Neonatal Musculoskeletal System and Screening for Developmental Dysplasia of the Hip PDF

Examination Skull Clavicle Upper limbs Legs Spine Hips Reproduced from:Examination of the Newborn: The Key Skills 3. The Hips | All4Maternity DD/Month/YYYY Professor/Dr: Topic title:...

Examination Skull Clavicle Upper limbs Legs Spine Hips Reproduced from:Examination of the Newborn: The Key Skills 3. The Hips | All4Maternity DD/Month/YYYY Professor/Dr: Topic title: 1 Observation Symmetry Posture Any signs of discomfort Range of joint motion DD/Month/YYYY Professor/Dr: Topic title: 2  Inspection and palpation – upper limbs Shoulder – reduced mobility, absence of reflexes, birth trauma – brachial plexus injury, erbs palsy, klumpke's palsy and dislocated shoulder (rare) Clavicle (collar bone)- size, contour; crepitus, brusing, puffiness, signs of pain, callus (later sign) - fracture (#)? Length of arms - symmetry Humerus – length, contour; mass (haematoma) or pain on palpation – fracture? - mainly detected later – callus forms Elbow, forearm – radius/ulna and wrist – size, shape and number of bones and range of joint motion, tumours – deep Images reproduced within the arm or on the skin from: Campbell & Hands – shape, size and posture, Inspection of palmar Dolby 2018 creases Fingers – number, shape and length. Usually flexed in a fist with thumbs under the fingers. Fingernails – smooth and soft – examine for size and shape DD/Month/YYYY Professor/Dr: Topic title: 3 Amniotic constriction band/ Amniotic Band Syndrome (ABS) Rare, 1 in 1,200 births Fibrous bands from the amnion wrap around the developing fetus inhibiting growth, from slight indentations to complete prevention of limb formation Reproduced from: (PDF) Clinical assessment of the results of one-stage circular incision techniques for limb ring constriction due to amniotic band syndrome (researchgate.net) DD/Month/YYYY Professor/Dr: Topic title: 4 Fingers Dactyly = the condition of having digits Reproduced from:- Polydactyly (Supernumerary Polydactyly – extra digit(s) Digit) Condition, Treatments and Pictures for Infants - Skinsight Oligodactyly – missing digit(s) Syndactyly – fused fingers or toes - can occur sporadically or be inherited and occurs in 1 out of 2,000 births. Can just include skin or include bone Clinodactyly – curving finger; may cause overlapping Reproduced from: DD/Month/YYYY Professor/Dr: Topic title: What is Syndactyly? | The Hand Society (assh.org)5 Inspection and palpation – lower limbs and feet Legs of the newborn always appear slightly anterior Images reproduced from: bowed and flexed at rest Campbell & Dolby 2018 Length of legs Femur – length, shape, symmetry and movement – able to move fully and joints are functional. Any fractures, especially with a traumatic birth or breech extraction. Allis sign – positive sign may indicate developmental hip displacement Tibia and Fibula - length, shape, symmetry and movement – able to move fully and joints are functional. Any fractures, especially with a traumatic birth or breech extraction. DD/Month/YYYY Professor/Dr: Topic title: 6 Feet and Toes Feet - shape, size and posture; is moving both feet and adopts a normal position when at rest Toes - number, position, spacing, the presence of webbing and whether the nails are a normal shape and appearance Many abnormalities are similar to the hands Absent or deformed nails Clinodactyly, Oligodactyly, Polydactyly, Syndactyly Webbing – may limited movement or extend up the length of toe or as excessive folds Sandal gap (hallux varus)– wide space between first and big toe – associated with trisomy 21 or benign Single crease (simian crease) - deeply grooved plantar crease running longitudinally from between the big and second toe. Commonly associated with trisomy 21, 13, FAS, other genetic conditions or benign Images reproduced from: Campbell & Babinski reflex Dolby 2018 DD/Month/YYYY Professor/Dr: Topic title: 7 Talipes Positional Talipes – most common, one or both feet turn inwards – invert. Results from constriction in utero and reduced joint movement. Congenital Talipes Equinovarus (CTEV). - clubfoot Talipes / Clubfoot - STEPS Charity (stepsworldwide.org) Image reproduced from: Positional clubfoot - Ponseti Foundation Image reproduced from: Talipes (clubfoot) and the Ponseti technique | CUH DD/Month/YYYY Professor/Dr: Topic title: 8 Inspection and palpation – Back and Spine Scapulae (shoulder bones) - should be roughly trianguler in shape, with a flat surface. Upper border is horizontal below clavicle height with normal shoulder movements Spinal curve – convex but straight. Exclude kyphosis, lordosis or scoliosis Spine integrity from base of the skull to coccyx; - inspect - for changes in normal skin colour, birthmarks Images reproduced from: Campbell & Dolby 2018 (naevus simplex) or masses, hairy patches (other than lanugo), deformities, dimples (of any depth); - palate – whole back and full length of spine, ensuring normal curvature and that all spinal processes are felt Sacral dimple – are mostly shallow enough to see the base; innocent Anal patency – normally situated patent anus Reproduced from: Reproduced from: Newborn Perceptual Motor emeesykidney.nhs.uk/images/Users/Educatio Behaviour - Physiopedia (physio-pedia.com) n_meetings/Spring_2016/Conundrums2016_ DMcA.pdf DD/Month/YYYY Professor/Dr: Topic title: 9 Spinal neural tube disorders Concerns with a lump, dimple, hairy patch or naevus are seen over the midline – requires further investigation Spina bifida occulta (SBO) Spina bifida cystica (SBC)​ Spinal or dermal dimple – innocent sacrococcygeal dimple , particularly if lies over the coccyx Images reproduced from: Campbell & Dolby 2018 DD/Month/YYYY Professor/Dr: Topic title: 10 Developmental dysplasia of the hip (DDH) Definition: Developmental dysplasia of the hip (DDH) = abnormal development of the hip ‘ball and socket’ joint in babies and young children (GOV.UK 2024) Incidence: 1:100 instability – dislocatable 1:1000 dislocated Left leg most common, bilateral in 20% Risk Factors: Family history, first born, breech (from 36 weeks), female (6:1), oligohydramnious, multiple pregnancies Why? Lax ligaments, bad joint position, impairs development of hip Combination of maternal and fetal laxity, genetic laxity, intrauterine and post-natal malpositioning DD/Month/YYYY Professor/Dr: Topic title: 11  Diagnosing DDH Performed during NIPE examination – within 72 hours of birth Minimising risk of long-term complications e.g. impaired mobility and Screen negative – repeated at 6-8 week NIPE pain, osteoarthritis of the hip and back examination by GP With early diagnosis and treatment, children are less likely to need surgery, and more likely to develop normally Screened positive - referral for Hip USS by 4-6 weeks (that all babies are scanned by 6 weeks) NIPE national risk factors: first degree family hx with hip problems in early life, breech presentation at or after 36 weeks; breech presentation (GOV.UK, 2024) at time of birth from 28 weeks gestation onwards. Observation and manipulation: Leg length; Allis sign – level of knees when hips and knees are bilaterally flexed; Restricted abduction of hip flexion Ortolani and Barlows Manoeuvres: (during NIPE examination) Barlow manoeuvre is used to screen for a dislocatable hip (a dislocatable hip will be displayed out of the joint by this manoeuvre). Ortolani manoeuvre is used to screen for a dislocated hip (a dislocated hip will be felt clunking into place) DD/Month/YYYY Professor/Dr: Topic title: 12 Treatment of DDH 3 to 5 per 1,000 live births that may require a Pavlik Harness 1 to 2 per 1,000 live births that may require surgery – if diagnosed after 6 months or pavlik harness has not worked (GOV.UK, 2024) Worn constantly for 6-12 weeks, adjusted during follow-up appts. Information given on how to change the baby without removing harness, how to clean harness, position baby while asleep, avoid skin irritation etc. Avoid swaddling – sleeping bags good, baby carriers with wide hips good Reassure –vast majority do well Direct parents to STEPs website video and NHS link about DDH Hip Dysplasia (DDH) - STEPS Charity (stepsworldwide.org) DD/Month/YYYY Professor/Dr: Topic title: 13