What is this:

combination of lateral tilt & rotation deformity of cervical spine

inability to move one way

Sternocleidomastoid muscle

theory: compartment sydrome of SCM, fascia tight

Hip Dysplasia:  20%

&

Cranial/Facial Asymmetry

C-spine x-ray

Hip ultrasound

CT scan

C1/C2 rotary subluxation

Stretching

But do NOT stretch until other etiology investigated

> 1 yr of age

cosmetic

limited ROM

What is this:

Lateral curvature of spine greater than 10 degrees

Scoliosis

Idiopathic

Neuromuscular

Congenital

Spinal cord anomalies/neoplasms

Poor posture

Hips stick out

Uneven shoulders

These are part of what condition?

Skin lesions

leg lenght discrepency

significant pain

parasthesias

bowel/bladder sx

left sided curve

PE for scoliosis:

Observe?

Palpate?

ROM?

Neuro?

Observe:  skin, asymmetry, gait

Palpate:  pelvic height, areas of pain

ROM:  Adams forward bend, popliteal angles

Neuro:  tone, reflexes, strength

RED FLAG:  proximal weakness

Growth plates on iliac crest

Cartilage is replaced by bone normally starting anteriorly to posterior

Scoliosis, this does not occur

Treatment of Scoliosis at:

<25 degrees

25-50 degrees

>50 degree

<25 degrees:  Observe

25-50 degrees:  Brace

>50 degree:  Surgery

What condition is this?

Defect in pars interarticularis

most common L5-S1

Scotty sign on obliques x-ray

What's the difference between

Spondylolysis vs Spondylolisthesis?

Spondylolysis: fracture

Spondylolisthesis:  forward slippage of the fracture

Which one is this, Spondylolysis or Spondylolisthesis?

Restricted activities

PT

low chance of profression

Brace for comfort

Which one is this, Spondylolysis or Spondylolisthesis?

surgery for grade 3 & above

neurological fingings/deformity

Pain is continous, numbness & tingling present

What is this?

avascular necrosis of the femoral head

 etiology unknow, may be d/t hemoglobinopathies

male> female

7 yr average

Usually unilateral

What is this?

subchondral necrosis

cartilage overgrowth

revascularization & regrowth

Pt presents with:

PAINFUL limp

limited rom

weakness

What's the treatment of Legg-Calve-Perthes?

LCP

Maintain rom

limit progression

complications

surgery

What is this?

Displacement of proximal femoral epiphysis from the metaphysis?

SCFE

Slipped Capital Femoral Epiphysis

Male> female

average age 12

30-60% BILATERAL

Obesity predisposition

Hypothyroidism

Hypogonadism

Growth Hormone therapy

other:

Idiopathic

Renal Osteodystrophy

Radiation therapy

What is this?

Limp

thigh/groin pain

knee pain 30%-Obturator nerve innervation

decreased hip internal rotation

painful hip rom

Which SCFE is this:  Stable or Unstable

able to walk

Which SCFE is this:  Stable or Unstable

cannot walk

50% avn risk

What condition is this?

1.5 cases/1000 births

ethnic variations

risk factors:

female 4xrisk

+family hx 4x risk

breech 10x risk

Hormonal-Maternal relaxin

Dysplasia Gene

Mechanical

breech

oligohydraminos

Extra-Articular

iliopsoas contracture

excessive capsular tissue

Clinical dx at what age for Dev. Dysplasia of hip?

asymmetrical thigh folds

Galezzi sign

Ortalani & Barlow manuevers

Clinical dx at what age for Dev. Dysplasia of hip?

asymmetrical thigh folds

Galeazzi sign

Asymmetrical abduction

Clinical dx at what age for Dev. Dysplasia of hip?

Leg lenght discrepancy

PAINLESS limp

hyperlordosis

asymmetrical abduction

What's a + sign for:

Ortolani

&

Barlow

Ortolani:  Able to push ball IN the joint

&

Barlow:  Able to push ball OUT of the joint

Harness/brace used to tx Dev. Dysplasia of hip

 flexion 100 degrees & abduction 50 degrees

worn for minimun of 3 months 

Femoral nerve palsy (flexion)

AVN (abduction)

What is done if DDH 6 months-2 years

&

Palvik failed?

Closed reduction in OR

Open reduction in OR if older than 2 yrs & failed closed

Complications:

AVN

Re-dislocated/sublux

What are these conditions considered?

Femoral anteversion

Internal tibial torsion

metatarsus adductus

What condition has this pathophysiology?

1.Synovial fluid

2.Decreased jt activity

3. Decreased rom/strength

4.Articular cartilage & subchondrial bone erosion

5.Deformity

T/F

JRA has no correlation with adult disease

altered, pain free kinematics

stiffness with inactivity

fatigue

jt warmth

muscle atrophy

jt contracture

growth disturbance

hyperemic physis

Fever

Rash

Hepatosplenomegaly

Lymphedema

Uveitis

CBC-anemia, leukocytosis

ESR- extremely elevated

CRP,ANA

These are seen on x-rays for what condition?

 early jt widening

late jt narrowing

periosteum reaction

osteoporosis

ROM/strenght preservation

deformity prevention

function restoration

pain control

extra skeletal manifestations mgmt

NSAIDs, Steroids

70-85% good prognosis

Clubfoot

1-2 per 1000 live births

boys>girls

50% bilateral

What is this?

Talus is short

Navicular subluxed medial

ankle in equinus

subtalar jt inverted

Clubfoot

Congenital Talipes Equinovarus

What are the etiologies of clubfoot?

chromosonal

neuromuscular

postural

idiopathic

chromosonal: Arthogryposis

neuromuscular:  Myelomeningocele

postural:  Intrauterine molding

idiopathic:  MOST COMMON

What is this?

fibrous,cartilaginous, bondy connection b/w 2 or more tarsal bones

Tarsal coalition

congenital failure of segmentation of tarsal bones

50% Bilateral

Talocalcaneal

&

Calcaneonavicular

atraumatic ankle pain

activity dependent

chronic ankle sprains

peroneal spastic flat foot

immobolize-calm down soft tissue

strengthen/stretch

resect

Osteomyelitis tx in:

< 3 months

3 months-4 yrs

>5 yrs

< 3 months:  Nafcillin, Clinda & Gent

3 months-4 yrs:  Unasyn & Clinda

>5 yrs: Nafcillin & Clinda

Vancomycin if staph like, MRSA hx, very ill