Musculoskeletal Dysfunction

1. Shabnam
Demonstrator (INS-KMU)
Pediatric Musculoskeletal
Disorders

2. Objectives
At the end of this session learners will be
able to:
 Understand about Kyphosis, lordosis , Scoliosis
and its management accordingly.
 Discuss common fractures in children.
 Know about Rheumatoid Arthritis.
 Discuss congenital hip dislocation.
 Nursing care for, child with cast and traction,
rehabilitative care and other medical and surgical
management for the children with the above
disorders.

3. Musculoskeletal Development
• Infant bones are only 65% ossified
• Long bones are porous and less dense and can
bend, buckle or break easily
• Growth takes place in Epiphyseal plates, and if
these are injured, can cause abnormal growth
• Growing bones heal quickly and decrease need
for treatment

4. kyphosis
• Kyphosis is the bowing of the spine that causes a bowing or rounding
of the back, which leads to a hunchneck or stouching posture.

6. Etiology,incidence and risk factors
• It can occur at any age
• Very rare at birth
• Postural khyposis occurs as a result of poor posture and
weakening of muscles and ligaments.
• Congenital kyphosis occurs as a result of improper development of
vertebrae or fusion of vertebrae.

7. Types of skyphosis
• There are three main type of kyphosis:
1.Postural kyphosis
2.Scheuemann’s kyphosis
3.Congenital kyphosis

13. khypnologic brace

14. Surgical management

15. Lordosis

16. Lordosis
• Lordosis is a medical term used to describe an inward curvature of
a portion of the lumber and cervical vertebral column

17. Etiology
• Causes of lordosis has been linked to achondroplasia and
spondylolisthesis.
• Lordosis is also associated with poor posture, a congenital
problem with the vertebrae ,neuro muscular problem, back
surgery or a hip problem.

18. Clinical feature
• Prominance of buttocks
• Back pain
• Pain down the legs

19. Manageement
Management is based on:
• Child age, overall health ,medical history, cause and extent of
the condition.
• Goal of treatment to stop the progression of the curve,
prevent deformity.
• Simple exercise are sufficient ,if lordosis is associated with
poor posture.

20. Scoliosis

22. Scoliosis
• Assessment findings:
 Lateral curvature of spine
 Truncal asymmetry
 Uneven shoulders
 Prominent scapula – uneven height
 Rib-hump
 uneven hips

23. Braces used in Treatment of Scoliosis

24. Treatment and Nursing Care for Scoliosis Spinal
Fusion
Pre-operative teaching
 Demonstrate incentive spirometer
 Discuss all potential equipment (chest tubes,
IV, O2 masks & nasal canula, Foley catheter)
 Teach use of pumps for PCA or epidural block.
 Demonstrate log rolling and assist out of bed.

25. Nursing Care for spinal fusion
Post-operative Care
 Maintain airway
 NeurovascularAssessment of lower
extremities
 Teach passive and active ROM
exercises
 Encourage independence in ADL’s
 Provide with resources / information on
scoliosis support groups

26. Serial Casting

27. Serial Casting
• Cast applied to hold foot in desired position.
• Changed every 1-2 weeks until maximum correction is achieved.
Nursing Care:
– Cast care
– Skin Care
– Education of parents

28. Neurovascular Assessment
• Circulatio
n
C
•Sensory
S
•Motion
M

29. Cast Care – Assessment
• Unusual odor beneath the cast
• Tingling, burning, numbness of toes
• Drainage through cast
• Swelling or inability to move toes
• Toes that are cold, blue or white
• Sudden unexplained fever
• Pain that is not relieved by comfort measures

30. Cast Care Teaching
• “Petaling” the edges of the cast
• Drying of the cast
• Prevention of swelling
• Protecting the cast
• When to call the doctor

31. Parent Support
• Parents should be trained to become active participants in the physical
therapy treatments.
• Nurses need to help the parents understand the time commitment
involved.
• Assess the parents’ ability to monitor the child adequately for
complications and confirm they understand the signs and symptoms of
the
complications.

32. Developmental Dysplasia of Hip
Clinical Manifestations
1. Limited abduction of
the affected hip during
Ortolani maneuver.
May hear a
click upon movement.
1. Asymmetry of gluteal and
thigh fat folds when lying
with legs extended.
2. Limp and abnormal gait in
older child
Ortolani maneuver
Asymmetry of gluteal folds

34. Treatment and Nursing care of a child with
Dysplasia of the Hip:
• Spica cast
Covers lower half of
body except perineal area
• Nursing Care
 Elimination/ protection of cast
 Positioning
 Neurovascular assessment
 Skin care
 Hygiene

35. Treatment and Nursing care of a child with
Dysplasia of the Hip:
• Pavlik harness
– Ensures hip flexion and
abduction and does not
allow hip extension or
adduction.
– It maintains correct
position of the femoral
head in the acetabulum.

36. Nursing Care
– Teach parents/caregivers to
remove and apply harness
appropriately –only remove
for bathing and skin checks.
– Teach skin assessment
– Encourage cuddling infant to
promote cognitive
development and
infant/caregiver bonding

38. Causes of Fractures
• Increased mobility and immature motor
skills
• Trauma
• Bone diseases

39. Treatment
Reduction
• Repositioning of the
bone fragments into
normal alignment
Retention
• Application of a
device or mechanism
that maintains
alignment until
healing occurs

40. Retention
• Application of Cast
• Traction
Pull or force exerted on one part of the body

41. Complications associated
with Orthopedic Trauma/
Fractures
• Fat Embolism
Particles of fat are carried through circulation and lodge in
lung capillaries causing:
• Pulmonary edema
• Respiratory distress with hypoxemia
Treatment
• Increase in IV fluids
• Respiratory support and adequate oxygenation

42. Manifestations of Fracture
• Pain or tenderness at site
• Immobility or decreased ROM
• Deformity of extremity
• Edema
• Other signs – crepitus, ecchymosis, muscle spasm and
inability to bear weight

43. Orthopedic Trauma / Fracture
Complications
• Compartment syndrome (very serious)
Paresthesia
Pain
Pallor
Paralysis
Pulselessness

44. Legal & Ethical implications when
caring for a child with a fracture?
• All fractures entering the hospital via ER require
social service consult for documentation of
suspected abuse or neglect.
• The nurse must report all suspected abuse to the
appropriate authority.
• Do not discuss the possibility of abuse with the
parents or guardians!! Do not attempt to prove or
disprove abuse.

45. Juvenile Rheumatoid Arthritis
• Juvenile arthritis (JA) is an umbrella term used to describe the
many autoimmune and inflammatory conditions that can develop
in children ages 16 and younger.

46. JRA – Classification Criteria
• JRA – American College of Rheumatology 1970
three types of onset:
• oligo aurticular, polyarticular, & systemic in the
first 6 months of life.

47. Etiology
• Immune mediated disease
• Complex genetic predispositions
• Environmental triggers
• Infections
• Trauma
• Stress

48. Systemic JA
• Definition:
Arthritis with or preceded by daily fever of at
least 2 weeks’ duration.

49. Systemic JRA
Rash –
 Maculopapular
– flat to slightly
raised
 Trunk and
extremities
 Pruritic 5%
 Persistent with
fever spike

50. Polyarticular JA
• Five or more joints in the
first 6 months of disease
• Asymmetric joint
involvement
• Large joints of knees,
wrists, elbows and ankles
often affected
• Morning stiffness, joint
pain
• Intermittent low-grade
fever

51. Polyarticular JA
• Arthritis affecting 5 or more joints in the first 6
months of disease.
• Similar to adult RA
• Females with onset in adolescence
• Early onset of erosive synovitis
• Symmetric joint involvement
• Small joints of hands or feet are affected
• Cervical spine may be affected

52. Oligoarticular JIA
• Arthritis in 1 to 4 joints
during the first 6
months of disease
• Girls 1 to 4 years
• Knees, ankles, elbows
• Painless swelling of
joints is common

53. Treatment
• FDA approved for
pediatric use
– Aspirin
– Ibuprofen

54. The End