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Alterations of Musculoskeletal Function in Children

Alterations of Musculoskeletal Function in Children. Chapter 43. Bone Formation. Bone formation begins in two phases at about the eighth week of gestation Delivery of bone cell precursors to sites of bone formation Aggregation of the bone cell precursors at primary centers of ossification.

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Alterations of Musculoskeletal Function in Children

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  1. Alterations of Musculoskeletal Function in Children Chapter 43

  2. Bone Formation • Bone formation begins in two phases at about the eighth week of gestation • Delivery of bone cell precursors to sites of bone formation • Aggregation of the bone cell precursors at primary centers of ossification

  3. Bone Formation • Intramembranous formation • On or within the mesenchyme • Endochondral formation • Cartilage anlage • Perichondrium • Periosteal collar • Secondary centers of ossification

  4. Bone Formation

  5. Bone Growth • Until adult stature is achieved, bone growth occurs at the epiphyseal plate through endochondral ossification • Factors affecting bone growth • Growth hormone • Nutrition • General health • Many growth factors and regulators

  6. Skeletal Development • In the newborn, the entire spine is concave anteriorly (kyphosed) • In the first 3 months of life, the cervical spine begins to arch (lordotic) • Curve of the lumbar spine develops with sitting • Compared to an adult, a newborn has a large head, long spine, and short extremities

  7. Skeletal Development • Genu varum (peaks by 2½ years) • Bowleg • Genu valgum (5-6 years) • Knock-knee

  8. Muscle Development • Between birth and maturity, muscle nuclei in the body increase 14 times in boys and 10 times in girls • The composition and size of muscles vary with age

  9. Congenital Defects • Syndactyly • Webbing of the fingers • Fusion of the soft tissues of the fingers • True syndactyly also includes fusion of the bones and nails • Vestigial tabs • Extra digit

  10. Syndactyly

  11. Congenital Defects • Developmental dysplasia of the hip • Abnormality of the proximal femur, acetabulum, or both • Risk factors • Female sex, metatarsus adductus, torticollis, oligohydramnios, first pregnancy, and breech presentation • The hip can present as subluxated, dislocatable, or dislocated

  12. Congenital Defects • Developmental dysplasia of the hip • Manifestations • Asymmetry of gluteal or thigh folds • Limb length discrepancy • Limitation of hip abduction • Positive Ortolani sign • Positive Barlow test • Positive Trendelenburg gait • Pain

  13. Developmental Dysplasia of the Hip

  14. Congenital Defects • Deformities of the foot • Metatarsus adductus • Equinovarus deformity • Positional equinovarus • Idiopathic congenital equinovarus • Tetratologic equinovarus • Pes planus

  15. Osteogenesis Imperfecta • “Brittle bone disease” • Defect in collagen production • Bone and vessel collagen • Sillence classification • Results in osteoporosis, bowed and deformed limbs, short stature, spine curvature, and bluish sclera • Can be evident before birth (in utero fractures)

  16. Osteogenesis Imperfecta

  17. Rickets • Disorder causing mineralization failure, “soft” bones, and skeletal deformity • Causes • Insufficient vitamin D • Insensitivity to vitamin D • Renal wasting of vitamin D • Inability to absorb calcium or vitamin D in the gut

  18. Rickets

  19. Scoliosis • Scoliosis is a rotational curvature of the spine • Nonstructural • The curvature is from a cause other than the spine • Structural • Spine curvature associated with vertebral rotation • Skeletal abnormalities, neuromuscular disease, trauma extraspinal contractures, bone infections of the vertebrae, metabolic bone disorders, joint disease, and tumors

  20. Scoliosis

  21. Osteomyelitis • Osteomyelitis in children frequently begins as a blood abscess in the metaphysis of the bone • The abscess ruptures under the periosteum and spreads along the bone shaft or into the bone marrow • Sequestra • Sections of dead bone due to periosteal separation • Involucrum • Periosteal new bone

  22. Osteomyelitis

  23. Juvenile Rheumatoid Arthritis • Childhood form of rheumatoid arthritis • The basic pathophysiology of JRA is the same as the adult form • One difference is the mode of onset • Arthritis in fewer than five joints • Arthritis in more than five joints • Systemic disease

  24. Juvenile Rheumatoid Arthritis • Differences in JRA and adult RA • Large joints are affected • Subluxation and ankylosis of the cervical spine • Joint pain is not as severe • Positive antinuclear antibody test • Chronic uveitis • Low detection of rheumatoid factor • Limited subcutaneous rheumatoid nodules • Common in the heart, lungs, eyes, and other organs

  25. Osteochondrosis • Avascular diseases of the bone • Legg-Calvé-Perthes disease • Interrupted blood supply to the femoral head • Self-limiting disease • Deformation due to ischemia is permanent • Osgood-Schlatter disease • Tendinitis of the anterior patellar tendon and osteochondrosis of the tubercle of the tibia

  26. Legg-Calvé-Perthes Disease

  27. Cerebral Palsy • A static disorder of muscle tone and balance caused by an ischemic insult to the brain • Perinatal disorder • Disease patterns • Hemiplegia, diplegia, quadriplegia

  28. Muscular Dystrophies • Group of disorders that cause degeneration of skeletal muscle fibers • The muscular dystrophies cause progressive, symmetric weakness and wasting of skeletal muscle groups

  29. Duchenne Muscular Dystrophy • Most common of the muscular dystrophies • X-linked recessive inheritance • Deletion of a segment of DNA or a single gene defect on the short arm of the X-chromosome • Duchenne muscular dystrophy gene • Encodes for the dystrophin protein • Dystrophin mediates the anchorage of the actin cytoskeleton of the skeletal muscle fiber to the basement membrane

  30. Duchenne Muscular Dystrophy • Manifestations of the disorder begin to appear by approximately 3 years of age • Slow motor development • Progressive weakness • Muscle wasting • Sitting and standing are delayed • The child is clumsy, falls frequently, and has difficulty climbing stairs

  31. Muscular Dystrophy

  32. Muscular Dystrophies • Becker muscular dystrophy • Fascioscapulohumeral muscular dystrophy • Scapuloperoneal muscular dystrophy • Limb girdle muscular dystrophy

  33. Bone and Muscle Tumors • Nonossifying fibroma • Simple bone cysts • Aneurysmal bone cysts • Osteoid osteoma • Fibrous dysplasia • Osteosarcoma • Ewing sarcoma • Rhabdomyosarcoma

  34. Nonaccidental Trauma • “Corner” metaphyseal fractures • Long bone fractures caused by a twisting force • Transverse tibial fractures are the most common • Associated with child abuse, but osteogenesis imperfecta must be ruled out

  35. Nonaccidental Trauma

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