Pediatric Orthopedics Part 1 Flashcards
(119 cards)
1
Q
What are the general range differences that are increased?
A
Increased: Shoulder extension and rotation Wrist flexion Hip abduction and rotation Ankle DF and Inv/Ev
2
Q
What are the general range differences that are decreased?
A
Decreased hip and knee extension
Decreased ankle PF
3
Q
General range differences: What is going on at the hip?
A
Anteversion/antetorsion
4
Q
General range differences: What are we looking for at the knee?
A
Varus/Varum
5
Q
General range differences: The first baby usually has more _____ _____
A
Range limitations
6
Q
General range differences: At birth, do we expect to see full ROM for hip extension?
A
No, we have -10 degrees
7
Q
General range differences: How many degrees PF do we have at birth?
A
10 degrees PF
8
Q
Anteversion:
Babies have normal increased ______ at birth, which puts the thigh into ____
A
Anteversion
ER
9
Q
Anteversion:
When the baby stands up to walk, what muscle is not in a position to work, and why?
A
Glute Med
It is too far behind
10
Q
Anteversion: How will the baby put glut med into position?
A
They will now in-toe
11
Q
Anteversion: So… an anteverted hip will result in ____ _____
A
In toeing
12
Q
Anteversion: If the baby doesn’t ___ ____, then anteversion will stay because did not have good, prolonged ____ ____
A
Weight bear
Weight bear
13
Q
Anteversion: which way is the femoral head facing?
A
Forward
14
Q
Retroversion: Which way is the femoral head facing?
A
Backward
15
Q
Version: head of the femur into the _________
Torsion is the twist of the ______
Ante: takes the baby to ____
Then _____ _____ ______, puts it back into alignment
As we stand on it, both correct
Hip comes into less ________ and less ______ ______
Between the two, we have a _____ _______
A
Acetabulum Femur ER Medial femoral torsion Anteversion; Medial torsion Neutral thigh
16
Q
Developmental progression of varus to valgus:
Babies start off with ____ ____, then weight bear, and start going into an increased ______, then will go to normal levels of ______
A
Genu varum
Valgus
Valgus
17
Q
Developmental progression of varus to valgus: Bones will start aligning with _____ _____
A
Normal WB
18
Q
Developmental progression of varus to valgus: If a baby has poor head control, how do you get WB?
A
Put them in standers!
19
Q
Developmental progression of varus to valgus: Newborn?
A
Moderate genu varum
20
Q
Developmental progression of varus to valgus: 6 months?
A
Minimal genu varum
21
Q
Developmental progression of varus to valgus: 1-2 years?
A
Legs straight
22
Q
Developmental progression of varus to valgus: 2-4 years?
A
Physiologic genu valgum
23
Q
Developmental progression of varus to valgus: 16 y.o. Female?
A
Slight genu valgum
24
Q
Developmental progression of varus to valgus: 16 y.o male?
A
Slight genu varum
25
What is the most common form of episodic musculoskeletal pain?
Growing pains
26
Growing Pains: What age group is this common in?
Kids 3-12 years of age
27
Growing Pains: What are the 4 symptoms?
1. Nonarticular, most often in shins, calves, thighs, popliteal fossa
2. Almost always B/L
3. Pain lasts minutes to hours in duration, mild to severe in intensity
4. Pain free episodes
28
Growing Pains: Are there signs of inflammation on exam?
NO
29
Growing Pains: What is the treatment if symptomatic?
Muscle stretching
Massage
Resolve with time
30
Growing Pains: What medication can you take?
Tylenol
31
Growing Pains: What is the explanation behind this?
BONE grows quickly, but MUSCLE takes time to lengthen out
32
Peds. Injury: It can be either a ______ _______ or ______ _______
Single macrotrauma
Repetitive microtrauma
33
Peds. Injury: What is an example of single macrotrauma?
Serious contact/landing
34
Peds. Injury: What are 4 examples of repetitive microtrauma?
1. Training errors
2. Musculoskeletal imbalance (growth spurts)
3. Anatomical alignment
4. Footwear
35
Peds. Injury: What is an example of a training error?
Repeated over time
| Over training/over doing/fatigue
36
Peds. Injury: What is an example of anatomical alignment?
Increased valgus puts body at more risk.
For example a female basketball player is at more risk than a male basketball player.
37
Peds. Injury: Anatomical Alignment: Turn out should be at _____, not ____ or _____
HIP
Not knee or foot!
38
Peds. Injury: Footwear: need shoes that ____
FIT!
39
Types of injuries:(3)
Fractures
Joint Injury
Musculotendonous unit
40
Types of injuries: Once growth plates are fused, go to the ____ _____
Adult pattern
41
Types of injuries: Kids will only stay up at night if they have ____ or _____
A fracture
Cancer
42
Types of injuries: Fracture: Can be either at the ______ _____ or can be a _____ ____
Growth plate
Stress Fracture
43
Types of injuries: Fracture: Growth plate: open area of bone that helps _____ and gets tall over time.
Opens, fills in, and gets _________
At ____ ends of the bone; one is usually more contributory to _______ of bone
Lengthen
Length
Both
Length
44
Types of injuries: Fracture: Stress fracture in ________ bone seen _____ weeks post onset of pain
Cancellous
6-8 weeks
45
Types of injuries: Fracture: This fracture looks like a splinter...
Greenstick fracture
46
Types of injuries: Joint injury: Can either be a _______ or _______
Ligament sprain
Derangement
47
Types of injuries: Musculotendonous Unit: You will see this before seeing tendinitis
Avulsion fx
48
X-ray information: Never Do aggressive _____ in Peds client
ROM
49
X-ray information: Hand: You see ____ _____ at every bone
Ring finger, prox phalanx has a _______ fx
^ The problem is that they can pivot as they heal and ____ the bone. A ______ will not help rotation. Need to ____ and put in full _____
Growth plates
Greenstick
Spin
Splint
Align
Cast
50
Sports Screening: Must assess _______ and _____ ______
Maturity
Overall fitness
51
Sports Screening: ___ of all musculoskeletal problems ID in screening unknown by primary physician
1/3
52
Sports Screening: When looking at specificity of sport, what two things must you look at?
Are they prone to particular injuries?
Range requirements
53
Sports Screening: Look at ______ staging
Maturity
54
Sports Screening: _____ use and _______ abuse
Drug
Dietary
55
Sports Screening: We need to STOP these two things....
Sports trauma
Overuse
56
Infancy: If hip dislocated, what motion do you lose?
Abduction
57
Infancy: Congential ________/_________
| How many grades are there?
Dislocation/dysplasia
5
58
Infancy: The long it takes to find the congenital dislocation/dysplasia, the better, T/F?
FALSE
Find it early = less treatment time
59
Infancy: Metatarsus adductus has 3 classes, what are they? And what would each intervention be?
Flexible: HEP, watching
Semirigid: HEP, tape, cast, special shoes
Rigid: Surgery
60
Infancy: Clubfoot - Talipes Equinovarus
What 3 things are present in club foot?
Metatarsus adductus
Hindfoot varus
Ankle Equinus
61
Infancy: If you have a flexible club foot, when they get up to walking it will....
Correct itself
62
Infancy: Club foot: if rigid and too tight, then what do PTs need to do?
Stretch it out
63
Clubfoot: also presents with _____ and _____ and the ankle
If severe, they will _____ at ankle. Why is this not a good thing?
PF and inversion
Fuse
Because balance reactions come from this angle!
64
Developmental Muscular Torticollis: What is this a result of from the mother?
Tight uterine package
65
Developmental Muscular Torticollis: What is the position of the neck; and what muscles are tight?
Rotation to opposite side, lateral flexion to same side
SCM is tight
66
Developmental Muscular Torticollis: What are the causes? (6)
```
Tumors- 1/3
Trauma
Pseudotumors
Fetal malposition
Uterine compression
Inflammatory conditions
```
May occur with other conditions (check out hips)
67
Developmental Muscular Torticollis: Impairments: Asymmetrical pressure on ____ of head
Back
68
Developmental Muscular Torticollis: Impairments: SCM tightness (lateral flexion to tight side, rotation to opp. Side)
What other neck muscles can be affected?
UT
Scalenes
Hyoids
Tongue and facial muscles
69
Developmental Muscular Torticollis: Impairments: May have secondary ______ asymmetry, _______, and ________
Facial
Plagiocephaly
Scoliosis
70
Developmental Muscular Torticollis: Impairments: In plagiocephaly, one side of the face moves _____ and other moves ______
Back
Forward
71
Developmental Muscular Torticollis: Functional limitations?
Usually only affects ______ _______
With increasing severity can affect ability to WB on _____ ____
Righting reactions
I/L UE
72
Torticollis: What additional history do you want to look at?
How much time is child spending in equipment?
What is the sleeping position? Need to spend time on bellies!
73
Torticollis: Examination:
| ROM including _____ ____ ______ —> discharge when ____ _____
Resting head tilt
Neural head
74
Torticollis: Examination:
| _____ and _____ symmetry —> helmets mold their head
Facial and skull
75
Torticollis: Examination:
| Palpation of ______ (note: size, physical characteristics, location)q
SCM
76
Torticollis: Examination: ____ and ____ Motor Development
Gross
Fine
77
Torticollis: Intervention: Better Px if treatment starts early, ___ ____ 1 year of age
Less than
78
Torticollis: Intervention: Gentle stretching with slight ____ ____
Cervical traction
79
Torticollis: Intervention: Strengthening including: (2)
Visual tracking
Righting reactions —> use this to drive head tilt
80
Torticollis: Intervention: Positioning to provide ____ _____
| At least _____ positioning of head
Prolonged stretch
Midline
81
Torticollis: Intervention: Handling/carrying —> change _____ of the room
Orientation
82
Torticollis: Intervention: Orthotics. Must have some ____ and _____
PROM and AROM
83
National Guideline Prevention and Management of Positional Skull Deformities: Prevention includes what 2 things?
Parent education
Prone play time when awake and observed
84
National Guideline Prevention and Management of Positional Skull Deformities: Diagnosis is based on what two things?
Physical exam
Head shape for diff Dx between deformational plagiocephaly and craniosynostosis
85
National Guideline Prevention and Management of Positional Skull Deformities: What is craniosynostosis?
Skull stops expanding, but brain is still growing
If sutures fuse, there is cranial pressure
Sometimes prominent ridge —> emergency
86
National Guideline Prevention and Management of Positional Skull Deformities: Management includes:
```
Preventive __________
_______ adjustments (repositioning) and _______
Skull molding ______ (if conservative management does not work for mild/mod plagiocephaly)
```
Counseling
Mechanical, and exercises
Helmets
87
National Guideline Prevention and Management of Positional Skull Deformities: What is the term when the head is a trapezoid shape?
Plagiocephaly
88
National Guideline Prevention and Management of Positional Skull Deformities: What is the term when the baby’s head is a long oval vertically?
Scaphocephaly
Squished horizontally, too much S/L
89
National Guideline Prevention and Management of Positional Skull Deformities: What population of babies would you see scaphocephaly?
S/L a lot, so premature babies; too much on side, head will compress bc gravity
90
National Guideline Prevention and Management of Positional Skull Deformities: What term is it called when babies have a long horizontal head?
Brachycephaly
Will have bald spot on back of head
91
Molding helmets: How many points of pressure?
Must be _____ frequently, must allow baby’s head to _____
Wear until good _____
3
Redone
Grow
Shaping
92
Childhood: Legg-Calve Perthes:
What is the ratio for M:F?
What is the age range?
4:1
5-10 years old
93
Childhood: Legg-Calve Perthes: What happens to femoral head?
AVN
94
Childhood: Legg-Calve Perthes: Where does one feel pain?
Groin
Hip
Knee
95
Childhood: Legg-Calve Perthes: How will one walk?
With a limb and + Trendelenberg secondary to pain and decreased strength
96
Childhood: Legg-Calve Perthes: What ranges are limited?
IR (early sign)
Abduction
97
Childhood: Legg-Calve Perthes: If this is not picked up, what will happen as an adult?
Early onset arthritis
98
Childhood: Legg-Calve Perthes: AVN is more likely to happen if you have an ______ to hip
Insult
99
Childhood: Legg-Calve Perthes: Knee pain is ____
BAD!
Must check hip right away
100
Childhood: Legg-Calve Perthes: Shuts off What muscle?
Glute med
101
SCFE: What is the ratio for M:F
| What is the age?
2-3:1
7-15 years old
102
SCFE: What is the first sign?
KNEE PAIN
103
SCFE: Initially you will have an _____ _____/_____
Then chronic ______ lurch, and ____ toeing
Antalgic gait/limp
Abductor
Out
104
Osgood Schlatter’s:
F>M
True or false?
False, M>F
105
Osgood Schlatter’s: What are the ages?
10-15 years old
106
Osgood Schlatter’s: What is it?
Separation of tibial tubercle.
| You end up having a large tib tub, and avulsion fracture is possible
107
Osgood Schlatter’s: Where do you feel pain?
Over the tubercle
108
Osgood Schlatter’s: Development of ______
Limp
109
Osgood Schlatter’s: What are the treatments?
Rest
Ice
Decreasing activity
Avoid jumping and squatting
110
Sever Disease: What are the age groups?
7-10 and also 10-14 (rapid growth spurts)
111
Sever Disease: What is it?
Fracture and avulsion at ACHILLES TENDON attachment
112
Sever Disease: Where you feel pain, and when do you feel pain?
Pain in heel
| Especially after activity
113
Sever Disease: Where will you feel tenderness?
Posterior aspect of heel
114
Sever Disease: Development of _____
Limp
115
Sever Disease: What is the treatment?
Rest
Heel cups/lift
Reduced activity
Heel cord stretching
116
X-ray: Need to keep kids into _________ by putting them in a ________.
Some signs and then you get total compression of femoral head, then splintering of it (ossification centers/spotty)
Abduction
Brace
117
X-ray: If the SCFE is greater than ____% off, then you need surgery
50%
118
```
Management for: LCPD, SCFE, Osgoods, Sever:
Alleviate _____
Improve/maintain _______
Improve _______
Improve ______ _______
```
Pain
Range
Strength
Functional skills
119
Management for: LCPD, SCFE, Osgoods, Sever: What functional skills should yo be looking at?
Gait pattern
Gait speed (think of keeping up with peers)
Sports specific activities if appropriate
