FNP Pedi Musculoskeletal
Femoral Anteversion management
refer to ortho mild cases condition will normalize by ages 8-9 (night splints and shoe modifictions) severe cases - surgery
What is the management of genu valgum?
referral to orthopedics
If 1 component of the female triad exists what should you do?
screen for the other triad symptoms. If eating disorder refer to nutritionist and other health professional. If concerned about bone do a dexascan.
How would you tell the difference btw osgood-schlatter and a shin splint?
shin splint is more of the medial aspect of the tibia. Osgood is at the insertion of the tibial tuberosity.
Menstrual dysfunction, disordered eating pattern and osteopenia or osteoporosis
should alert provider to conduct a more thorough history and evaluation
Brachial plexus injuries are
stretch or traction injuries in which paralysis results due to arm innervation disruption
What would you advise a male athlete that suffers from muscle cramps while practicing during the summer?
stretch, warm up and stay hydrated
What is scoliosis?
structural lateral curvature of the spine greater than 10 degrees in the coronal plane
Baker cysts clinical finding
swelling behind the knee, benign cyst
Osgood Schlatter- disease is inflammation of the______
tibial tubercle
What are scoliosis clinical findings?
unequal scapula prominences and heights, unequal rib prominences or rib heights, unequal waist angles
Clavicle fracture
usually occurs during birth
Baker cysts management
usually resolve in 1-2 years. Refer large painful cysts
Pes Planus (flatfoot) management
refer to orth, management would be arch support.
Synovial lesion which result from herniation of the synovium of the knee joint
popliteal/baker cysts
genu valgum is
"knock knees", joint pain or stiff gait caused by adduction
What are the diagnostics with Slipped Capital Femoral Epiphysis?
1. AP pelvis 2. Frog-leg lateral 3. Lateral views of pelvis 4. CT is used if pt going to surgery
What is the management of Slipped Capital Femoral Epiphysis?
1. Immediate referral to orthopedist 2. non-weight bearing crutches until admitted to hospital
What are the signs/symptoms of Slipped Capital Femoral Epiphysis?
1. Pain in the groin and often referred to thigh &/or knee 2. thigh atrophy 3. limited abduction and extension 4. external rotation of leg when walking 5. limp 6. extremity shortage
What are the laboratory/diagnostics with Legg-Calve-Perthes Disease?
1. Radiograph studies 2. bone scans and mri
What are the signs/symptoms of scoliosis?
1. Rarely painful 2. Asymmetry of shoulder, ribs, hips, and waistline. (Adam's forward bend test)
What is the management of Legg-Calve-perthes disease?
1. Refer
What is the management of Osgood-Schlatter disease?
1. Self-limiting disease 2. Limit activity to control pain 3. hamstring and quadriceps exercise before sports 4. Knee immobilizers may provide some relief 5. NSAIDS 6. Patella tendon strap 7. NP can manage bc it involves modifying activities
What are the clinical findings of Legg-Calve-Perthes Disease?
1. early sign is intermittent limp 2. persistent pain 3. pain often occurs at night and with weight bearing 4. acute onset: sudden onset of pain in knee or groin 5. chronic onset: recurring hip pain or referred to the knee
What is Osgood-Schlatter disease
1. inflammation of the tibial tubercle which is usually due to repetitive trauma 2. most common cause of knee pain in adolescents engaging in sports which involve jumping or sprinting 3. occurs in boys age 10-15; and girls age 8-14 y/o
What is the etiology/incidence of Legg-Calve-Perthes Disease?
1. ischemic episode which interrupts the vascular circulation to the capital femoral epiphysis. 2. the shape of the femoral head is altered. 3. Most common in Caucasian boys, ages 4-8.
What are the clinical findings of Genu Valgum?
1. joint pains or stiff gait 2. valgus angle > 15 is outside of range 3. Bilateral tibial femoral angle < 5 degrees of valgus in child up to 7 y/o is normal. 4. awkward gait 5. unilateral deformity 6. intermalleolar distance with knees together measurement is > 4-5 inches needs evaluation
What are the clinical findings of osgood-schlatter disease?
1. pain is worse during and following activity 2. point tenderness over tibial tubercle 3. pain with knee extension with passive resistance or full passive knee flexion
What are the physical findings of genu varum?
1. tibial femoral angle > 15 degrees 2. intercondylar (knees) distance with the ankles together > 4-5 inches should be evaluated 3. joint laxity of the lateral collateral ligaments in older children
When does Slipped Capital Femoral Epiphysis occur and what is the incidence?
1. typical during grouth spurt and prior to menarche in girls - 12 y/o 2. boys more than girls - 13.5 y/o
What is Slipped Capital Femoral Epiphysis?
1. weakness of the physis of the femur (growth plate) which causes the head of the femur to slip 2. blood supply to the epiphysis crosses the weakened area and the epiphysis becomes at risk for avascular necrosis. 3. the growth plate eventually closes with the position of the epiphysis has assumed in relation to the femoral shaft.
Growth spurts for girls in tanner stage
2-5
Growth spurts for boys in tanner stage
3-5
genu varum after age ______ needs to be evaluate?
30 months
The female athlete has ______ times the risk of knee injury than male?
4-6
genu valgum is pathologic in children older than
6-7 years, tibial femoral angle greater than 15 degrees valgus
The female most common injury involves ________?
ACL
What is the management for ankle sprain?
All grades unless a severe grade III will respond well to RICE Rest: wt bearing should be avoided for the 1st svrl days Ice: should be applied on top of the compression dsg as quickly as possible following injury, 30 min on & off alternately Compression: immediate secure compression will minimalize edema & support stability of the ankle Elevation: for several days following injury reduces pain and swelling and promotes recovery also NSAIDS
What is Genu varum?
Bowing of legs is common up to 2-3 years of age. Varus after 30 months needs to be evaluated to r/o conditions such as rickets, tumors, neurologic problems, infections, etc.
What are examples of structural musculoskeletal disorders?
Genu varum Genu Valgum Scoliosis Hip dysplasia
What is Genu valgum?
Knock-knee. physiologic in children beginning 2-4 years of age pathologic in children older than 6-7 y/o tibial femoral angle greater than 15 degrees valgus
What are examples of non inflammatory musculoskeletal disorders?
Legg-Calve-Perthes Disease Slipped Capital Femoral Ephiphysis
Soft tissue laxity or a tight Achilles tendon
Pes Planus (flatfoot)
What laboratory/diagnostics are done for scoliosis?
Radiographs for further evaluation
What is the management of genu varum?
Refer
What is the management of scoliosis?
Refer to specialists
What is the management of developmental dysplasia of the hip?
Referral to orhtopedics
What is ankle sprain?
Stretching &/or tearing of the ligaments around the ankle, typically involving the lateral ligament complex
Baker cysts diagnostic
US and diagnostic aspiration of synovial fluid
What are the laboratory/diagnostics for developmental dysplasia of the hip?
US is most sensitive in neonates, radiography AP view is more reliable by 2-3 months of age
What is the Etiology of Slipped Capital Femoral Epiphysis?
Unknown; perhaps precipitated by puberty related hormone changes
What is Gower's maneuver noted with muscular dystrophy?
a. child "walks" hands up legs to attain standing position when getting up b. suggests pelvic muscle strength
Limps physical exam
assess for swelling or erythema, have child walk and run, then you can determine limp type, neuro exam, ROM, Refer
Brachial plexus injuries results usually from
birth through traumatic stretching of the shoulder and neck, usually injuries are transient
genu varum is
bowing of legs, tibial femoral angle > 15 degrees
Brachial plexus injury clinical finding depends on injury
can't abduct arm or rotate externally, absent bicep reflex and Moro reflex on affected side, limp wrist and hand with absent grasp reflex,
Back problem diagnostics
cbc, esr, C-reactive protein
Limps diagnostic studies
cbc, esr, crp
Pes Planus (flatfoot)
commonly seen in neonates and toddlers and usually resolves by 2-3 years of age
Trendelenburg sign identifies
condition that causes weakness in the hip abductors
What is developmental dysplasia of the hip?
dysplasia, subluxation, complete dislocation of the femoral head
What are the clinical findings of developmental dysplasia of the hip?
early first 6 months positive ortolani and barlow, late after 6 months limited abduction of the affected hip, positive galeazzi sign, asymmetry of inguinal or gluteal folds, positive trendelenburg, lordosis, limping and waddling gait
What time of day do growing pains occur?
evening or late day
Galeazzi maneuver
flexing the hips and knees while infant is supine by placing soles of the feet on table near buttock and looking at knee height for equality. + sign is unequal
Heat exhaustion treatment
get to a cool environment, apply ice to axilla and groin, eat salty food
To prevent heat illness
gradually expose athletes to high temperatures for minimum of 14 days
Female increased risk of injury is due to the following
greater joint laxity in females and hormonal effects on connective tissue
Leg aches
growing pains, front of thighs, calves or behind knees
Heat exhaustion symptoms
ha, fatigue, nausea, skin cold and clammy.
Trendelenburg sign
have child stand and raise 1 leg off ground. If pelvis (iliac crest) drops on the raised leg side, the test is + and indicates weak hip abductor muscles on the side that is weight bearing (when child stands on dislocated hip the opposite side of the pelvis drops)
Femoral Anteversion is when
head and neck of the femur are rotated at and increased angle anteriorly. Discourage W sitting in front of TV as it increases risk.
Leg aches management
heat, analgesics, heat, reassurance, refer if pain continues
Prescribing ibuprofen for a 5 year old weighing 46 pounds?
ibuprofen 100mg/5ml 10.5 ml every 6 hours as needed for pain for 10 days. Dispense 450ml.
What is Legg-Calve-Perthes Disease?
idiopathic juvenile avascular necrosis of the femoral head.
Clavicle fracture management
immobilization of the shoulder, pin sleeve of infants arm to front of shirt
Femoral Anteversion clinical findings are
in toeing gait, unsteady gait may cause frequent falling, awkward run
Brachial plexus injuries "Horners syndrome"
ipsilateral ptosis, miosis, enophthalmos, anhidrosis
Heat exhaustion
is the most common heat illness
Pes Planus (flatfoot) clinical findings
lack of arch, tight Achilles tendon, abnormal shoe wear on inner side
Heat stroke
medical emergency, mortality rate 50%, core body temp can get over 104 degrees
Female athlete triad
menstrual dysfunction disordered eating pattern osteopenia or osteoporosis
Heat cramps
mildest form of heat illness due electrolyte depletion and happens after intense exercise.
Femoral Anteversion diagnostics
no radiographs are necessary unless surgery is necessary.
Heat cramps treatment is
oral rehydration solution, rest, gentle stretching
What are the laboratory/diagnostics for genu varum?
radiographs
