Musculoskeletal Disorders in the Pediatric Population

1. Musculoskeletal Disorders in the Pediatric Population Kathryn Stilp

2. Anatomic Differences • Fontanels • Long Bones • Maturation complete at age 20 • Growth takes place at the epiphyseal plate • Muscular system mature at birth

3. Disorders of the Feet & Hands • Metatarsus Adductus • Clubfoot • Genu Varum & Genu Valgum

4. Metatarsus Adductus • Most common congenital foot disorder • Inward turning of the forefoot “intoeing” • 1 in 1000 births • Uterine positioning & genetic • Simple exercises • Resolve spontaneously

5. Club Foot • Congenital/ obvious @ birth • 1-3 in 1000 births • Intrauterine positioning, neuromuscular/vascular problem, genetic, family hx • Box p. 1321

6. Genu Varum & Genu Valgum • Varum=“bowlegs” • Valgum= “knock knee” • Normal until age 4-5 • Blount Disease & Rickets • Braces • Surgery

7. Disorders of the Hip • Developmental Dysplasia of the Hip • Legg-Calve’-Perthes Disease • Slipped Capital Femoral Epiphysis

8. Developmental Dysplasia of the Hip • Hip instability, dislocation, sublaxation,dysplasia • Genetic factors • Limited abduction of the affected hip • Gluteal & thigh fat folds (affected side) • Ortolani & Barlow maneuver • Pavlik harness • Traction, keep in abduction

9. Legg-Calve’-Perthes Disease • Self-limiting • Avascular necrosis of the femoral head • Interruption of blood to femoral epiphysis • Premies, Increased parental age, tobacco smoke • Stages box. P. 1327 • Toronto brace & non-wgt bearing

10. Slipped Capital Femoral Epiphysis • Femoral head is displaced from the femoral neck • Cause unknown • Adolescent growth • Acute sudden onset vs chronic • Surgery usually necessary

11. Disorders of the Spine • Scolosis • Torticollis, Kyphosis, & Lordosis

12. Scoliosis • Lateral S or C shape to the spine • Girls ages 10-13 • Measured in degrees (10=abnormal) • Congenital, idiopathic or acquired • Exercises, braces, electric stimulation, rods (pass through spine canal)

13. Torticollis, Kyphosis & Lordosis • Tilt of head caused by rotation of the cervical spine • Kyphosis= hunchback • Lordosis= swayback • Box p. 1335

14. Disorders of the Bones & Joints • Osteomyelitis • Osteogenesis Imperfecta • Juvenile Rheumatoid Arthritis

15. Osteomyelitis • Infection of the bone (long) • Age 1- 12 • Boys > girls (trauma) • Microorganisms, staph, strep, h flu • Pain, edema, tenderness, erythema • Antibiotics (IV) 6 weeks or longer

16. Osteogenesis Imperfecta • Connective tissue disorder • 1 in 30,000 boys=girls • Multiple fx, blue sclera, thin, soft skin, short stature, joint flexibility, enlarged fontanel • Mistaken for abuse • No cure

17. Juvenile Rheumatoid Arthritis • Debilitating disease • Connective tissue disorder • Need periods of rest • Medications

18. Muscular Dystrophies • Duchenne • Baker • Facioscapulohumeral • Emery-Dreifuss • Congenital • Box p. 1340

19. Injuries to the Musculoskeletal System • Fractures • Amputations

20. Fractures • Types box. 1342 • Trauma • Chronic/direct repetitive activities • Complications box p. 1343 • Traction box p. 1345

21. Amputations • Trauma • Congenital • Phantom pain

22. Nursing Management • You tell me!!!!

23. NANDAS