Week 3 Flashcards
(36 cards)
How can brain injury in CP cause bony deformity?
Bone inj, incr tone, abnorm posture, contracture, bony deform
Effects of spine in CP
Lung function impaired
Resp illness due to scoliosis
Requires:
Moulded seating
Spinal fusion
What are the phases of the gait cycle?
Stance:
IC = initial contact
LR = load response
MST = midstance
TST = terminal stance
PS = preswing
Swing:
ISW = initial swing
MSW = midswing
TSW = terminal swing
(one stride = full step of both feet)
Describe Rockerbottom feet
Congenital vertical talus.
Causes a rigid flat foot deformity.
Associated with NMD and chrom abnormalities.
Initial manipulation and casting, then surgical releases ages 6-12 months
Describe club feet
Common condition, Genetic component.
Postural talipes is often cause by crowding.
Passively correctible with stretching, casting, splinting
Red flags in leg pain
Asymmetry
Good localisation
Short history
Persisting limp
Not thriving
Pain worsening
Describe osteochondritis dissecans
Cartilage/subchondral bone lesion often in the knee (also elbow/ankle)
Pain on activity w stiffness/swelling
Subchondral drilling or pinning for unstable lesions.
Where does hip pain commonly refer to in kids?
Knees (usually hips cause poorly localised pain)
Describe HSMN
Genetic progressive condition, two types, type 1»>
Bilateral (usually) effects on peroneals, tib ant, intrinsics of hand, cavovarus foot, laterl foot pain
Weakness/numbness/clumsiness
Treat via maintenance of functional foot pos with orthotics/surgery
Unilateral cavovarus foot primarily suggests…
CNS tumour
(MRI brain/spinal cord)
What is a positive finding for scoliosis in Adam forward bend test?
One shoulder higher than other
Features of developmental dysplasia
Shallow acetabulum, reduced coverage of femoral head. Increased risk of dislocation, pain, early OA.
Causes and management of dev dysplasia
Causes:
Laxity
Relaxin - females
Crowding/moulding
Breech
Man:
Pavlik harness
Surgery (CR/OR spica) if caught late
Describe SCFE/SUFE
8-18y, endo/meta causes, weight
Causes KNEE/hip/groin/thigh PAIN, limp
Missed diagnosis
Exam findings of SCFE
Antalgic gait
Lower limb
-Short
-Externally rotated
-Loss of internal rotation
-Loss of deep flexion
Pain at extreme hip ROM
Describe transient synovitis
Inflammation of the synovium, often secondary to virus
Clin pres of transient synovitis
Hx virus
Limp and hip/groin pain
Maybe referred pain to knee (but less common)
Hip lying flexed/externally rotated
Pain at end range of hip movements
Systemically well, apyrexial
How can transient synovitis be diagnosed?
Kocher’s criteria
(WCC >12
Inability to WB
Temp >38.5
ESR >40 or raised CRP)
US +/- syno aspiration
Clin pres of hip septic arthritis
SURG EMERGENCY
Short duration of symptoms
Unable to weight bear and hip/groin pain
Hip lying flexed/externally rotated
Severe hip pain on passive movement
Usually pyrexial but may be haemodynamically stable
Management of septic arthritis
Inv: bloods, cultures, Kocher’s, radiology, US +/- aspiration
Treat: open surgical washout, antibios 6w via PICC
Describe Perthe’s disease risk factors
positive family history
low birth weight
Passive smoke
Asian, Inuit, and Central European decent
What is Perthe’s disease?
Idiopathic avascular necrosis of the hip
Bilateral in 12% cases but NEVER at same time
Typical patient pres of Perthe’s disease
Delayed bone age
Retarded growth soon after diagnosis later catch up growth
Undersized at Dx
Small hands and feet
30% have attention disorder
Management of Perthe’s disease
Containment
Movement
Seeing through fragmentation
Restrictions
Crutches/wheelchairs
Healing
Minimise degenerative changes
