Pediatric Cases

Cases

  • Spina Bifida
  • Cerebral Palsy
  • Leg Length Discrepancy
  • Rotational Profile: Intoeing/Outtoeing
  • Talipes Equinovarus
  • Multiple Hereditary Osteochondromatosis
  • Arthrogryposis
  • Achondroplasia
  • Rickets
  • Genu Valgum or Varum
  • Scoliosis
  • Spondylolisthesis
  • Lesser Toe Deformities
  • Tarsal Coalition and Idiopathic Flatfoot
  • Popliteal Cyst
  • HSMN (Hereditary Sensory and Motor Neuropathy)
  • Muscular Dystrophy
  • Cleidocranial Dysostosis
  • Klippel-Feil Syndrome & Sprengel Shoulder
  • Radio-Ulnar Synostosis
  • Congenital Radial Head Dislocation
  • Congenital Hand Deformities
  • Madelung’s Deformity
  • Pseudoarthrosis of the Clavicle
  • Trigger Thumb
  • Limb Deficiency: Fibular Hemimelia, PFFD
  • Post DDH, SUFE, or Perthes
  • Coxa Vara
  • Osteogenesis Imperfecta

Spina Bifida

Examination

Look

  • Legs, feet, spine, orthoses, wheelchair.
    • L4: Community ambulators with an AFO.
    • L5: Typically do not require orthoses.
    • L2: May require a KAFO.
  • Assess gait with and without orthoses.
  • Describe deformities, wasting, or ulcers.
  • Check for healed ulcers and cutaneous manifestations (hair tufts, pits, café-au-lait spots).
  • Observe for scoliosis.

Feel

  • Sensory Examination: Determine the lowest functional level.

Move

  • Assess hips for dislocation.
  • Passive ROM in joints.
  • Evaluate tone and motor power to establish the motor level.
  • Check the power of individual muscle groups in the feet.

Cerebral Palsy

History

Background & Developmental History

  • Age and date of diagnosis.
  • Birth and pregnancy history: Assess developmental milestones (sitting, walking, talking).

Chronic Problems

  • Spine, hips, knees, feet.

History of Treatments

  • Orthotics: Walking aids, braces, AFOs, wheelchair, sitting support.
  • Medications: Baclofen, Botox, neuroleptics (e.g., for epilepsy), current medications.
  • Surgery: Addressing spine, hips, knees, feet, upper limbs, and contracture release.

New and Current Problems

  • Assess functional level and limitations (walking, sitting, sleeping, self-care, feeding).
  • Identify problematic deformities.

Social Circumstances

  • Home Help: Home modifications, schooling.
  • Self-Care: Catheter use, intermittent catheterization.

Past Medical History

  • Notable issues, especially epilepsy.

Examination

Look

  • Walking aids, wheelchair, seating support.
  • Presence of an intrathecal baclofen pump.
  • Posture at rest:
    • Head: Position.
    • Upper Limbs: Position.
    • Balance: Sagittal and coronal.
    • Lower Limbs: Contractures.
  • Feet: Hallux valgus, cavus, ulceration, plantar callosities.
  • Spine: Coronal and sagittal balance, scars.
  • Gait: Describe systematically (head, shoulders, trunk, hips, knees, feet, gait phases, and foot progression angle).

Feel & Move

  • Assess spine (standing): Forward bend test to display rib hump.
  • Supine:
    • Pelvic obliquity, measure leg lengths.
    • Passive ROM in joints to quantify contracture:
      • Hips: Dislocation, ROM, pain, fixed flexion deformity (Thomas test).
      • Knees: Hamstring contracture, popliteal angle.
      • Feet: Gastrosoleus contracture, forefoot deformities (Silverskiold test).
  • Prone:
    • Rotational profile: Femoral version, Gage’s test, thigh-foot angle.
    • Staheli test for FFD.
    • Ely test for rectus femoris contracture.
  • Side:
    • Ober’s test for ITB tightness.

Achondroplasia

Examination

Look

  • Face/Head: Frontal bossing, flattened midface, button nose.
  • Stature: Short stature with normal trunk and rhizomelic shortening of the arms.
  • Elbows: Decreased ROM, radial head dislocation.
  • Hands: Brachydactyly, trident hands.
  • Spine: Lumbar hyperlordosis, kyphosis.
  • Legs: Genu varum, coxa valga.

Other Tests

  • Assess the spine for stenosis (lumbar, foramen magnum).

Multiple Hereditary Osteochondromatosis

Examination

Keys

  • Lump characteristics: Sessile or pedunculated, hard, non-expansile, pain-free/painful.
  • Location: Adjacent to joints, with no skin changes.
  • Neurovascular assessment distal to the lesion.
  • Limb length or angular deformity: Offer to measure supine.
  • Look for additional osteochondromas in other regions (pelvis, knees, spine).
  • Symptoms: Mechanical or malignancy-related (e.g., growth, night pain).

Management

  • Excise suspicious or mechanically bothersome lesions.
  • Delay excision until maturity if possible.

For further specific cases, expand as needed based on detailed clinical features and assessments.

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