Chapter 24

Muscular and Skeletal System

Muscular and Skeltal System

Overview great portion of skeletal growth occurs between 4-8 weeks   **arises from the MESODERM in the embryo** in children the epiphyses are still present (growth plate) break is serious can impede longitudinal growth Assesment Children who do not walk independently by 18 months have a serious delay and should be referred Toddlers have unstable gait but by 18 MONTHS the wide base narrows and the walking is more stable 4 years of age can hop on one foot and arm swings occur while walking 6 years walk resembles an adult **toe walking after age 3 can indicate a muscle problem** Observationsymmetry of movement, contour of body and extremities, have child push your hands with their foot/hands to test, test reflexes, senses and note any spasms

TESTSCBC, ESR, HLA ESR: erythrocyte sedimentation rate- rule out septic arthritis or osteomyelitis HLA: Human leukocyte antigen diagnose rheumatological disorders Arthroscopycommonly performed on adolescents with sports injuries (they look inside the joint, usually the knee or shoulder) foreign particles removed or repairs are madeMuscle biopsy: detects muscular dystrophyBone Biopsy: show malignancy 

SOFT TISSUE INJURIES contusion: tearing of subq tissue results in hemorrhage, edema and pain, the "escape" of blood into the tissue is a hematoma, "black-blue mark" sprain: ligament is torn or stretched away from bone to the point of trauma, swelling, disability and pain are symptoms  strain: microscopic tear to muscle or tendon that occurs over time, ss: edema and pain TX RICE: Rest. Ice. Compression. Elevation Ice no longer than 30 minutes (can cause ischemia and impede perfusion)  Preventionpedestrian safety, car seats/boosters, helmets and protective gear for athletics, pool fences, window bars, locks on doors and cabinet

Fractures break in a bone usually caused by accidents  SS: pain, tenderness on movement and swelling. Discoloration, limited movement and numbness may occur Children heal more quickly due to periosteum is stronger and thicker and there is less stiffness on movement Nursing Tips weights hang freely, out of reach of child ropes on pulleys, knots are not resting on pulleys bed linens are not on traction ropes counetrtraction is in place, apparatus does not touch foot of bed monitor for infection, pin care

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Caption: : Buck's extension: femur fracture and in hip and knee contractures. Do not put bed in high fowlers this reduces counter traction. Sometimes used to reduce pain and muscle spasm associated with slipped capital femoral epiphysis

Caption: : Bryant's Traction

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Caption: : russell skin traction: sling is under the knee which suspends the distal thigh above the bed::Prevents posterior subluxation of the tibia on the femur, which can occur with children in traction......two sets of weights on suspending the thigh and the other a pull on the leg, with weights at the head and foot of the bed

Casts and splints plaster: 10-72 hrs to dry not water resistant and heavy fiberglass 5-30 minutes to dry water resistant and light Child is at increased risk for impaired skin integrity and compartment syndrome progressive loss of tissue perfusion b/c ^ pressure caused by edema or swelling that presses on the vessels and tissues must monitor closely Checks tissue perfusion on toes or fingers, distal to injury site or cast check: peripheral pulse and quality, color, cap refill, warmth, movement and sensation, also numbness or tingling 

Osteomyelitis infection of the bone from staph and H influenza Uses WBC, ESR, X-Ray and bone scans to diagnosis TX includes 6-8 wks of antibiotics, early ROM, pain relief and physical therapy Children younger than 1 and those 5-14 Duchenne's (more common & sex linked to boys) or Becker's (slower progression) (pseudohypertrophic) Muscular Dystrophy (MD) group of disorders in which progressive muscle degeneration occurs, 2-6 years old when symptoms show SS: calf muscle hypertrophied, progressive weakness (falling, clumsiness, contractures of ankles and hips and GOWERS' MANEUVER) ^ serum creatine phosphokinase, muscle biopsy shows degeneration of muscle fibers replaced by fat and connective tissue Death usually results from cardiac failure or respiratory infection --TX mainly supportive to prevent contractures and maintain quality of life, help with depression, nutritional support as well

Osteosarcoma malignant tumor of long bones (most common with Ewing's Sarcoma) 10-15 years old, radiation to TX other conditions ^ risk for this (retinoblastoma) Metastasis quickly due to vascularity and goes to lungs commonly or brain SS: pain and swelling at the site (can be attributed to growing pains) reoccurring fracture Need biopsy for diagnosis, CT and bone scan TX: amputation Care: phantom pain, body image disturbances Ewing's Sarcoma malignant growth in marrow of long bones in older school age children and early adolescents when metastasis is present the prognosis is poor w/out it the survival rate is 60% TX: radiation and chemo

Juvenile Rheumatoid Arthritis (JRA) now referred to as juvenile idiopathic arthritis (JIA) most common arthritic condition of childhood  systemic autoimmune disease that involves joints connective tissue and viscera Types Oligo: 4 or fewer joints, and uveitis (inflammation of the eye 30% Polyarthritis: 5 or more joints and uveitis 10% Systemic Arthritis: Fever, rash and joint inflammation, uveitis occurs in about 10%----manifested by intermittent spiking fever above 103 for more than 10 days, nonpruritic macular rash, ab pain, elevated ESR, C-Reactive protein(lab test) and presence of nuclear antibodies and possibly enlarged liver----children 1-3 and 8-10 TX reduce joint pain and swelling, promote mobility(ROM), growth, development, independent functioning and preserve joint function NSAIDS and methotrexate, steroids can also be used

Scoliosismore common in girls2 types Functional: poor posture, curve is flexible and easily corrected Structural: changes in the shape of the vertebrae or thorax,  hips and shoulders may appear uneven and rotation of the spine Structural congenital, cerebral palsy, muscular dystrophy, cause unknown may be hereditary link TX: up to 20 degrees none//20-40 milwaukee brace//>40 fuse bones