Cause: Sternocleoidomastoid muscle due to atlanto axial rotary displacement of C1 on C2

Etiology:Higher incidence in children with breech presentation and forceps delivery 20% have DDH

S&S: Childs head tilted toward side of contracture

chin rotated away from contracted side

Palpable tumor after 4 weeks, then receds

Diagnostic: Cervical radiograph.

Treatment: stretching. Surgery if after 1 year

DDH

Developmental Dysplasia of the Hip

Abnormal development dislocation of the hips or ligamentous laxity

Etiology: Breech, First born Femal, Caucasian, left hip most common

Physical: Galeazzi's sign-knee hight comparison w/infant supine (asyemmetry, shortening of femoral segment limits abduction and full extension) Limited abduction in older child, Barlow's sign-Positive when mvmt of femoral head can be felt as it slips out onto the posterior lip of acetabulum. Ortolani's sign- positive clunk as femoral head enters or exits acetubul

Diagnosis: US before 6 mo, xray after 6 mo

Mgmt: before 6 mo Pavlik harness, after 6 mo surgery

Tibial Torsion

Abnormal bowing of tibia

Spontaneous correction with growth

Encourage supine sleeping

Bow leg

Concidered normal until 36 months. Physiologic bowing of up to 20 degrees in somral in children until 18-24 month of age, bowing does not increase after 16 months. 

Physical: space between knees is greater than 2in

Further evaluation with xray if: Genu varum present after 2 yo, Progressive after 1 yo, unilateral involvement, appears to be severe, occurese in high risk group ie) obese

Knock Knee

A natural shifting occurs from varum to valgus between 30-60 months

Normal alignment about about 8 years old

Physical: knees are together and distance btwn medial malleoli is greater than 3in when standing, full rom, no pain.

Further Evaluation: Genu valgum present after 7 years of age, unilateral involvment

Transient Synovitis of the Hip

• Self-limiting inflammation of the hip joint
• Etiology: possible viral or immune process. Most common cause of irritable hip. Males. Occurs most often 3-12yo.
• S&S: Acute or insidous painful limp or hip (groin) pain, usually unilateral and proceded by a URI. Afebrile or low grade temp.
• Physical: ROM causes spasam and pain.
• Diagnositic: x-ray shows widened joint, US can show and effusion, normal or sl elevated WBC
• Mgmt: hospitalize if high fever if unsure if septic arthritis. Ibp q6-8 hour x 5 days, bedrest

Legg-Calve-Perthes Disease

(LCPD)

Etiology: generally slightly shorter stature/delayed bone age. Boys ages 4-9.

S&S: Insidious onset of limp w/knee pain that is activity related and resolves w/rest. Pain in groin or lateral hip. Pain less acute and severe than transient synovitis or septic arthritis. AFEBRILE.

Physical: limited passive internal rotaion and abduction of hip. mild spasam or gaurding.

Diagnostic: x-ray shows disease progression of fem head. used for intial definitive dx. used to assess repairative process.

Mgmt: restore ROM while maintaining fem head w/in acetabulum. Agressive tx if >1/2 fem head involved and child is >8yo. Can last 1-3 years.

Etiology: onset 3-5 years (most common 8-12yo). r/t rapid growth, pubety

S&S pain/ache localized to lower extremities; usually intermittent sometimes nocturnal.

Inflammation of tibial tubercle from repetitive stresses in athletes with immature skeletal development.

Etiology: Tiny stress fx in apophysis, occurs 10-15yo

Physical: point tenderness over tibial tubercle, affected side can be enlarged

Mgmt: self-limiting, pain resolves with full ossificaiton of tibal tubercle and closure of apophysis. Stretching helpful, use knee immoblizer in combo with thigh muscle strengthening.

Scolosis (Idopathic)

Etiology: 70% idopathic, most common immediatley before adolescent growth spurt. Female.

S&S: not painful

Mgmt: If painful refer. Curve of 25 degree, no further tx if skeletaly mature, f/u if still growing. 46-50 degrees likely in increase if >50 even after growth complete. Surgery likely for thoracic curve >50 or lumbar curve >40.

Slipped Capital Femoral Epiphysis

SCFE

Etiology: Can be r/t trauma. Occurs during growth spurt. More common in AA males and obese w/sedentary lifestyle.

S&S: limp, varying degrees of pain/aching

Physical: unable to flex hip as femur abducts/rotates externally. Limb shortening. loss of internal rotation w/hip flexed 90 degrees.

Diagnostic: xray

Mgmt: immediate referral, no ambulation on acute/unstable SCFE. Surgery. Monitor other hip

• Definition: Chronic, autoimmune idopathic arthritis characterized by the presence of chronic synovial inflammation with associated swelling, pain, heat and or limitied ROM.
• Etiology: most common autoimmune inflammatory dzs of childhood. Females more often.
• S&S: swelling with heat, redness, pain, limited rom of joint. Hallmark of systemic disease high spiking fever w/rash.
• Physical: Age of onset <16yo. Swelling or effusion in one or more joints and presence of 2 or more of--rom limitation, tenderness, pain w/mvmt, increased heat. duration 6w or longer, (polyarthritis 5 or more joints) (Oligoarthritis-- 4 or less joints)
• Systemic: High daily intermitt spiking fevers 102 or higher. Lineral evanescent rash (salmon-colored nonpruritic macular lesions on trunk and proximal extremities)
• Diagnostic: HLA B27, CBC anemia, ESR alway selevated, ANA positive
• Mgmt: NSAID

Systemic Lupus Erythematosus

SLE

Multisystem autoimmune disorder chara by widespread inflammatory involvement of connective tissues w/immune complex vasculitis

Etiology: usually after 5yo, females more often

S&S: fever, malise, wt loss, malar facial rash, arthralgias

Physical: Rash malar erythematous, butterfly distribution across bridge of nose and over cheeks. disciod rash over sun exposed areas. Arthritis inovlves small joints. Perdicaritis. Recurrent headaches, szs, chorea, proteinuria hypertension.

Diganostic: ANA, coombs +,

Mgmt: fluid and lyte balance, adequate nutrition

Etiology: Staph aureus, <1yo & 9-11 yo, males

S&S: malaise to shock, neonates afebrile, swollen or motionless limb. refual to bear weight or flexion of hip.

Physical: fever, local bone tenderness, fluctuant mass

Diagnostic: WBC, ESR, CRP elevated. Aspiration always indicated to show pathogen

Mgmt: refer abx 4-6 w

Duchenne Muscular Dystrophy

(DMD)

Progressive gentic disorder tha affects muscles in lower extremities and eventually muscles of upper extremities, chest wall, and heart.

Etiology: x-linked, most common inhereited neuromuscular disease in children 3-5 yo

S&S: clinical evident 3-5 yo w/abonormalities of gait and posture, hx of delayed developmental milestones, lg muscular looking calves, inabilityt o keep up with peers when running. wheelchair dependent by 10-12 yo

Physical: lumbar lordosis, pelvic waddling, gowers maneuve, calf hypertrophy

Fem neck roatated fwd or anteriorly

Etiology: 3-8yo W sitting

Physical: towing in, normal femoral anteversion less than 70 degrees

Mgmt: resolves by 8yo, no W sitting

Physical: high fever, malaise, joint pain, irritability, joint: red, warm, swollen

Dx: culture of joint fluid. most often Staph aureus.

Mgmt: abx