Topics

• History
• Screening and Health Promotion
• Pediatric Variations

NDNP 819: Advanced Health Assessment Across the Lifespan

Module: Musculoskeletal

Pediatric Variations

Musculoskeletal Disorders

Kids tend to have more sports injuries including fracture, sprain, and overuse of the head/neck, back, upper and lower extremities. Both fractures and sprains include decreased ROM and pain. Fractures have edema, erythema, ecchymosis, pain, angulation and bony point tenderness. Sprains vary in pain degrees, swelling, difficulty weight bearing, and detectable joint laxity, while overuse includes various degrees of pain with or w/o activity limitations.

Newborns may be born with developmental dysplasia of the hip. At birth, instability is without significant fixed deformity. If not detected at birth, the dislocation becomes fixed, with less instability, and more limitation of abduction. These kids limp noticeable at the onset of walking. This is where Barlow’s sign and Ortolani’s sign is important in infants before walking.

Torticollis (Wry Neck) is a contracture of one of the sternocleidomastoid muscles. There is a fusiform, firm mass in the body of contracted muscle. It is palpable after 4 weeks of age, then recedes.

The congenital form of talipes euinovarus congenital (clubfoot) includes the absence of other congenital abnormalities and variable rigidity of the foot with mild calf atrophy and hypoplasia of the tibia, fibula, and foot bones. The foot is small with limited dorsiflexion, deep crease on medial border of foot and more obvious in older children, calf muscles that are thin and atrophic.

It is important to assess limp onsets in children.  Limited ROM indicates more serious conditions (Legg-Calve-Perthes disease, Slipped Capital Femoral Epiphysis).

Growing pains usually have no physical findings and are pain/ache localized to lower extremities more nocturnal.
Older children may have metatarsus adductus/metatarsus varus (toeing in gait). Physical findings include full ROM with adductus and limited ROM with varus. No problems with ankle joint. Bowleg (genu varum) and knock knees (genu valgum) can be a variation that resolves with age.

Scoliosis is more likely detected on routine adolescent screening.

As with adults, ask about systemic symptoms including multiple joint involvement, fevers and rashes.