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Download CH. 50 MUSCULOSKELETAL
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MUSCULOSKELETAL DISORDERS THE MUSCULOSKELETAL SYSTEM • Bones and bone growth – Epiphyseal plates…bone growth occurs here and when these seal over, there is no more growth – Ages 17-18 for males, about 2 years after menarche for females DISORDERS OF BONE DEVELOPMENT • Flat feet • Bowlegs (Genu Varum) • Knock knees (Genu Valgum) • Toeing in • Limps • Growing pains DISORDERS OF BONE DEVELOPMENT • Osteogenesis imperfecta – Bones are easily broken – May be treated with growth hormone, calcitonin, biphosphonates • Legg-Calve-Perthes disease – Avascular necrosis of the femoral head – More common in boys 4-9 – S/S…limp, possible refusal to walk, and pain. No fever, no obvious signs of inflammation – Treatment • If over six…brace, if under six, observe DISORDERS OF BONE DEVELOPMENT • Osgood-Schlatter disease – – – – – Thickening and swelling of tibial tuberosity Occurs in adolescence or preadolescence Sports related More common in males 10-13 Treatment usually is limiting activity • Slipped capital femoral epiphysis – Avascular necrosis may occur – Need early detection – More common in males and obese adolescents with sedentary lifestyle – S/S…onset of unilateral hip pain – May need surgery and pinning INFECTIOUS AND INFLAMMATORY DISORDERS OF THE BONES AND JOINTS • Osteomyelitis – Often caused by staph – Very common after stepping on a nail that goes through a tennis shoe – Very difficult to treat…IV antibiotics, maybe for 6 weeks. Bone cells have little capacity to replace bone destroyed by infection DISORDER OF SKELETAL STRUCTURE • Scoliosis: functional – Caused by unequal leg length or visual problems – Compensatory mechanism used by child • Scoliosis: structural – – – – Permanent curvature of spine Peaks age 8-15 More common in females Assessment done during PE starting age 10 • Look for… – – – – Shoulder height Shoulder prominence Leg lengths Rib prominence – Treatment is surgery for >40 degree curvature or a brace for >20 DISORDERS OF THE JOINTS AND TENDONS • Juvenile Arthritis – Probably autoimmune – Subtypes pg. 1434 – S/S • Persistent fever and rash • Joint swelling – Treatment • • • • Exercise Heat Nutrition Meds – NSAIDS – DMARDS DISORDERS OF THE SKELETAL MUSCLES • Muscular Dystrophy – Duchenne’s is the most common form – Sex-linked recessive – Gower’s sign-pressing hand against ankles, knees, and thighs to rise to stand – Calf muscles are hypertrophied, shoulder muscles are weak – Death occurs around age 20 due to heart failure Fractures • Fractures – Break in the continuity of the bone – Common fractures in childhood • • • • • Forearm Clavicle Femur Dislocation of Radial Head Salter-Harris – Fracture of the growth plate – Graded from I-V
