Pediatric Movement Patterns and Mechanics

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Questions and Answers

What is indicated by asymmetrical rotation in an individual's movement?

Potential hip pathology (correct)

Muscle strength imbalance

Normal variation in hip function

Increased range of motion

What is the typical progression of the foot progression angle in children?

In-toeing which increases over time

Consistent straight alignment

Out-toeing which decreases over time (correct)

Variable without any noticeable trend

What characterizes anteversion of the femur?

Abnormal hip extension

Neutral alignment of the femur

Internal rotation and in-toeing (correct)

External rotation and out-toeing

At what age do external rotation contractures typically resolve in children?

By 5-6 years of age Signup and view all the answers

What does a negative thigh-foot angle indicate?

Medial tibial torsion Signup and view all the answers

What is the most common type of Slipped Capital Femoral Epiphysis (SCFE)?

Chronic Signup and view all the answers

Which of the following is NOT a typical risk factor for SCFE?

Female gender Signup and view all the answers

What percentage of patients with SCFE reportedly have good outcomes?

60% Signup and view all the answers

What is a characteristic of unstable SCFE?

The child is unable to put weight on the affected leg Signup and view all the answers

Which treatment approach is NOT supported for SCFE?

Orthotics Signup and view all the answers

What is the main goal of treatment for club foot (talipes equinovarus)?

To restore alignment and correct deformity Signup and view all the answers

What does a negative foot progression angle indicate?

Severe intoeing Signup and view all the answers

What is the typical rate of lengthening in the Illizarov Method for correcting leg length discrepancies?

1 mm per day Signup and view all the answers

Which condition might contribute to in-toeing?

Metatarsus adductus Signup and view all the answers

Which of the following describes a common characteristic of developmental dysplasia of the hip?

Predominance of hip pain and functional disability Signup and view all the answers

What is the normal upper range of internal rotation for girls?

70 degrees Signup and view all the answers

Following the Pavlik harness treatment, what is the expected reduction in hip instability?

95% Signup and view all the answers

Which position may worsen in-toeing in children?

Prone with internal rotation Signup and view all the answers

What does an external rotator contracture in the hip typically result in?

Out-toeing Signup and view all the answers

What is a necessary consideration regarding the treatment of leg length discrepancies?

Ensuring stability of joints above and below the affected leg Signup and view all the answers

Which treatment method for club foot is considered highly effective?

Ponsetti Method Signup and view all the answers

Which of the following conditions is NOT associated with out-toeing?

Internal hip rotation Signup and view all the answers

Which feature of club foot involves the position of the forefoot?

Adduction and Pronation Signup and view all the answers

What age factor is relevant when assessing musculoskeletal concerns in children?

Age when concerns were first noted Signup and view all the answers

What is a primary characteristic of muscles affected by club foot?

Hypoplastic and persistently weak Signup and view all the answers

What is the term for a child's foot position where the foot is angled inward while walking?

In-toeing Signup and view all the answers

What is the primary goal of interventions for Club Foot using the Ponseti method?

To correct foot alignment and allow for weight bearing Signup and view all the answers

Which condition is characterized by avascular necrosis of the femoral head?

Legg Calve Perthes Disease Signup and view all the answers

What is a common intervention for Legg Calve Perthes Disease when the bone age is less than 6?

Observation and activity restriction Signup and view all the answers

During which age range is Legg Calve Perthes Disease most likely to develop?

3-13 years Signup and view all the answers

What is a typical clinical finding in a child with Legg Calve Perthes Disease?

Pain localized to the knee and hip Signup and view all the answers

What is a key component of the Ponseti method for the treatment of Club Foot?

Serial casting and percutaneous Achilles tendon lengthening Signup and view all the answers

What is a typical gait observed later in children with Legg Calve Perthes Disease?

Trandelenberg gait Signup and view all the answers

What is often necessary after surgery in the treatment of Club Foot?

Bracing or splinting to maintain correction Signup and view all the answers

What is a hallmark characteristic of Arthrogryposis Multiplex Congenita?

Joint contractures in two or more body areas Signup and view all the answers

Which intervention is commonly utilized for managing Osteogenesis Imperfecta?

Internal fixation with IM rods Signup and view all the answers

What type of physical therapy intervention is important for children with Arthrogryposis Multiplex Congenita?

Positioning and splinting Signup and view all the answers

How does Osteogenesis Imperfecta primarily manifest?

Recurrent fractures with minimal trauma Signup and view all the answers

What is a common environmental factor affecting individuals with Osteogenesis Imperfecta?

Short stature impacting accessibility Signup and view all the answers

What is the primary goal of physical therapy intervention for patients with Osteogenesis Imperfecta?

Prevent deformities and promote functional independence Signup and view all the answers

Which physical characteristic is NOT commonly associated with Arthrogryposis Multiplex Congenita?

Excessive muscle growth Signup and view all the answers

In Arthrogryposis Multiplex Congenita, the positioning of the hips is typically characterized by which condition?

Flexed and dislocated hips Signup and view all the answers

What unique feature is commonly seen in individuals with Osteogenesis Imperfecta?

Blue sclera of the eyes Signup and view all the answers

Which strategy is NOT considered an effective intervention for managing Arthrogryposis Multiplex Congenita?

Maintaining joint stability through immobilization Signup and view all the answers

Study Notes

Pediatric Orthopedic Conditions

Covered conditions include rotational changes, lower extremity issues, limb deficiencies/amputations, spinal conditions, and whole-body conditions.
Musculoskeletal assessment includes history (birth, age of concern, family history, sleeping/sitting positions), postural screen, range of motion (ROM), strength, lower extremity alignment, and normal developmental changes/rotational profile.

Rotational Changes

Rotational profile, in-toeing/out-toeing, metatarsus adductus, and knee alignment are examined.
Differential diagnoses for in-toeing include metatarsus adductus, internal tibial torsion, internal hip rotation, contracture, and excessive femoral anteversion. In-toeing may be worsened by childhood positions like reverse tailor or W-sitting, and prone with internal rotation.
Differential diagnoses for out-toeing include calcaneovarus, external tibial torsion, contracture of external rotators. Out-toeing may be worsened by prone sleeping or wide diapers/walkers.
Rotational profile assessment includes foot progression angle, examination in prone position, thigh foot angle, medial/lateral rotation, and forefoot adductus.

Thigh-Foot Axis

Measuring tibial torsion involves examining the long axis of the foot versus the long axis of the thigh (internal (-) or external (+)).
Treatment is needed if natural resolution doesn't occur. Treatment options include tibial transformers, Dennis Browne bar, or a derotation strap.
Infants typically have internal tibial torsion (-30 to +20), with spontaneous de-rotation as they learn to walk.

Metatarsus Adductus

Characterized by adduction of the forefoot relative to the hindfoot (kidney-shaped foot).
Associated with intrauterine positioning.
Mild cases resolve with conservative care.
Moderate cases might require serial casting, BeBax bootie.
Severe cases require orthotic referral and possible casting, bracing, or surgery.

Calcaneovalgus

Forefoot is curved laterally.
Full or excessive dorsiflexion ROM is present.
Typically resolves naturally, but orthotics might be used.
Possible diagnosis of vertical talus, requiring X-ray.

Developmental Displasia of the Hip (DDH)

Incidence is approximately 1 in 1000 live births.
Common in Caucasians, less common in African Americans.
63% of cases are unilateral.
Classification includes: normal, subluxatable, dislocatable, subluxed, dislocated.
Risk factors: common with breech position in the third trimester and in smaller intrauterine spaces.
Physiological factors include hormone influence in females (estrogen and relaxin).
Environmental factors include swaddling, positioning, and carrying.
Evaluation includes examination of hip ROM, asymmetry of thigh/gluteal folds, apparent shortening of femur/uneven knees (Galeazzi sign), and "clicks." Imaging with ultrasound at 6 weeks (repeat at 4 weeks if positive), X-ray at 4 months. Ortolani and Barlow maneuvers are used.
Intervention in infants utilizes Pavlik Harness. Older children may require closed reduction and abduction orthoses or surgical interventions, including open reduction with spica cast.

Leg Length Discrepancies

Lengthening the shorter leg may be considered in surgical interventions.
Factors to consider are soft tissue mobility and stability of joints.
Physeal distraction (Ilizarov method) involves 1mm per day correction, with ½ mm 4 times per day.

Club Foot (Talipes Equinovarus)

Occurs in approximately 1 in 1000 live births, and persists over the child's lifespan.
Hypoplastic muscles are present.
Positional/limited intrauterine space can be a contributing cause.
Associated with other disorders, such as spina bifida and arthrogryposis.
Treatment typically involves Ponsetti Method (serial casting). Goals include correct deformity for weight bearing and normalized function of the foot. Surgical intervention is usually utilized at about 6 months of age.

Legg-Calve-Perthes Disease (LCPD)

Avascular necrosis of the femoral head.
More common in males.
Family history, blood clotting disorders, HIV, small active children, and exposure to secondhand smoke are risk factors.
Spontaneous resolution is possible over 1–3 years. Early diagnosis is more favorable.
Common presentation is limp (antalgic early), Trandelenberg gait, limited abduction, and internal rotation.
X-ray shows subchondral fracture and femoral head collapse.
Intervention options include observation, casting, and derotational osteotomy.

Slipped Capital Femoral Epiphysis (SCFE)

Most common hip condition among adolescents.
Higher incidence in boys (2-3 times more than girls).
Possible risk factors are obesity, slow skeletal maturity and growth plate weakness.
Graded I, II, or III based on femoral head displacement.
The presentation includes pain in groin, medial thigh, and medial knee.
Treatment usually includes pinning surgery, followed by non-weight bearing. Untreated cases may lead to avascular necrosis, chondrolysis, and osteoarthritis.

Blount's Disease (Tibia Vara)

A growth disorder of the medial aspect of the proximal tibia.
X-ray shows thickening of the medial tibial cortex and breaking of the medial metaphysis.
Classified into three types based on onset (infantile, juvenile, and adolescent).
Children often have bowed legs and a lateral thrust of the knee during stance.
Treatment includes orthotics (KAFO, Blount's brace) for cases among younger children but is often more advanced reconstruction (surgical intervention).

Limb Deficiencies and Amputations

These may be congenital or acquired.
Causes include spontaneous mutations, trauma, medical issues such as bone diseases.
Treatment is often based on surgical revision or replantation, depending on the site/type of amputation.

Spinal Conditions

Congenital scoliosis, neuromuscular scoliosis, and idiopathic scoliosis are examined.
Evaluation typically includes assessing spinal axis deviation and screening for shoulder/pelvic symmetries (forward bend test, scoliometer) and radiology.
Quantification assesses components like Risser sign (skeletal maturity) and Cobb angle (curvature severity). Assessing curves for structural or non-structural features.

Other Orthopedic Conditions

Arthrogryposis Multiplex Congenita (AMC) is a nonprogressive condition present at birth.
Osteogenesis Imperfecta (OI) is a connective tissue disorder, resulting in a multitude of presentations (bowed long bones, fractures due to minimal trauma).
Treatment is often a balance between conservative means, and surgical intervention if needed. Specialized physical therapy is necessary for long-term management and care.

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Description

This quiz explores important concepts in pediatric movement patterns, including asymmetrical rotation and the foot progression angle in children. Learn about the characteristics of anteversion of the femur and how external rotation contractures resolve. Test your knowledge on these critical aspects of children's movement mechanics.