Question 24

What are 6 effects of OI?

Answer 24

1. OP
2. excessive fractures
3. bowling of long bones
4. spinal deformities
5. muscle weakness
6. ligamentous laxity

Question 25

2 management strategies for OI?

Answer 25

1. bisphosphonates | 2. orthopaedics

Question 26

PT management of OI?

Answer 26

function and participation!!!

Question 27

At what age should you start to worry about toe walking?

Answer 27

if it persists past the age of 3

Question 28

What are 2 differential diagnosis's for ITW?

Answer 28

1. autism spectrum disorder | 2. CP

Question 29

Are males or females more likely to be ITW?

Answer 29

males

Question 30

There is a ___ association between ITW and language delays, learning impairments and prematurity

Answer 30

+++

Question 31

3 symptoms aside from toe walking in ITW?

Answer 31

1. pain in legs 2. frequent tripping / falling 3. ankle injuries

Question 32

4 treatments for ITW management?

Answer 32

1. casts/braces 2. PT 3. botox-A 4. surgery

Question 33

PT algorithm for ITW?

Answer 33

1. stretching 2. strengthening 3. manual therapy 4. balance/coordination exercises 5. gait training

Question 34

_____ disease = avascular necrosis of the femoral head due to loss of blood supply

Answer 34

legg calve perthes disease (LCP)

Question 35

What are 5 possible causes of LCP disease ?

Answer 35

1. trauma 2. transient synovitis 3. infection 4. congenital or developmental vascular irregularities 5. thrombotic vascular insults

Question 36

Most common onset of LCP disease is ____ ages __-__ years

Answer 36

boys; 5-7

Question 37

4 stages of LCP disease?

Answer 37

1. condensation 2. fragmentation 3. reossification 4. remodelling

Question 38

______ = femoral head slips or is displaced from normal alignment on femoral neck

Answer 38

slipped capital femoral epiphysis (SCFE)

Question 39

SCFE is often associated with onset of ______

Answer 39

puberty

Question 40

5 clinical presentations of SCFE?

Answer 40

1. pain in groin, medial thigh or knee 2. limp 3. ER of leg 4. limited hip ROM 5. inability to WB due to severe pain

Question 41

Management of SCFE?

Answer 41

1. surgery; stabilize growth plate with a pin fixation 2. bedrest 3. casting 4. PT

Question 42

Ogood-Schlatter disease (OSD) = ______ injury

Answer 42

overuse

Question 43

OSD = _______ of tibial tubercle

Answer 43

apophysitis

Question 44

OSD is common in boys ages __-__ years old and girls ages __-___ years old

Answer 44

10-15; 8-13

Question 45

OSD management?

Answer 45

1. ice 2. rest 3. stretch 4. strengthen

Question 46

Osteochondritis dissecans (OCD) = ______ lesion, distal femur most common

Answer 46

osteochondral

Question 47

Ages of OCD?

Answer 47

13-17

Question 48

Clinical presentation of OCD?

Answer 48

1. generalized pain which increases with activity 2. increase in pain with rotational movements 3. swelling 4. instability 5. locking

Question 49

_____ disease = localized disorder of bone remodelling

Answer 49

pagets

Question 50

__-__ % of Paget's disease is asymptomatic

Answer 50

70-90

Question 51

______ disease normally involves multiple bones, especially axial skeleton

Answer 51

pagets

Question 52

There is a very strong _____ link with pagets disease

Answer 52

familial

Question 53

_____ = hormonal disorder that develops when your pituitary gland produces too much growth hormone during adulthood

Answer 53

acromegaly

Question 54

_____ is characterized by short stature

Answer 54

dwarfism

Question 55

Most common type of drawfism?

Answer 55

achondroplasia

Question 56

What are the 2 types of dwarfism?

Answer 56

1. disproportionate | 2. proportionate

Question 57

5 clinical presentations of LCP's disease?

Answer 57

1. limp 2. pain 3. +ve trendelenberg 4. decreased ROM 5. muscle spasm (++ abd and IR, flexion contracture)