6782239
Description
Flashcards by Louise Weir, updated more than 1 year ago
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Created by Louise Weir
over 7 years ago
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| Question | Answer |
| what 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 |
| normal LL alignment changes 1 | infant - 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 |
| normal LL alignment changes 2 | hip + 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) |
| factors we want to know re presentation | underlying 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 |
| common presentations | LL mal-alignments: - transverse, coronal or saggital plane gait variations: - toe walking, intoeing, out toeing scoliosis: - idiopathic, postural or neurological |
| MSK Assessment | - neurological / MSK - screening of age approp motor skills - rotational profile (femur, tibia, foot or all) - check asymmetry - pain (subjective from parents) |
| clinical examination | posture and gait leg length (symmetry) bony alignment / muscle length muscle tone and spasticity |
| posture 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 |
| posture and gait ax lateral view | - trunk and arm swing - pelvis AP |
| sagittal plane muscle length tests | thomas 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) |
| coronal plane standing then supine | pelvis (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 |
| genu valgum / genu varum management | inform 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 |
| assessment 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 |
| Measurements 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) |
| Measurements 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 |
| implications of deformity | med 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 |
| variations in ms deformity: structural postural acquired | structural: 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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