Flashcards
PHS302 - MSK Development and Assessment in Children
Cards in this deck (17)
- 1what is the normal development of ULs and LLs from 8/52 gestation?upper limb buds - med to lat rotn
lower limb buds - lat to med rotn - 2normal LL alignment changes 1infant - bow legged (genu varus)
18 mths - straight
3.5 yrs - knock kneed (genu valgus)
7 yrs - straight
BUT - Check parents posture as can also be due to genetics / ethnicity - 3normal LL alignment changes 2hip + femur
- hip flxn / ER ST contractures, rapid dec over 2 years
med bony fem torsion dec over 7 yrs+
knee + tibia
- dec in kn flxn contracture
med bony tibial torsion dec (more rapidly than femurs)
foot + ankle
- dec forefoot supn
- hindfoot inv -> ev (talar and calcaneal) - 4factors we want to know re presentationunderlying pathologies? (tumour, injury)
is alignment typical for age?
is it impacting fx?
does it require rx, monitoring or referral?
NOTE: Injury to growth plates => inc blood supply => inc growth => asymmetry - 5common presentationsLL mal-alignments:
- transverse, coronal or saggital plane
gait variations:
- toe walking, intoeing, out toeing
scoliosis:
- idiopathic, postural or neurological - 6MSK Assessment- neurological / MSK
- screening of age approp motor skills
- rotational profile (femur, tibia, foot or all)
- check asymmetry
- pain (subjective from parents) - 7clinical examinationposture and gait
leg length (symmetry)
bony alignment / muscle length
muscle tone and spasticity - 8posture and gait ax anterior and posterior view- trunk and arm swing
- pelvis
- patella position
- shank
- foot progression angle
(intoeing 1yr, straight 8yrs,
out toeing 14 yrs)
- symmetry - 9posture and gait ax lateral view- trunk and arm swing
- pelvis AP - 10sagittal plane muscle length teststhomas test - psoas, rec fem, ITB
duncan ely test - rec fem
popliteal angle - hams
knee FFD, hyperextension
ankle DF - gastrocs, soleus
jack's test (arches)
- lift big toe (flexi vs rigid) - 11coronal plane standing then supinepelvis (posn, rotn, symmetry)
leg length (Galeazzi)
hip abdn (dynamic R1 measures)
genu varum (measure dist btwn knees)
genu valgum (measure dist btwn med malleoli)
calcaneo varus / valgus
foot posture index - 12genu valgum / genu varum managementinform parents of normal development
monitor if on outer limits
refer (ortho/paediatrician) if:
* >7.5cm btwn mm or knees
* genu varum post 3 yrs of age
* asymmetry
* painful
* worsening over time
* assoc w short stature - 13assessment transverse plane (rotational profile)foot progression angle
(obs in walking/running)
hip IR and ER
thigh/foot angle (TFA)
transmalleolar (Bimalleolar) axis (TMA)
foot configuration
- forefoot supn / pron
- metatarsus adductus / abductus - 14Measurements Thigh-Foot Angle (TFA)neonate = 0-20deg IR
adult ~ 30deg ER
child lies prone, kn flx to 90deg, foot in PG
long arm of goniometer in line with femur, measuring arm thru axis of foot (2/3 toe) - 15Measurements Trans Malleolar (Bi Malleolar) (TMA)child in prone
draw line across bottom of heel (med to lat malleolus)
long arm of goniometer in line w femur
measuring arm in line with line on heel - 16implications of deformitymed rotn deformity = improves w growth
lat rotn deformity = increases w growth
deformities at > 1 level:
- additive = femur/tib turn in same directn
- compensatory = turn in opp directn - 17variations in ms deformity: structural postural acquiredstructural:
early gestation - 0 to 8 weeks
teratological / idiopathic
- arthrogryposis, absent limbs
- talipes
postural:
late gestation - 3rd trimester
moulding, packaging, in utero, crowding
- torticollis, metatarsus adductus, DDH
acquired:
infancy and childhood
altered intermittent forces
- CP, SB, DMD
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- Normal development and assessment in paediatrics
- Created by
- Louise Weir · Oct 2016
- Updated
- Oct 26, 2016
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