Peds Musculoskeletal Dysfunction

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Peds Musculoskeletal Dysfunction
2012-11-18 17:39:39

The Child with Musculoskeletal Dysfunction
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  1. What are the three essential elements of traction?
  2. What is the difference between skin and skeletal traction and what are some examples of each?
    • Skin: involves tapes, boots, etc, but no machinery.
    • – Buck’s Extension
    • – Russell Traction
    • – Cervical Traction 

    • Skeletal: this is the heavy machinery type with pins and rods and screws etc. 
    • – Halo
    • – Balanced suspension
    • – Femoral traction 
  3. What's important to assess after a fxr?
    • The 5 P's:
    • Pain and Point of tenderness
    • Pulse-distal to the fracture site
    • Pallor
    • Paresthesia-sensation distal to the fracture site
    • Paralysis-movement distal to the fracture site 
  4. What are some nursing considerations for chilren in traction?
    • • Skin care issues
    • • Pain management/comfort 
    • (See Guidelines on p. 1762)
  5. What are some psychological effects of immobilization?
    • Diminished environmental stimuli
    • Altered perception of self and environment
    • ncreased feelings of frustration, helplessness, anxiety
    • Depression, anger, aggressive behavior
    • Developmental regression. The older the child, the more severe the psychological impact. 
  6. What are some typical MSk congenital dysfunctions?
    • • Clubfoot
    • • Developmental Dysplasia of the Hip
    • • Legg-Calve’-Perthes Disease
    • • Slipped Capital Femoral Epiphysis 
  7. What can you do to correct clubfoot?
    • shortly after birth cast will be admin'd and changed 1-2 weeks to remodel foot/calf. 
    • after cast, will move to brace.
  8. What are the three degrees of DDH
    • • Unstable hip: Mildest form-hip ligaments are lax, allowing displacement
    •  • Sublaxated hip: Head of femur is under lip of acetabulum, but not well seated
    • • Dislocated hip:Femoral head loses contact with acetabulum 
  9. SnSs of DDH in an infant?
    • – Shortened limb on affected side
    • – Restricted abduction of the hip on affected side
    • – Unequal gluteal folds when infant prone
    • – Positive ortolani test
    • • Click heard when hips pulled up to flex. 
    • --Positive barlow test
    • • Click heard when hips abducted
  10. SnSs of DDH in an older child?
    • • Affected leg shorter than the other
    • • Trendelenburg Sign
    • – Hips should remain level when weight is shifted from one leg to the other
    • • Greater trochanter is prominent
    • • Waddling gait if bilateral dislocations 
  11. Tx of child with DDH?
  12. What is Legg-Calve'-Perthes Disease?
    • • Osteochondritis deformans juvenilis or coxa plana
    • Self-limited, idiopathic, occurs in juveniles ages 2 to 12, more common in males ages 4 to 9
    • Avascular necrosis of the femoral head (avascular because head of femur does not articulate with acetabulum.)
    • 10%-15% have bilateral hip involvement
    • After resolving may have normal femoral head or may have alteration
  13. SnSs of Legg-Calve'-Perthes Disease?
    • – Insidious (slow) onset, may have history of limp, soreness or stiffness, limited ROM, vague history or trauma
    • –  Pain and limp most evident on arising and at end of activity
    • –  Diagnosed by x-ray
  14. What is Tx for child with Legg-Calve'-Perthes Disease?
    • – Goal: keep of femur in acetabulum
    • – Containment with various devices
    • – Rest, no weight bearing initially
    • – Surgery, in some cases
    • – Home traction, in some cases
  15. What is Slipped Capital Femoral Epiphysis?
    • Affects the upper (capital) femoral growth plate/slips backwards in the acetabulum
    • Hip disorder related to times of growth, especially during adolescence
    • Cause is unknown, but 
    • Connection to stress on the epiphyseal plate just prior to closure, ie usually occures in obesce clients during puberty b/c structure cannot support the child's weight plus growth. 
    • Majority of patients exceed 95th percentile for weight and 90th percentile for height
  16. SnSs of child with Slipped Capital Femoral Epiphysis?
  17. Tx of Slipped Capitol Femoral Epiphysis?
  18. What do you need to know about fxrs that damage the epiphyseal growth plates?
    • • Weakest point of long bones is the cartilage growth plate (epiphyseal plate)
    • • Frequent site of damage during trauma
    • • May affect future bone growth
    • • Treatment may include open reduction and internal fixation to prevent growth disturbance 
  19. What are the four types of fxr?
    • Compound or open: Fractured bone protrudes through the skin
    • Complicated: bone fragments have damaged other organs or tissues
    • Comminuted: small fragments of bone are broken from fractured shaft and lie in surrounding tissues
    • Greenstick: compressed side of bone bends, but tension side of bone breaks causing incomplete fracture
  20. What are some possible complications with a bone fxr?
    Fat embolism: remember the yellow marrow (usually femur fxr)? Fat from yellow marrow leeches into vasculature and embolizes in heart, lung, ect. 

    Compartment syndrome: Area is crushed/constricted. Cuts off vasculature/nerve function. Will turn necrotic. Can occur with casting.
  21. What is Osteogenesis Imperfecta (OI)?
    • • A group of autosomal recessive inherited disorders of connective tissue
    • • Involves a gene deficiency that leads to deficiency in collagen
    • • Characterized by excessive fragility and bone defects
    • • Multiple classifications ranging from stillborn/early death to mild bone fragility
  22. What are the three types of soft tissue injuries?
    • Sprains
    • Strains
    • Contusions
  23. Be able to talk about sprains
    • • Trauma to a joint from ligament partially or completely torn or stretched due to force
    • • May have associated damage to blood vessels muscles, tendons and nerves
    • • Presence of joint laxity as indicator of severity
    • Rapid onset of swelling with disability 
  24. Be able to talk about strains
    • A microscopic tear to musculotendinous unit
    • • Similar to sprain
    • • Swollen, painful to touch
    • • Generally incurred over time 
  25. Be able to talk about contusions
    • Damage to soft tissue, subQ tissue, and muscle
    • • Escape of blood into tissues-ecchymosis-black and blue discoloration
    • • Swelling, pain, disability
    • • ie Crush injuries 
  26. What is Tx for Soft Tissue Injuries?
    • RICE & ICES
    • R = rest
    • I = ice (max 30 min at a time)
    • C = compression
    • E = elevation

    • I = ice (max 30 min)
    • C = compression
    • E = elevation
    • S= support
  27. What is treatment of Osgood-Schlatter's Knees?
    • • Disease is usually self-limiting
    • • Treatment is conservative
    • • Avoidance of activities that cause knee pain
    • • Wrapping with elastic bandages
    • • PT
    • • Ice, heat, and NSAIDs
    • • Knee brace 
  28. What is Osteomyelitis?
    • Inflammation and infection of bone by bacteria
    • May be caused by exogenous or hematogenous sources
    • Exogenous
    • – Infectious agent invades following penetrating wound, surgery (orthopedic pinning most common in children), etc.
    • Hematogenous
    • – Preexisting infection spreads to bone from skin, URI, abscessed tooth, phyelonephritis, etc.
  29. What is Tx for Osteomyelitis?
    • • Any organism can cause, but most common is staph aureus
    • • Signs and symptoms begin abruptly, resemble those of arthritis and leukemia
    • – Erythema, limited ROM, fever, lethargy, pain
    • • Treatment:
    • – IV antibiotics for extended time 
  30. What is Juvenile Arthritis?
    • Autoimmune inflammatory disease
    • No known cause
    • Peak ages: 1-3 years and 8 to 10 years
    • Often undiagnosed
    • 90% have negative Rheumatic Factor
    • Symptoms may burn out and become inactive
    • Chronic inflammation of synovium with joint effusion, destruction of cartilage 
  31. SnSs of JA?
    • Stiffness, swelling, loss of mobility in affected joints (worse in the am)
    • Warm to touch, usually without erythema
    • Symptoms increase with stressors
    • Growth retardation
    • Treatment: NSAIDs, corticosteroids 
  32. Why might a child have a kyphosis?
    Can result from TB, arthritis, osteodystrophy or compression fracture
  33. What is Lordosis?
    • • Accentulation of the cervical or lumbar curvature beyond physiologic limits
    •  • May be idiopathic or secondary due to complication of trauma
    •  • May occur with flexion contractures of hip, CHD
    • • In obese children, abdominal fat alters center of gravity, causing lordosis