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35 Cards in this Set

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torticollis
turning of the head preferentially to one side
"wry neck"
torticollis (turning of head preferentially to one side) acquired after infancy
coengenital causes of torticollis
1. Klippel-Feil Syndrome (congenital synostosis of cervical vertebra, short neck, decr neck motion, scoliosis)

2. Sprengel's deformity (congenital elevatio of scapula; cervical spine abnl)
causes of torticollis
A. Positional Preference of the head

B. Infanile Muscular Torticollis (subset of "A")

C. "Wry Neck"
Infantile Muscular Torticollis-
presentation?
sequelae?
prognosis?
present:
@ birth or 1-2 wks later
head tilted toward affected SCM muscle and chin rotated away
-firm swelling in SCM

sequealae:
-ipsilateral flattening of face
-plagiocephaly (lopsided head)

Prognosis: 90% resolve spontaneously
Positional Preference of the head:
-who gets it?
-presentation?
-sequealae?
Molded baby syndrome AKA squint baby syndrome:

Infants get it, assoc w:
-scoliosis
-congenital hip dysplasia (limited ABduction contralateral hip)
-foot abnl

-present: head turned toward one side, usu R
-sequealae: plagiocephaly (lopsided)
who gets wry neck?
children and teenagers
Obstetrical palsy
-results from injury to brachial plexus during delivery

-Erb's palsy (C4,5,6)
-Erb-Duchenne-Klumpke (entire plexus: C4-T1)
-Klumpke's (C8, T1)
Erb's palsy:
-root levels
-clinical findings
-nature of injury
-prognosis
-C4,5,6
-clinical features:
*adduction, internal rotation
*contracture of shoulder, w/loss of elbow extension

nature of injury: incomplete
-pronosis: excellent, spontaneously resolve
Erb-Duchenne-Klumpke
-root levels
-clinical findings
-nature of injury
-prognosis
-entire plexus (C4-T1)
-clinical findings: total flaccid paralysis
-nature of injury: rupture of lower roots
-prognosis: fair, most have full recovery
Klumpke's:
-root levels
-clinical findings
-nature of injury
-prognosis
-C8-T1
-clinical findings:
*Claw Hand (d/t C8=ulnar nerve; muscles of forearm and
arm)
*Horner's (d/t loss of SNS; miosis, enopthalmos)

-nature of injury: rupture sympathetic chain
-prognosis: poor
clavicle fracture:
-how get?
-where break?
-present?
mechanism: fall on shoulder>direct blow>fall on outstreched hand
-present: crepitus, shoulder drop
-whefe break:
middle 1/3 >
lateral 1/3 >
medial 1/3
causes of anterior knee pain
A. Osgood-Schlatter Apophysitis
B. Patellofemoral pain
C. Patellar Subluxation/Dislocation
D. Patellar tendonitis
E. Pre-patellar bursitis ("wrestler's knee"
Osgood-Schlatter Apophysitis:
-et?
-present?
(apophysis=site of attachment for large muscle; growth plate grows b/w and separates apophysis from tibia)

et: =prototypical "apophysitis";
stress fracture of physis at tibial tubercle from overuse

-present:
pain localized to tibial tubercle;
in active old child/teen
patellofemoral pain:
-present?
-exam?
-present: pain after prolonged sitting or deep knee flexion

-exam: benign except tenderness of medial and lateral patellar facets
patellar subluxation/dislocation
-who gets?
-present?
-exam?
-labs?
-present:
girls>boys
patellar dislocation is a violent event in which pt has extreme pain + "pop"

-exam: large soft-tissue swelling+ecchymosis
*(+) apprehension test is pathognomonic for patellar sublux/dislocation

*do x-ray to r/o fracture in acute dislocation
(+) apprehension test when push laterally on patella
patellar subluxation/dislocation
patellar tendonitis:
-et?
-present?
-et= "jumper's knee"
-present: atletes, sharp pain below patella
pre-patellar bursitis
-et?
-present?
AKA "wrestler's knees" (spend lots of time on knees)

-et: inflamm of pre-patellar bursa d/t repetitive trauma/friction

-present: burning pain + swelling over patella
growing pains
Dx of exclusion which must meet the following criteria:

1. pain localized to calves, thighs, knees
2. no leg pain during activity (leg pain after activity(
3. Heavy daytime activity
4. ROS not suggestive of systemic dz, bone or joint prob
5. phys exam is nl
what causes back pain in kids
A. Scoliosis
B. Spondylolysis
C. Spondylolisthesis
scoliosis: et?.
infants to pre-school: congenital/pathological

elementary school: 50/50 idiopathic vs. pathologic

adolescence: idiopathic
scoliosis; tx?
curves w/Cobb angle >25 degrees req surgery
scoliosis: idiopathic vs pathologic
idiopathic:
1. thoracic, convex R
2. thoracic, double major R
3. single L lumbar

PATHOLOGIC:'
1. thoracic, convex L
3. cervicothoracic curve
4. "tight" curve
spondylolysis:
-mech?
-X ray?
-mech: stress fracture or acute fracture of pars interarticularis ("Scottie dog collar") after hyperextension of back

X-ray: fracture of "Scottie dog collar" @ L5 or L4
Spondylolisthesis:
et?
slipping forward or vertebra with rspect to adjacement distal vertebra

*occurs at L4-5 or L5-S1
causes of elbow injuries?
A. Nursemaid's elbow
B. Elbow trauma (fat pad sign)
Nursemaid's elbow:
-et?
-present?
-et: subluxation (partial dislocation) of radial head w/stretching or tearing of annular ligament
**caused by pulling extended, pronated forearm
-present: children present with forearm flexed and pronated @ elbow
elbow trauma--
where?
what suggests?
-elbow trauma=condylar or supracondylar fracture

-X-ray: "fat pad sign" (wedge shapred lucency about the distal humerus; most sensitive radiological indicator of traumatic elbow effusions)
most sensitive radiological indicator of traumatic elbow effusions
"fat pad sign"
MC occult fracture with +fat pad sign and no obvious fracture
fracture of radial head
MC acute joint injury in peds?
-ankle sprains (usu lateral ankle ligament)
ankle sprain: tenderness over what ligaments
anterior talo-fibular>
calcaneio-fibular>
psoterial talo-fibular
ankle sprain: grades?
Grade I: pain but no ligament laxity (looseness)

Grade II: moderate pain;
some ligament laxity/joint instab

Grade III: mod-severe pain;
marked ligamentous laxity (usu indicates rupture of lateral ligament)
ankle sprain: indications for X-rays (Ottawa Ankle Rules: USMLE)
1. unable to bear weight
2. bony tenderness
3. tenderness in area of tibio-fibular syndesmosis