Polydactyly

syndactyly

mesoderm

Musculoskeletal system development

Perterm infant and newborn

Musculoskeletal system Development

Infant

Musculoskeletal System Development

Toddler

Musculoskeletal System Development

Preschooler

Musculoskeletal System Development

School-age child

Musculoskeletal System Development

Adolescent

Hormonal changes impact ligaments and tendons; laxity of knees in particularly common in adolescent females, making them vulnerable to injury

Flexion

A decrease in the angel of the resting joint i the upper or lower extremities

Extension

An increse in the joint angle

Hyperextension

increase in the angle of the joint beyond the usual arc

abduction

movment away from midline

adduction

movment toward midline

rotation

movment around a central axis

circumduction

roation or circular movment of the limbs

dorsiflexion

backwards rotation

hinge joint

between humerus and ulna

permits motion in one plane

pivotal joint

between the radial-ulnar joint

allows rotation only

condyloid joint

wrist allows flexion, extension, adduction, abduction, and circumduction

saddle join

thumb allow flexion, extension, adduction, abduction

circumduction, forms a concave-convex fit

to achieve motion

ball and socket

hip and shoulder

gliding joints

vertebral & carpal joints of hands/feet

Erby's palsy

injury to the 5th and 6th cranial nerves

no spontaneous abduction of the shoulder muscles,

or flexion of the elbow is found.

The arm is adducted and internally rotated, but normal grip in the hand is present

Subluxation

partial dislocation of the radius from the humerus is common in children 2-4 years of age

child usually refuses to use affected arm

passive range of motion is possibe except for supination

dislocation of shoulder in preschooler

swelling, pain, limp arm

Bowleggedness or

genu varum

Normal until 2 1/2 to 3 years.

Most common cause of toeing-in in children < 3yo

Normally resolves with growth

Evaluate watching toddler walk from rear for impact on motor development and performance

If severe and older than 2 referal reccomended

Tibial torsion

twisting of the tibia after 3-4 years.

intrauterine positon may be a contributing factor

Genu valgum

knock-knee

present if the medial malleoli are mroe than an an inch apart and the knees are touching

This condition is normal until 7 years of age, when rotational development of the lower extremities is nearly complete

pes planus

flat foot in children is rare

Ortolani's sign

presence of a clunk during the maneuver

is a positive sign for dislocation of the hip

Barlow's test

with the infant supine and the knees flexed

the thigh is grasped and adducted while applying

a downward pressure. With the pressure on the

acteabulum the hip goes from a reduced position to

a dislocated position. A dislocation of the femoral head is a postive Barlow's.

Galeassi's or Allis sign

knees when flexed are unequal in height

Foot alignment

Rigid foot with limited range of motion.

Rigid in-turnng, inability of foot to assume

normal angle to leg

Trendelenburg sign

When child bears weight, not any asymmetry in level

of iliac crests

With leg lifted, iliac crest drops, indicating hip

abductor muscles on weight-bearing side are weak

Foward bend test

Asymmetrical elevationof scapula or rib hump;

unequal shoulders or iliac crests, uneven

waist line

A spinal rotation of 5-7 degrees should be evaluated

Flexion of neck

Nuchal ridgitiy-resistance or pain when neck is

flexed when lying supine

Brudzinski sign

Involuntary flexion of knees or legs when

neck is flexed when lying supine

Kernig sign

Resistance to or pain on straightening knees

or legs from flexed position when lying supine

Anterior/Posterior Drawer

• With the child supine, the hips flexed 45 degrees, the knees flexed 90 degrees and the feet stablized on the exam table, pace both hands above the calf of the lower leg, and try to pull the leg foward (anterior drawer test) and backward (posterior drawer test) Excessive movment of the knee is unexpected. Laxity suggests rupture of the anterior or posterior cruciate ligament.
• Tests for anterior or posterior cruciate ligament damage.

Varus/Valgus Stress Test

• With the child supine and the knee flexed to 30 degrees, stabilize both the femur and the ankle. Apply both gentle varus and valgus stress to the knee and repeat with a gentle rockign motion. Laxity or opening in the joint space suggest a tear of the medial collateral or lateral collateral ligament.
• Tests for damage ot medial collateral or lateral collateral ligaments of knee.

McMurray Test

• With the child lying supine, flex the knee completely with foot on examing table near the buttocks. Maintain flexion and stablilize the knee with thumb and forefinger. Using the other hand, rotate the lower leg to a lateral position whie extending the knee to the 90 degrees. Any clicking, pain, or lack of extension is a positive finding and indicates a meniscal injury. Repeat with the lower leg rotated medially.
• Tests for damage to medial, lateral, posterior meniscus.

Ballottement sign

• with knee extended, the examiner appleis downward pressure on the suprapatellar pouch to force fluid between the patella and the femur and then pushes the patella downward against teh femur. Patella floats back to position if fluid is present. A palpable click on patella striking the femur is positive for knee joint effusion.
• Tests for effusion or the presence of excess fluid in the knee joint.

Bulge Sign

With knee extended the examiner uses the ball of the hand to milk fluid distally from teh suprapateallar pouch several times and then presses behind margin of the patella. If swelling reappears int eh suprapatellar pouch, it is postive for knee joint effusion.

Tests for effusion or the presence of excess fluid in the knee joint.

Apley Compression Test

• When the child or adolescent in the prone position on the exam table, flex the knee to 90 degrees. While supporting the leg, apply pressure to the heel firmly and compress the tibia into the femur, rotating the tibia internally and externally on the femur. Presence of pain, clicks, or resistance indicates a positive finding.
• Test to determine the presence of a meniscal tear.

Adam's Foward Bend Test

• Child should bend foward and touch the teos if possible with hands dangling or diving position. Observe for alignment of spine, any curvature, asymmetry, or rib hump from th erear and sides. A level ruler or scoliometer can be used to assess the ange of trunk rotation. Place the scolimeter ont eh trunk at the peak of the curvature to evaluate alignment. A rotation of 5-7 degrees should be evaluated further.
• Tests for scolosis

Clubfoot

Talipes calcanevalgus

Eversion and dorsiflexion of forefoot

Metatarsus adductus

Vaus abnormality of forefoot at the tarso--metatarsal junciton; ankle and hindfoot re normal; lateral border of foot is curved rather than straight, usually shaped like a "kidney bean"; line drawn medially from heel often intersects 3rd toe

Pes planus (flat feet)

Flattening of longitudinal arch in school-age child when standing erect with full weight bearing on feet bilaterally; flat feet in toddler are developmentally normal and often are accentuated by fat pad on ventral surface

Tibial torsion

Slipped femoral capital epiphysis

Legg-Calve-Perthes

Femoral anteversion

Osgood-Schlatter syndrome

Inflammation fo tibita causing swelling and tenderness at insertaion of infrapatellar tendon into tibial tubercle; presents with knee pain after vigorous activity; common finding in adolescent athletes, especially 9-25 years of age

Developmental dysplasia of the hip

Idiopathic scoliosis