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Evie Roberts

on 24 October 2013

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musculoskeletal disorders

Musculoskeletal Disorders
Upon completion of this WebQuest, the NNP student will be able to:
Identify types of musculoskeletal disorders
Identify risk factors
Recognize clinical presentations
Understand the pathological processes
Diagnose musculoskeletal disorders
Manage musculoskeletal disorders
Klippel-Feil Syndrome
Risks: Congenital; Scoliosis, spina bifida, cleft palate, heart defects,Sprengel's deformity
Presents: Short neck, low hairline, limited neck movement
Patho: fusion of any 2 of the 7 cervical vertebrae
Diagnose: Clinically
Manage: Symptomatic; surgery
Extras: http://www.wheelessonline.com/ortho/klippel_feil_syndrome
Types of Musculoskeletal Disorders
Spina Bifida:
Upper Extremities:
Sprengel's Deformity
Cleidocranial Dysostosis
Brachial Plexus Palsy
Radial Dysplasia
Lower Extremities:
Developmental Dysplasia of the Hip
Congenital Absence of the Tibia or Fibula
Genu Recurvatum
Metatarsus Adductus
Clubfoot "Talipes Equinovarus"
Streeter dysplasia
Osteogenesis Imperfecta
Torticollis or "Wry Neck"
Risks: Birth trauma, in utero malposition, muscle fibrosis, venous abnormality; Associated with Hip Dysplasia and Metatarsus Adductus
Presents: hematoma, soft tissue swelling; by 2 wks a firm, fibrous mass 1-2 cm in diameter; hard, immobile; Head tilts laterally towards affected side and chin up
Patho: Shortening or excessive contraction of sternocleidomastoid muscle
Diagnose: Clinically; Xrays
Manage: PT, stretching
Congenital Scoliosis:
Risks: Congenital, idiopathic
Presents: C or S curved spine; one hip higher, uneven leg or arm length
Patho: Failure of vertebrae to form, segment, or both
Diagnose: xray
Manage: PT, surgery, bracing, casting
Associated with renal anomalies, Klippel-Feil, and Sprengel's Deformity
Extras: http://www.scoliosisjournal.com/content/8/1/12

Spinal Deformities
Neural Tube Defects:
Risks: Folic Acid deficiency, diabetes, obesity, hyperthermia (all in first trimester)
Presents:Meninges (meningocele) and/or spinal cord (myelomeningocele) can protrude into sac; May not have a skin disruption (Spina Bifida Occulta); look for hair tuft
Patho: Failure of caudal end of vertebral column to close
Diagnose: Clinically; Spinal Series
Manage: Surgery
Extras: http://www.ninds.nih.gov/disorders/spina_bifida/detail_spina_bifida.htm

Upper Extremities
Sprengel's Deformity "Congenital Elevated Scapula"
Risks: Female; Associated with Klippel-Feil, scoliosis, fused ribs, and spina bifida
Presents/Patho: One shoulder blade is higher than the other; due to failure early on for shoulder to descend from neck to its normal position; Usually the left shoulder but can be bilateral
Diagnose: Clinically
Manage: Surgery and physical therapy
Upper Extremities
Cleidocranial Dysostosis
Risks: Autosomal Dominant
Presents: Collarbone and cranium; painless swelling at 2-3 y/o; Failure of teeth to erupt, small chin, hypertelorism, large fontanelles
Patho: delayed midline ossification
Diagnose: Xrays
Manage: Surgery
Brachial Plexus Palsy
Risks: LGA, CPD, IDM, vacuum
Presents: Chest/ shoulder/arm/ hand palsy or combo
Patho: overstretching of nerves @ C5-C8 and T1
Diagnose: clinically & EMG
Manage: PT, surgery
Extras: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695299/

Upper Extremities
Radial Dysplasia
Risks: Inherited or sporadic; Thalidomide, intrauterine compression; Associated with Holt-Oram, VATER, Fanconi Anemia, TAR Syndrome
Presents: forearm is shortened, stiff elbow; may be minor or complete absence of radius
Patho: injury to apical ectodermal ridge during upper limb development
Diagnose: clinically, Xray
Manage: Splint, stretch, surgery
Radial Dysplasia:
Risks: Hereditary; syndromes
Presents/Diagnose:Two or more digits are fused together
Patho: Simple=joined by soft tissue; Complex=fused bones; Apert's; Occurs around 16 weeks gestation when apoptosis fails to occur
Manage: Surgery @ 6 mos to keep larger digit from curving towards smaller digit (thumb/index or ring/small fingers); Surgery @ 18-24 mos others
Polydactyly=extra digits
Risks: Autosomal dominant;
Presents/Diagnose: Most commonly on the ulnar side of the hand; African Americans mostly; may be associated with a syndrome in caucasians; Radial side=Asians
Patho: occurs the 4th week during rapid limb development; Usually soft tissue but can contain bone; rarely functional
Manage: Soft tissue type can usually be tied off, surgery is needed for bone/joint involvement

Lower Extremities
Developmental Dysplasia of the Hip
Risks: Breech, genetic, first born, female, torticollis, congenital foot deformities
Presents: different leg lengths, uneven thigh skin folds, hip "click" or "clunk"
Patho: lack of acetabular depth, stretched ligaments, abnormal intrauterine position
Diagnose: Ortolani and Barlow
Manage: Pavlik Harness, von Rosen Splint
Extras: http://pediatrics.aappublications.org/content/117/3/e557.full
Congenital Absence of the Tibia or Fibula
Risks: Genetic
Presents: Tibia=shortening of lower leg, foot normal or varus position, unstable knee with flexion contracture; Fibula=shortened leg, foot in severe valgus position.
Lower Extremities
Genu Recurvatum:
Risk & Patho: Oligo, frank breech, fibrosis of quads with deficient hamstrings, females
Presents: dislocation or hyperextension of knee
Diagnose & Manage: xray, presentation; early ortho consult
Lower Extremities
Metatarsus Adductus:
Risks: position in utero, oligo, multiple births, DDH
Presents/Patho: metatarsus bones deviate medially
Diagnose: Flexible=foot able to move past neutral position; Fixed= heel is valgus, high arch, can't move past neutral
Manage: may resolve spontaneously by 3 yrs of age or may need stretching exercises; a rigid foot may need ortho consult
Clubfoot "Talipes Equinovarus"
Risks: Males, Polynesians
Presents: adducted forefoot, heel is varus, & foot& toes point down
Patho: genetic and environmental
Diagnose: readily seen at birth
Manage: exercise, serial casting, surgery
Extras: http://fetalultrasound.com/online/text/30-020.HTM
Streeter Dysplasia "Amniotic Bands"
Risks: upper extremities especially, associated with clubfoot
Presents/Diagnose: band encircling arms, legs, fingers, toes; may have cleft lip & facial deformities
Patho: abnormal attachment of amnion to fetus
Manage: depends on severity
Osteogenesis Imperfecta:
Risks: defective gene
Presents: weak, short body, malformed bones, fractures, curved spine, blue sclera
Patho: collagen deficient or does not work properly
Diagnose: clinically, Hx, Xrays
Manage: treat symptoms
Risks/Patho: Autosomal Dominant but can be spontaneous
Presents: Bowed legs, low tone, large head-to-body size, frontal bossing, Dwarf, kyphosis/lordosis
Diagnose: long bone xrays, polyhydramnios, hydrocephalic
Manage: none
Extras: http://www.ghr.nlm.nih.gov/condition/achondroplasia
As evidenced by this WebQuest, neonatal musculoskeletal disorders come in a variety of packages that require a variety of treatments. The new neonatal nurse practitioner must be aware of abnormal presentations during the physical exam so that he/she can be prepared when called upon to act.
Evaluation of Learning
1. Klippel-Feil Syndrome is associated with:
a. Spina Bifida
b. Scoliosis
c. Sprengel's Deformity
d. All the above
2. Sprengel's Deformity s/s include:
a. Fused Cervical Vertebrae
b. Midline facial defects
c. One shoulder blade higher than the other
d. Amnion attaching itself to the fetus
Evelyn Roberts, RN, BSN, NNP Student
University of South Alabama

Musculoskeletal disorders in the neonate can range from simple to complex anomalies that may require minimal treatment or may even require surgery. In order to recognize a disorder when it appears, the neonatal nurse practitioner student should be well versed when performing the physical assessment and able to apperceive pertinent prenatal findings. Risks, clinical presentations, pathological processes, ways to diagnose and treatments for specific musculoskeletal disorders in the newborn will be discussed in this WebQuest.
Because the newborn's skeleton is flexible with elastic joints, the baby can readily pass through the birth canal. Ossification of the baby's skeleton is quick during year one. However, the muscles are almost complete by birth. The role of the musculoskeletal system is very important in that it provides movement, support and protection. When disorders occur, these very important roles are disrupted and the baby is at risk for injury and deformities.
Photo Credits
Book Credit
Tappero, E. P. & Honeyfield, M. E. (2009). Physical assessment of the newborn (4th ed). In Tappero, E. P., Honeyfield, M. E., Rait, C., & Rait, S. (Eds.), Musculoskeletal system assessment (pp. 133-156). Petaluma, CA: NICU Ink.
Conclusion & Evaluation
3. Radial Dysplasia s/s include:
a. Short forearm & stiff elbow
b. Short lower leg & normal or varus foot
c. short leg w/foot severe valgus
d. Hyperextension of the knee
4. Another name for Streeter Dysplasia is:
a. Achondroplasia
b. Stickler's Syndrome
c. Arthrogryposa
d. Amniotic Bands
5. Osteogenesis Imperfecta is a disorder of:
a. Potassium
b. Collagen
c. Sodium
d. Vitamin D
See attachment for answers!
Just in Case You Want More
Osteopenia of Prematurity
Septic Arthritis
Fractured Clavicle
Stickler's Syndrome
Full transcript