Alterations in Musculoskeletal system in Children

Duchenne Muscular Dystrophy

Severe progressive degeneration of the skeletal muscle. X-linked inherited disorder, only in males. Mutations of gene that code for dystophin protein, also found in brain, Diagnosed at 3 yrs old.

Signs of DMD

Slow motor development. Begins in pelvis, through the shoulder. Waddling gait, toe walk, Gowers sign (lack of muscle in the lower body), depressed DTR, atrophy. Wheelchair bound at 10 and bedridden by 15. Complications include resp. insufficiency, cardiac arrhythmia. Only 1/4 patients reach 21 yrs.

Legg-Calve-Perthes Disease

common osteochondrosis usually occurring in children between 3 and 10, disorder is bilateral, boys more at risk. Lack of blood supply to femur leads to this self limited disease of the hip. Unsure of exact cause, may be from infection, smoking, thyroid trauma. Most common in Japanese and Caucassians.

Osgood-Schlatter Disease

consists of osteochondrosis of the tibia tubercle and associated patellar tendonitis. Occurs in preadolescents and adolescents who participate in sports and more prevelant in boys. From stress by the quadriceps.

3 types of scoliosis

idiopathic, tetralogic, congenital

Clubfoot

A range of foot deformities in which the foot turns inward and downward. It can be positional, idiopathic or teratologic

Subluxated Hip

partial contact between femoral head and acetabelum

4 stages of Legg-Calve-Perthes

1) Incipient Stage: Loss of blood supply, synovial membrane and joint capsule are swollen, edematous, hyperemic. 2) Necrotic Stage: Part of the epiphysis dies due to lack of vascularization, metaphysis is softened because of increased vascularization 3) Regenerative Stage: New bone is created and dead bone is replaced by precallus 4) Residual Stage: Remodeling

Scoliosis

Abnormal lateral curvature of the spine. One end of the vertebral bone's growth plate grows faster then the other. Females are more likely to get it. Idiopathic curves progress during growth spurts.

Ewing Sarcoma

Believed to come from primitive marrow or immature cells, malignant, doesn't form osteoid cells. In 5-15 yr old males, chromosomal translocation creates oncogene, high Sed rate, occurs in midshaft of long/flatbone. In femur/pelvis/humerus, can penetrate periosteum which extends to soft tissue, metastasis to lung, bone, brain marrow.

Pathology of Duchenne Muscular Dystrophy

Degeneration of muscle fibers, prolonged effort of repair and regeneration, progressive fibrosis. Elevated creatine kinase (indicates muscle damage)

Developmental dysplasia of the hip

Dislocation of hip bone at birth. Imperfect development of the hip joint and can affect the femur, the acetabulum, or both. Congenital, dysplasia may develop later. Can be idiopathic or teratologic. Females are more likely to get, family history, breech born.

Osteosarcoma

Malignant bone tumor charcterized by formation of neoplastic bone tissue from malignant osteoblasts. In 10-20 ys olds, mostly male, caused by mutations in tumor supressor genes. Rapid local growth, forms osteoid cells, occurs usually in metaphyses of long bones near active growth. Often in femur, tibia, humerus. May penetrate periosteum and even invade joint spaces. Spread to lung, bone, visceral organs. Symptoms: pain, swelling, warmth, redness

Dislocated Hip

No contact between femoral head and acetebelum

Nonaccidental trauma

avulsion fracture of metaphyseal plate, diagnostically specific for abuse in children.

Osteochondroses

family of orthopedic diseases usually found in children and adolescents. Involves areas with high amounts of tension or compression stress. Patho: Partial loss of blood supply, trauma, vascular injury, clotting sensitivity, osseous necrosis, bony weakness, microfracture

Acetabular Dysplasia

femoral head is in correct anatomical position but acetabulum is too shallow.

Ortolani

hip dislocation is present but can go back into place

Barlow

hip is in place but can be dislocated

Physical Abuse signs

injury afflicted into child by burns, bruise, fracture in various healing stages. Intracranial injury from blunt force trauma or acceler./deceller. injury. Visceral injuries: perforation, hematoma, laceration. Developmental and emotional changes with behavior, learning diability or fear of caregiver. History with inconsistent injury.