Lecture Musculoskeletal system in children.pptx

1. The morpho-functional peculiarities
of skeletal and muscular systems,
methods of examination,
semiology of disease,
care of children
with musculoskeletal system’s diseases

2. Bone Types
 Long bones - these are the bones connected with large movement.
Examples: the femur (thigh bone)
the humerus (upper bone in the arm)
the phalanges (fingers and toes)
 Short bones - these bones are almost cube shaped and associated with smaller, more
complex movements.
Examples: the carpals (small bones in the base of the hand)
the tarsals (in the feet)
 Flat bones - these bones protect the internal organs and include the skull (cranium), ribs,
scapula (shoulder blade), sternum (breast bone) and the pelvic girdle.
 Irregular bones - these bones are irregular in shape and include the vertebrae and some
facial bones.
 Sesamoid bones - these are small bones held within tendons and include the patella (knee
cap). Cartilage separates the femur and the patella, and acts as a shock absorber.

3. Bone Types
Long bone
Short bones
(cancellous)
Flat bone
Irregular bone

4. The formation of bone
1. Development of
ossification center
2. Calcification
3. Formation of
trabeculae
4. Development of
periosteum
Intramembranous
ossification
Endohondral
ossification
1. Development of cartilage model
2. Growth of cartilage model
3. Development of the primary ossification center
4. Development of the secondary ossification center
5. Formation of articular cartilage and epiphyseal plate

5. Bone age

6. Function of bone tissue
 Protection
 Shape
 Blood production
 Mineral storage
 Fat Storage
 Movement
 Acid-base balance
 Detoxification
 Sound transduction

7. Anatomophysiological peculiarities of osseous (bone)
tissue in childhood
 The energy of growth and bone regeneration is high
 Higher content of water and fibrous tissue and lesser percentage
of solid constituents
 Fibrous structure of bone in children (greater extent in the
fetus) and laminar structure in the adult
 Comparatively greater softness and resilience to pressure
bending, and a lesser tendency to fractures
 Greater vascularisation of children's bones
 Periosteum is thick, with a particularly well-defined internal layer
 Presence growing zone of cartilage in long bones

8. Changing of body proportion

9. The skull
Prevalence of the cranial part
Prevalence of the facial part

10. Observation of a skull
Microcephaly
Hydrocephaly

11. Fontanelles

12. Deciduous (milk) teeth
UPPER ERUPTS
BY
LOWER ERUPTS
BY
Central
incisor
8-10 Mo Central
incisor
6-9 Mo
Lateral
incisor
8-10 Mo Lateral
incisor
15-21 Mo
Canine
(Cuspid)
16-20 Mo Canine
(Cuspid)
15-21 Mo
First
molar
15-21 Mo First
molar
15-21 Mo
Second
molar
20-24 Mo Second
molar
20-24 Mo
X=n-4

13. Permanent teeth
X= 4n-20

14. cervical lordosis
thoracic kyphosis
lumbar lordosis
The physiological curvatures
of spinal (or vertebral) column

15. Anomaly of spinal cord
kyphoscoliosis

16. Chests of children and adults

17. Paraclinic methods investigation
 Laboratory Tests
 X-ray Evaluations
 Densitometry
 Arthrogram
 Computer Tomography
 Biopsy

18. Densitometry
norma osteoporosis

19. Semiotics of bone system’s diseases
 The fracture, dislocation (trauma)
 Congenital dysplasia of bone system
(dysplasia of the hip, cleft palate,
arthrogryposis …)
 Metabolic diseases (rickets)
 Inflammation diseases (arthritis, osteomyelitis)
 Autoimmune diseases (systemic connective
system diseases)

20. Congenital dysplasia of the hip –
is the hypoplasia of an acetabulum,
reduction its depth and inadequate size of
the femoral head

21. Clinical sings of
congenital dysplasia of the hips
 Asymmetry of thigh skin folds
 Shortness of one of the extremities
 Knee joints are situates at different levels
 The level of abduction of the leg less than 60º
Ortalani’s symptom – a click of
entrance will be felt as femoral head
slips into the acetabulum
(when the thigh is gradually adducted)
 Late sign – “goose” gait (limping at walking)

22. Treatment –
Pavlik harness can be
used for three to nine
months
The harness keeps the
hip in flexion and
abduction

23. Cleft palate and upper lip

24. Spina bifida

26. Deformation of joints

27. Rheumatic diseases

28. The morpho-functional peculiarities
of muscular systems,
methods of examination,
semiology of disease,
care of children
with muscular system’s diseases

29. Functions of Muscular System
Organ’s formation
Produce movement
Maintain posture and body
position
Support soft tissue
Maintain body
temperature
80

30. Anatomo – physiological peculiarities of muscular system in children
 Ratio of muscular mass to body mass is less in children then in adult:
newborn - 23,3%
8-year child – 27,7%
15 year – 32,6%
adult – 44,2%
 The muscles mass increases in postnatal period in 37 times, in the same
time mass of skeleton increases only in 27 times.
 Allocation of muscle system in newborn is distinguished from the same in
adult - the main mass of muscles of newborn is situated at body, in another
age period the main mass is on extremities.
 The histological structure of muscles is distinguished by lesser thickness of
muscle fibers, a more clearly defined interstitial tissue, and, chiefly, by an
abundance of rounded nuclei in the muscular and interstitial connective
ti8
s1
sue.

31.  The tone of flexion muscles is prevalence
in newborn - it determine the specific
posture of fetus in uterus.
 Peculiarity of development:
 Large muscles start development at first,
 then – muscles of forearm,
 the last – muscles of wrist.
It is why accurate movements of fingers are difficult for
children of early age. Only after 6-7 it is possible to start
teach child to write.
82
Anatomo – physiological peculiarities of muscles

32.  Motor development of children is transformed not steady, but by
sudden change, it is connected with neuroendocrine regulation.
 After 8-9 years ligaments become to be more strong, muscles
development increases and muscles mass increases. At the end of
puberty period muscles mass of arms, chest, back and legs increases.
 After 15 years development of small muscles occurs, coordination of
small movements becomes more perfect.
 Development of muscles is associated with a number of factors
 proper nourishment
 diseases
 family habits
 the child activity in general and in sports in particular
 peculiarities of labor
83
Muscular system development

33. Examination of muscles system
 Interrogation,
 Observation,
 Palpation
 The main features of muscles revealed by clinical
examination:
 Degree of development (atrophy, hypertrophy, symmetrical)
 Volume and nature of activity
 Muscle tone
 Muscle strength
84

34. Atrophy muscles of right hand

35. Hypertrophy

36. Central (spastic) paralysis
1. Diffuse paralysis of extremity
2. Spastic hypertonus of muscles (Tonus is increased in
the group of flexors in upper extremities and in the group
of extensors in lower extremities)
 “ clasp – knife “ symptom in course of evaluation tonus decreases
3. Hyperreflexion
4. Pathologic reflexes (Babynsky, Rossolimo…..)
5.Protective reflexes (the reflexes of spinal automatism) - squeezing of foot or
sharp plantar flexion of toes. The response is flexion of paralyzed extremities
(shortly reaction); opposite extremities thus straightens, being unbent in joints
(long reaction). Serial putting irritations on one and the other leg, can result in
imitation of automatisms of walking.·
6.Pathologic synkinesis - involuntary movements in paralysed extremity
are observed while moving by healthy extremity
Rossolimo Reflex

37. Peripheral (flaccid) paralysis
1.Areflexion or hyporeflexion
(diminished reflexes)
2. Atonic or hypotonic
3. Muscular atrophy
4. Fasciculation of muscles -
a brief spontaneous contraction
affecting a small number of muscle
fibers
5. It is limited paralysis

38. Muscle tone
 Tone is defined as resistance of muscle to passive movement at a joint.
 Alterations in Muscle Tone.
Tone Type Description Anatomic basis
Decreased Floppy, flaccid, hypotonic Motor neuron,
cerebellum, acute
stroke or cord lesion
(spinal shock)
Normal
Increased Spastic "One-way" resistance to extension (arm)
or flexion (leg), maximum at the beginning
of the extension or with faster stretch
Upper motor neuron
(pyramidal)
Rigid Resistance equal throughout the range of
motion in all directions and at all speeds;
can have a ratchety "cogwheeling" quality
that may be from a superimposed tremor
Basal ganglia
(extrapyramidal)
Paratonic
("gegenhalten")
Limb stiffens in response to any contact,
and the degree of resistance increases
with the force exerted by the examiner;
motor perseveration may also occur
Frontal lobes or
diffuse

39. Hypotonia in infant

40. Paraclinical methods of examination
 Laboratory test – calcium (in blood - 2,25-2,5 mmol/l),
kreatinfosphokinase, evaluation of aminoacids, enzymes in blood and
urine and so on.
 Dynamometry - evaluation of muscles strength by using of
dynamometer (hand and trunk dynamometer).
 Electromyography - registration of bioelectrical muscle activity.
This method can help to determine subclinical disorders of motor
activity, to locate pathological process, to differ character of
disorders.
 Chronaxymety - evaluation of minimal time from electrical signal to
muscle contraction.
 Biopsy
91

41. Hand Dynamometry
- effective measurement of grip
strength
- can be used to assess for
weakness related to a number of
conditions
Push-pull dynamometry - is
particularly useful for assessing
improvement post-surgery, or
during the participation of a
rehabilitation program.

42. Electromyography (EMG)
 The electrical activity of various
muscles is recorded both at rest
and during active contraction by
the patient
Myotonia congenita
(Thomsen disease)
93

43. Semiology of muscles system disorders
 Syndrome hypertonia
 Syndrome hypotonia
 Convulsion syndrome
 Change of motor activity
 Myopathy
94

44. Umbilical hernia
95

45. Conclusion
Knowledge of
morpho-functional peculiarities,
methods of examination,
semiology of
skin, subcutaneous tissue, born, muscle systems
is the base for future studying of
children diseases

46. The End
97