Not visible externally, seen by X-ray.

Spinal cord not involved. 

S/S: may be none. port wine stain, tufts of hair, tethered cord, foot deformitites, bowel and bladder issues.

Visible outpouching.

Sac contains meninges and spinal fluid.

No neuro defecits, still needs surgery.

Associated with hydrocephalus. 

Screen for Alpha fetal protein (will be high).

Nursing: cover sac with sterile, moist gauze to prevent from drying out and getting infected. 

Neural tube fails to close. 

Occurs anywhere along spine.

If below 2nd lumbar vertebra, s/s: flaccid paraylsis of lower extremities & sensory defect: blowel & bladder issues

Treatment: prevent sepsis, closure within 24 hours to prevent further damage

Pre-op Nursing: Position on stomach. Feed in the prone position, diapering contraindicated. 

Post-op Nursing: Monitor urinary and bowel function, Position offside or prone, measure head circumference for hydrocephalus (85% develop)

Latex allergy precautions (75%)

Female caucasians, genetic. Swaddled incorrectly, breech, first borns.

Infant S/S: (none), shortened limb unilateral, asymmetric thigh & gluteal folds

Positive Ortolani test: lift legs up and feel a click/jerk in hip

Barlow's Maneuver: adduction of knees while pushing in= abnormal movement in hip

Toddlers+ S/S: Trendelenburg sign- stands on affected side & opposite hip slants downward.

Treatment: Traction, Immobilization, Spica (cast), Pavlik Harness (3-6 months)

Nursing: cast loose enough (compartment syndrome), drainage, CMS, pain relief

Complications: persistent dysplasia, dislocation, necrosis of hip joint

Feet pointed doward or inward at birth. Males common & familial.

Treatment: serial casting q6-8 weeks, maintenance. Surgery before 1 year (walking)

Nursing: CMS, swelling, rapid growth during infancy

Pigeon-toed. Most common foot deformity.

Results from abnormal position in uterus.

Treatment: PT, orthotics

Brittle bone disease. May be mild->severe. 

S/S: defective bone formation, reduced thickness of bone, hyperextensibility of ligaments.

Treatment: supportive, limited benefit of drugs.

Nursing: limited to swimming, try to return to weight bearing ASAP, preventive braces, fluid balance (loss through skin), PT, OT, ROM, mobility aids, self-esteem (small stature)....possible abuse? (multiple fractures)

Pauciarticular: 4 or less joints (knees & ankles). Babies: irritable, tire, warm to touch & swollen joints, red eyes.

Polyarticular- 5 or more joints (spine, LE, UE). Shuffled gait, hurt to move, delayed growth.

Systemic- any joint. temp>103, rash

S/S: stiffness, swelling, loss of mobility, warm to touch.

Diagnosis: No definitive diagnostic tests, Based on criteria.

Treatment: Goal is to relieve symtpoms, preserve functioning, slow damage.

Drugs: NSAIDs: takes 3 weeks, SAARDs: check liver & kidney function, Corticosteriods, Cytotoxic agents: toxicity, takes 12 weeks. No narcotics given.

Complications: Uveitis (inflamed iris), contractures, anemia

Structural- rotated and malformed vertebrae.

Functional-(more common) caused by poor posture, trauma, unequal length of legs.

S/S: "S" curve, one shoulder higher, lordosis.

Diagnosis: screen at schools, X-ray

Treatment: TLSO Brace (turtle shell vest), Milwaukee/Boston Brace (doesn't come off), TENS unit, Traction, Surgical (Luque rods or Harrington rod)

Nursing: body image, prolonged brace treatment, logrolling, coughing & deep breathing, finanical concerns due to expensive surgery

Spastic: most common. Tense, contracted muscles. (quadriparesis, di- mon-, tri-, & paraplegia)

Dyskinetic: worm-like movements of hands, drooling, speech issues.

Causes: meningitis, prenatal: infection, nutritional deficiency, teratogenic meds. L&D: hypoxia, maternal analgesia->respiratory depression

S/S: stiff/rigid arms/legs, poor head control, floppy limbs, clenched fists, exvessive drooling, no smiling, Feeding difficulties: tongue thrusting, gagging, choking, dysphagia.

IQ- wide variation. Rigid, atonic and quadriparesis have most impairment. Do not get worse- stay the same!! 

Diagnosis: US, MRI, CT, etc. 

Treatment: PT ASAP to improve function, Baclofen pump, Surgery (cut ligaments, sever nerves), manual jaw control (swallowing). 

Nursing: foster independence, support groups, prevention!!

Hereditary, progressive, degenerative disease of the muscles. Genetic factor. 

S/S: difficulty standing or walking (LE affected first), trunk muscle (difficulty breathing), mild mental retardation, increasing abnormalities in gait and posture.

X-linked (males). Onset 3-5 years

S/S: waddling gait, clumsy, Gower sign: walk themselves up from hands and knees. Eventual death from respiratory or cardiac failure.

Diagnosis: Serum CPK levels high birth-2 years, then fall as muscles deteriorate.

Treatment: no effective treatment. Goal is to maintain function in unaffected muscles as long as possible. Keep active, ROM, bracing, corticsteroids, PT, eventual BiPAP, CPAP

Nursing: Help child and family cope, foster independence for as long as possible.

Sprain

is a stretch or tear of a ligament. A ligament is a band of tissue that connects two bones. The sprain occurs when the ligament is extended beyond the normal range for a particular joint.

S/S:bruising; decreased range of motion of the joint; difficulty moving the affected area; fluid within the joint (effusion) joint pain; swelling around the joint

refers to the stretching or tearing of a muscle or tendon as a result of excessive pulling during physical activity. Tendons are bands of tissue that connect muscles to bones.

S/S: change in color and bruising around the muscle or tendon; decreased range of motion in nearby joints; difficulty moving the injured area; joint pain; muscle spasm; muscle weakness; swelling around the muscle or tendon

Damage to soft tissue, subQ tissue and muscle. Blood into tissues->ecchymosis->bruising

S/S: swelling, pain, disability

• Regular conditioning program
• Daily stretching
• Wear shoes that fit well
• Healthy diet
• Follow sports safety guidelines
• Healthy weight
• Good body mechanics/Ergonomic workstation
• Wear seat belts
• Avoid alcohol/drugs when driving, exercising, etc.

• H&P
• check for slackness
• X-Ray
• Meds
• 4-6 weeks to heal (Sprain)
• RICE:
• Rest
• Ice 
• Compression
• Elevation
• Casts/Splints