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N114 Skeletal
N114 - Skeletal Dysfunction
Question | Answer |
---|---|
Dysplasia of the hip | Femoral head has abnormal relationship to the acetabulum (hip socket) |
Hip dysplasia patho | Maternal hormone secretion relaxin, frank breech birth, twins, large infant |
Degrees of DDH | Dislocatable - mildest form, Sublaxation - most common, Luxation - complete dislocation |
DDH treatment - newborn | Pavlik harness worn for 3-6 months |
DDH treatment - infant to toddler | Gradual reduction by traction |
DDH treatment - older child | Involves operation to release muscles & tendons |
Barlow maneuver | Unstable femoral head is pushed out of acetabulum by gentle lateral pressure |
Ortolani maneuver | Relocation of femoral head by abduction & external rotation |
Clubfoot | Congenital deformity of the foot |
Clubfoot patho | Foot points downward, forefoot turns inward, sole of foot turns inward, foot is rigid & fixed |
Clubfoot treatment | Serial casting, changed every 1-2 weeks |
Osteogenesis Imperfecta | Brittle bone disease |
Osteogenesis imperfecta symptoms | Little pain at fracture site, dental deformities, blue sclera, thin skin. Child bruises easily |
Osteogenesis imperfecta treatment | Early treatment of fractures & prevention of abnormalities |
Kyphosis | Excessive convex curvature of spine |
Congenital kyphosis | Failure of formation or segmentation of vertebral structure |
Postural kyphosis | Occurs in pre-adolescent years among girls who are self-conscious |
Kyphosis treatment | Optionss include no treatment, exercising, bracing or surgical intervention |
Lordosis | Concave curvature of lumbar spine - normal finding in toddlers |
Lordosis treatment | Postural exercises. Bracing & surgery are rarely needed |
Scoliosis | Spinal deformity, lateral curvature of the spine with vertebral rotation |
Scoliosis patho | On concave side, muscles & ligaments become contracted & thickened. On convex side they become thin & atrophied |
Scoliosis symptoms | Unequal shoulder & hip level, pain is uncommon until deformity is advanced |
Scoliosis treatment | Orthotic intervention - bracing, Boston & Milwaukee brace and surgical spinal fusion |
Boston brace | Underarm prefabricated plastic shell - low thoracolumbar & lumbar curves |
Milwaukee brace | High thoracic curves - plastic & metal w/chin extension |
Harrington rod | Used to fuse vertebrae |
Slipped femoral capital epiphysis | Slipping of proximal femoral epiphysis in a posterior & inferior direction |
Slipped femoral incidence | Occurs during adolescent growth spurt, occurs in very tall & obese adolescents |
Slipped femoral symptoms | Limp, referred pain to groin, hip or knee, limited ROM, external rotation of leg |
Slipped femoral treatment | Surgery is required, pre-surgical bed rest/traction, pin across growth plate, not-weight bearing |
Rheumatoid Arthritis patho | Chronic inflammation of a joint |
Rheumatoid symptoms | Morning immobility or stiffness & joint pain, joint swelling & heat, not red |
Rheumatoid tests | Elevated erythrocyte sedimentation rate, elevated c-reactive protein, elevated WBC & platelets |
Rheumatoid treatment | NSAIDS, Methotrexate - chemo drug, corticosteroids, physical therapy |
Muscular dystrophy | Degenerative inherited muscle wasting disease, x-linked recessive |
Muscular dystrophy patho | Absence of muscle protein dystrophin, results in degeneration of muscles |
Muscular dystrophy symptoms | Between 2-4, pelvic muscles weaken, difficulty climbing stairs, running |
Gower sign | Process that children use to stand up |
Muscular dystrophy progression | Enlargement of calves & wasting of thighs, 9-12 walking becomes impossible, breathing becomes difficult, heart weakens |
Fractures | Rarely occur in infants - usually a result of abuse |
Simple fracture | Skin remains intact |
Compound fracture | Broken bone protrudes through skin |
Transverse fracture | Fracture that is at right angles to long axis of bone |
Oblique fracture | Slanting or diagonal fracture across bone |
Spiral fracture | Circular or twist to fracture - commonly seen in abuse |
Greenstick fracture | Break through bone where one side only bends |
Traction | Immobilize fractures, realign the bone, decrease muscle spasm |
Skin traction | Applied directly to the skin |
Skeletal traction | Uses pins, wires or other apparatus that have been surgically placed |
5 P's of circulatory checks w/traction | Pain, paresthesia (tingling), paralysis, pulse, pallor |
Hazards of Immobility | Encourage coughing & deep breathing, wasting of bone, functional loss,urinary stasis, constipation |