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38 Notes
2012-04-06 13:05:53

Alterations of Musculoskeletal Function in Children
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  1. Congenital Defects
    • Clubfoot is a common deformity in which the foot is twisted out of its normal shape or position. Clubfoot can be positional, idiopathic, or teratologic.
    • Development dysplasia of the hip (DDH) is an abnormality in the development of the femoral head, acetabulum, or both. Like clubfoot, DDH can be idiopathic or teratologic. It is a serious and disabling condition in children if not diagnosed and treated.
    • Osteogenesis imperfecta (brittle bone disease) is an inherited disorder of collagen that affects primarily bones and results in serious fractures of many bones.
  2. Bone Infection
    • Osteomyelitis is a local or generalized bacterial or granulomatous (i.e., tuberculosis) infection of bone and bone marrow. Bacteria are usually introduced by direct extension from a nearby infection, through the bloodstream, or by trauma.
    • Septic arthritis can occur de novo or secondary to osteomyelitis in very young children where the metaphysis is still located within the joint capsule of certain joints.
  3. Juvenile Rheumatoid Arthritis
    Juvenile rheumatoid arthritis is an inflammatory joint disorder characterized by pain and swelling. Large joints are most commonly affected.
  4. Osteochondroses
    • Avascular diseases of the bone are collectively referred to as osteochondroses and are caused by an insufficient blood supply to growing bones.
    • Legg-Calvé-Perthes disease is one of the most common osteochondroses. This disorder is characterized by epiphyseal necrosis or degeneration of the head of the femur followed by regeneration of recalcification.
    • Osgood-Schlatter disease is characterized by tendonitis of the anterior patellar tendon and inflammation or partial separation of the tibial tubercle caused by chronic irritation, usually as a result of overuse of the quadriceps muscles. The condition is seen primarily in muscular, athletic adolescent males.
  5. Scoliosis
    Scoliosis is a lateral curvature of the spinal column that can be caused by congenital malformations of the spine, poliomyelitis, skeletal dysplasias, spastic paralysis, and unequal leg length, but it is most often idiopathic.
  6. Muscular Dystrophy
    The muscular dystrophies are a group of genetically transmitted diseases characterized by progressive atrophy of skeletal muscles. There is an insidious loss of strength in all forms of the disorder with increasing disability and deformity. The most common type is Duchenne muscular dystrophy.
  7. Musculoskeletal Tumors
    • The two most common forms of benign bone tumors are osteochondroma and nonossifying fibroma.
    • The two main types of malignant childhood bone tumors are osteosarcoma and Ewing sarcoma.
    • Osteosarcoma, the most common malignant childhood bone tumor, originates in bone-producing mesenchymal cells and is most often located near active growth plates, such as distal femur, proximal tibia, or proximal humerus.
    • Most children with osteosarcoma are diagnosed between 15 and 19 years of age, and osteosarcoma occurs equally in males and females.
    • Ewing sarcoma originates from cells within the bone marrow space and is most located in the midshaft of long bones or in flat bones. The most common sites include the femur, pelvis, and humerus.
    • Ewing sarcoma is more common in males and is diagnosed most often between the ages of 5 and 15 years.
    • Pain is the usual presenting symptom for either osteosarcoma or Ewing sarcoma.
    • The primary treatments are osteosarcoma are surgery and chemotherapy. The primary treatment for Ewing sarcoma is a combination of chemotherapy, radiation, and surgery.
  8. Nonaccidental Trauma
    • Nonaccidental trauma must be considered with any long bone injury in the perambulatory child.
    • The presence of soft tissue injury, corner fractures, and multiple fractures at different stages of healing is extremely helpful for making a diagnosis of nonaccidental trauma.
    • When nonaccidental trauma is suspected, a child must be evaluated radiographically for other fractures, heat trauma, and retinal hemorrhage.
    • All social strata are at risk.
    • The health care provider is legally responsible to report suspected nonaccidental trauma.