Lower Extremity Malalignment: When to Refer and When to Reassure?
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Genu Varum and Genu Valgum Genu Varum and Genu Valgum
Common Pediatric Lower Limb Disorders Dr.Kholoud Al-Zain Assistant Professor Consultant, Pediatric Orthopedic Surgeon Nov- 2018 Acknowledgement: Dr.Abdalmonem Alsiddiky Dr.Khalid Bakarman Prof. M. Zamzam Topics to Cover 1. In-toeing 2. Genu (varus & valgus), & proximal tibia vara 3. Club foot 4. L.L deformities in C.P patients 5. Limping & leg length inequality 6. Leg aches 1) Intoeing Intoeing- Evaluation • Detailed history – Onset, who noticed it, progression – Fall a lot – How sits on the ground • Screening examination (head to toe) • Pathology at the level of: – Femoral anteversion – Tibial torsion – Forefoot adduction – Wandering big toe Intoeing- Asses rotational profile Pathology Level Special Test • Femoral anteversion • Hips rotational profile: – Supine – Prone • Tibial torsion • Inter-malleolus axis: – Supine – Prone • Foot thigh axis • Forefoot adduction • Heel bisector line • Wandering big toe Intoeing- Special Test Foot Propagation Angle → normal is (-10°) to (+15°) Intoeing- Femoral Anteversion Hips rotational profile, supine → IR/ER normal = 40-45/45-50° Intoeing- Tibial Torsion Inter-malleolus axis Supine position Sitting position Intoeing- Tibial Torsion Foot Thigh Axis → normal (0°) to (-10°) Intoeing- Forefoot Adduction Heel bisector line → normal along 2 toe Intoeing- Adducted Big Toe Intoeing- Treatment • Establish correct diagnosis • Parents education • Annual clinic F/U → asses degree of deformity • Femoral anti-version → sit cross legged • Tibial torsion → spontaneous improvement • Forefoot adduction → anti-version -
Iliopsoas Tendonitis/Bursitis Exercises
ILIOPSOAS TENDONITIS / BURSITIS What is the Iliopsoas and Bursa? The iliopsoas is a muscle that runs from your lower back through the pelvis to attach to a small bump (the lesser trochanter) on the top portion of the thighbone near your groin. This muscle has the important job of helping to bend the hip—it helps you to lift your leg when going up and down stairs or to start getting out of a car. A fluid-filled sac (bursa) helps to protect and allow the tendon to glide during these movements. The iliopsoas tendon can become inflamed or overworked during repetitive activities. The tendon can also become irritated after hip replacement surgery. Signs and Symptoms Iliopsoas issues may feel like “a pulled groin muscle”. The main symptom is usually a catch during certain movements such as when trying to put on socks or rising from a seated position. You may find yourself leading with your other leg when going up the stairs to avoid lifting the painful leg. The pain may extend from the groin to the inside of the thigh area. Snapping or clicking within the front of the hip can also be experienced. Do not worry this is not your hip trying to pop out of socket but it is usually the iliopsoas tendon rubbing over the hip joint or pelvis. Treatment Conservative treatment in the form of stretching and strengthening usually helps with the majority of patients with iliopsoas bursitis. This issue is the result of soft tissue inflammation, therefore rest, ice, anti- inflammatory medications, physical therapy exercises, and/or injections are effective treatment options. -
Strain Assessment of Deep Fascia of the Thigh During Leg Movement
Strain Assessment of Deep Fascia of the Thigh During Leg Movement: An in situ Study Yulila Sednieva, Anthony Viste, Alexandre Naaim, Karine Bruyere-Garnier, Laure-Lise Gras To cite this version: Yulila Sednieva, Anthony Viste, Alexandre Naaim, Karine Bruyere-Garnier, Laure-Lise Gras. Strain Assessment of Deep Fascia of the Thigh During Leg Movement: An in situ Study. Frontiers in Bioengineering and Biotechnology, Frontiers, 2020, 8, 15p. 10.3389/fbioe.2020.00750. hal-02912992 HAL Id: hal-02912992 https://hal.archives-ouvertes.fr/hal-02912992 Submitted on 7 Aug 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. fbioe-08-00750 July 27, 2020 Time: 18:28 # 1 ORIGINAL RESEARCH published: 29 July 2020 doi: 10.3389/fbioe.2020.00750 Strain Assessment of Deep Fascia of the Thigh During Leg Movement: An in situ Study Yuliia Sednieva1, Anthony Viste1,2, Alexandre Naaim1, Karine Bruyère-Garnier1 and Laure-Lise Gras1* 1 Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, Lyon, France, 2 Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique, 165, Chemin du Grand-Revoyet, Pierre-Bénite, France Fascia is a fibrous connective tissue present all over the body. -
Peds Ortho: What Is Normal, What Is Not, and When to Refer
Peds Ortho: What is normal, what is not, and when to refer Future of Pedatrics June 10, 2015 Matthew E. Oetgen Benjamin D. Martin Division of Orthopaedic Surgery AGENDA • Definitions • Lower Extremity Deformity • Spinal Alignment • Back Pain LOWER EXTREMITY ALIGNMENT DEFINITIONS coxa = hip genu = knee cubitus = elbow pes = foot varus valgus “bow-legged” “knock-knee” apex away from midline apex toward midline normal varus hip (coxa vara) varus humerus valgus ankle valgus hip (coxa valga) Genu varum (bow-legged) Genu valgum (knock knee) bow legs and in toeing often together Normal Limb alignment NORMAL < 2 yo physiologic = reassurance, reevaluate @ 2 yo Bow legged 7° knock knee normal Knock knee physiologic = reassurance, reevaluate in future 4 yo abnormal 10 13 yo abnormal + pain 11 Follow-up is essential! 12 Intoeing 1. Femoral anteversion 2. Tibial torsion 3. Metatarsus adductus MOST LIKELY PHYSIOLOGIC AND WILL RESOLVE! BRACES ARE HISTORY! Femoral Anteversion “W” sitters Internal rotation >> External rotation knee caps point in MOST LIKELY PHYSIOLOGIC AND MAY RESOLVE! Internal Tibial Torsion Thigh foot angle MOST LIKELY PHYSIOLOGIC AND WILL RESOLVE BY SCHOOL AGE Foot is rotated inward Internal Tibial Torsion (Fuchs 1996) Metatarsus Adductus • Flexible = correctible • Observe vs. casting CURVED LATERAL BORDER toes point in NOT TO BE CONFUSED WITH… Clubfoot talipes equinovarus adductus internal varus rotation equinus CAN’T DORSIFLEX cavus Clubfoot START19 CASTING JUST AFTER BIRTH Calcaneovalgus Foot • Intrauterine positioning • Resolve -
5/19/2016 18
5/19/2016 1 Pediatric Orthopaedics for Primary Care Providers 22 Disclosure Statement No conflicts related to this presentation 33 44 Goals 1. Discuss some common pediatric problems seen in the clinic 2. Examination techniques 3. Basics of treatment 55 Overview 1. DDH 2. Clubfoot 3. Gait abnormalities 4. Shape abnormalities 5. Fracture topics 6. Hip and knee problems 7. Tumors 66 Developmental Dysplasia of the Hip Spectrum of abnormal development of the hip May be congenital or develop during infancy or childhood Incidence ~ 1:1000 of infants 77 Risk Factors 1st born Girls Family history Breech Metatarsus adductus/CMT Joint laxity 88 Diagnosis Clinical examination (at birth and subsequent well-baby examinations) Clunks signify dislocating hip (Barlow sign) or relocating hip (Ortolani sign) Sustained dislocation may demonstrate decreased hip abduction or leg length discrepancy (unilateral) 9 10 1 11 5/19/2016 Sustained dislocation may demonstrate decreased hip abduction or leg length discrepancy (unilateral) 99 Bilateral DDH 1010 Ortolani Maneuver 1111 Barlow Maneuver 1212 Screening All newborns should have examination of the hip as part of routine exam Imaging is not recommended on a routine basis At risk babies should have ultrasound examination at 4-6 weeks of age (+/- AP pelvis radiograph at 6 months of age) 1313 Treatment Early identification Pavlik harness 1414 Try to prevent situations like these 1515 Dysplasia Unfortunately, cases like these are going to be missed 1616 Congenital Talipes Equinovarus Multifactorial etiology Incidence -
Natural History of 39 Patients with Achondroplasia
ORIGINAL ARTICLE Natural history of 39 patients with Achondroplasia Jose Ricardo Magliocco Ceroni,I,* Diogo Cordeiro de Queiroz Soares,I Larissa de Ca´ssia Testai,II Rachel Sayuri Honjo Kawahira,I Guilherme Lopes Yamamoto,I Sofia Mizuho Miura Sugayama,I Luiz Antonio Nunes de Oliveira,III Debora Romeo Bertola,I Chong Ae KimI I Unidade de Genetica, Instituto da Crianca (ICR), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. II Centro de Pesquisas sobre o Genoma Humano e Celulas-Tronco (CEGH-CEL), Instituto de Biociencias (IB), Universidade de Sao Paulo, Sao Paulo, SP, BR. III Unidade de Radiologia, Instituto da Crianca (ICR), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. Ceroni JR, Soares DC, Testai LC, Kawahira RS, Yamamoto GL, Sugayama SM, et al. Natural history of 39 patients with Achondroplasia. Clinics. 2018;73:e324 *Corresponding author. E-mail: [email protected] OBJECTIVES: To characterize the natural history of 39 achondroplastic patients diagnosed by clinical, radiological and molecular assessments. METHODS: Observational and retrospective study of 39 patients who were attended at a public tertiary level hospital between 1995 and 2016. RESULTS: Diagnosis was made prenatally in 11 patients, at birth in 9 patients and within the first year of life in 13 patients. The most prevalent clinical findings were short stature, high forehead, trident hands, genu varum and macrocephaly. The most prevalent radiographic findings were rhizomelic shortening of the long bones and narrowing of the interpediculate distance of the caudal spine. There was motor developmental delay in 18 patients and speech delay in 16 patients. -
Hamstring Muscle Injuries
DISEASES & CONDITIONS Hamstring Muscle Injuries Hamstring muscle injuries — such as a "pulled hamstring" — occur frequently in athletes. They are especially common in athletes who participate in sports that require sprinting, such as track, soccer, and basketball. A pulled hamstring or strain is an injury to one or more of the muscles at the back of the thigh. Most hamstring injuries respond well to simple, nonsurgical treatments. Anatomy The hamstring muscles run down the back of the thigh. There are three hamstring muscles: Semitendinosus Semimembranosus Biceps femoris They start at the bottom of the pelvis at a place called the ischial tuberosity. They cross the knee joint and end at the lower leg. Hamstring muscle fibers join with the tough, connective tissue of the hamstring tendons near the points where the tendons attach to bones. The hamstring muscle group helps you extend your leg straight back and bend your knee. Normal hamstring anatomy. The three hamstring muscles start at the bottom of the pelvis and end near the top of the lower leg. Description A hamstring strain can be a pull, a partial tear, or a complete tear. Muscle strains are graded according to their severity. A grade 1 strain is mild and usually heals readily; a grade 3 strain is a complete tear of the muscle that may take months to heal. Most hamstring injuries occur in the thick, central part of the muscle or where the muscle fibers join tendon fibers. In the most severe hamstring injuries, the tendon tears completely away from the bone. It may even pull a piece of bone away with it. -
Leri-Weill Dyschondrosteosis Syndrome: Analysis Via 3DCT Scan
medicines Case Report Leri-Weill Dyschondrosteosis Syndrome: Analysis via 3DCT Scan Ali Al Kaissi 1,2,* , Mohammad Shboul 3, Vladimir Kenis 4 , Franz Grill 2, Rudolf Ganger 2 and Susanne Gerit Kircher 5 1 Ludwig Boltzmann Institute of Osteology, at the Hanusch Hospital of WGKK and, AUVA Trauma Centre Meidling, First Medical Department, Hanusch Hospital, Vienna 1140, Austria 2 Paediatric department, Orthopaedic Hospital of Speising, Vienna 1130, Austria; [email protected] (F.G.); [email protected] (R.G.) 3 Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan; [email protected] 4 Department of Foot and Ankle Surgery, Neuroorthopaedics and Systemic Disorders, Pediatric Orthopedic Institute n.a. H. Turner, Parkovaya str., 64–68, Pushkin, Saint Petersburg, Russia; [email protected] 5 Department of Medical Chemistry, Medical University of Vienna, Vienna 1090, Austria; [email protected] * Correspondence: [email protected]; Tel./Fax: +43-180-182-1260 Received: 17 May 2019; Accepted: 27 May 2019; Published: 29 May 2019 Abstract: Background: Leri-Weill dyschondrosteosis (LWD) is a pseudoautosomal form of skeletal dysplasia, characterized by abnormal craniofacial phenotype, short stature, and mesomelia of the upper and lower limbs. Methods: We describe two female patients with LWD. Their prime clinical complaints were severe bouts of migraine and antalgic gait. Results: Interestingly, via a 3D reconstruction CT scan we encountered several major anomalies. Notable features of craniosynostosis through premature fusion of the squamosal sutures and partial closure of the coronal sutures were the reason behind the development of abnormal craniofacial contour. A 3D reconstruction CT scan showed apparent bulging of the clavarium through the partially synostosed coronal and totally synostosed squamosal sutures. -
Back of Thigh
Back of thigh Dr Garima Sehgal Associate Professor King George’s Medical University UP, Lucknow DISCLAIMER: • The presentation includes images which have been taken from google images or books. • The author of the presentation claims no personal ownership over these images taken from books or google images. • They are being used in the presentation only for educational purpose. Learning Objectives By the end of this teaching session on back of thigh – I all the MBBS 1st year students must be able to: • Enumerate the contents of posterior compartment of thigh • Describe the cutaneous innervation of skin of back of thigh • Enumerate the hamstring muscles • List the criteria for inclusion of muscles as hamstring muscles • Describe the origin, insertion, nerve supply & actions of hamstring muscles • Describe origin, course and branches of sciatic nerve • Write a short note on posterior cutaneous nerve of thigh • Write a note on arteries and arterial anastomosis at the back of thigh • Discuss applied anatomy of back of thigh Compartments of the thigh Cutaneous innervation of back of thigh 1 4 2 3 Contents of Back of thigh Muscles: Hamstring muscles & short head of biceps femoris Nerves: Sciatic nerve & posterior cutaneous nerve of thigh Arterial Anastomosis: The Posterior Femoral Cutaneous Nerve (n. cutaneus femoralis posterior) Dorsal divisions of – S1, S2 & Ventral divisions of S2, S3 Exits from pelvis through the greater sciatic foramen below the Piriformis. Descends beneath the Gluteus maximus with the inferior gluteal artery Runs down the back of the thigh beneath the fascia lata, to the back of the knee and leg Posterior Femoral Cutaneous Nerve contd…. -
L2 Hip Flexors | Iliopsoas
International Standards for the Classification of Spinal Cord Injury Motor Exam Guide Grades 0, 1 & 2 Patient Position: The shoulder is in neutral rotation, neutral flexion/extension, and adducted. The elbow is in full extension. The forearm is in full pronation and the wrist in neutral flexion- extension. The MCP joint is stabilized. An alternate position is with the shoulder in internal rotation, adducted, and neutral flexion/extension. The elbow is in 90° of flexion, the forearm and wrist are in neutral flexion /extension, and the MCP joint is stabilized. Examiner Position: Stabilize the dorsal wrist and hand by pressing down lightly on the back of the hand. Be sure that the MCP joints are stabilized to prevent hyperextension. Palpate the abductor digiti minimi muscle and observe the muscle belly for movement. Instructions to Patient: “Move your little finger away from your ring finger.” Action: The patient attempts to abduct the little finger through the full range of motion. T1 Common Muscle Substitution Finger extension can mimic 5th finger abduction. Proper positioning and stabilization will minimize this error. L2 Hip Flexors | Iliopsoas Grade 3 Patient Position: The hip is in neutral rotation, neutral adduction/abduction, with both the hip and knee in 15° of flexion. Examiner Position: Support the dorsal aspect of the distal thigh and leg. Do not allow flexion beyond 90° when examining acute thoraco-lumbar injuries due to the kyphotic stress placed on the lumbar spine. Instructions to Patient: “Lift your knee towards your chest as far as you can, trying not to drag your foot on the exam table.” Action: The patient attempts to flex hip to 90° of flexion. -
Medical Term for Thigh Region
Medical Term For Thigh Region Is Harry unflawed when Domenico pasteurize connubial? Overlying and commiserative Brook revolutionising her Douala interpose or outvoting latently. Abridged Rod phlebotomises anticipatorily, he regionalizes his lumbers very inexpugnably. Donovanosis may excite or injury severity of low or across a term for medical Glossary of Medical Terminology OA Knee Pain. Medical Abbreviations L GlobalRPH. What does Your Spondylolisthesis Diagnosis Mean Penn. Anatomical regions The entire school body is divided into regions an approach called regional anatomy Each plan area below neck thorax abdomen upper eyelid lower extremities are divided into several smaller regions that aid compartmentalization. Inner thigh pain Causes symptoms and treatment Medical. Quadriceps a great extensor muscle of one leg situated in the wobble and. 5 Facts About sex Female Egg Cell Human Eggs Natural Cycles. An Illustrated Guide to Veterinary Medical Terminology Paul. The term 'slipped disc' doesn't really make conscious as there isn't. Also occur in idiopathic pulmonary fibrosis describes the term for informational purposes only. Additional noteworthy anatomic regions in the lung include the. K The vertebral region is to which two scapular regions. Common medical abbreviations for medical transcription Medical. Thigh Anatomy Diagram & Pictures Body Maps Healthline. Patients with this syndrome are often admitted to the hospital hire a medical. What joint the biggest cell in the being human body? Medical terminology may taste like many foreign language to. However when medical information is transferred between hospitals doctors and other. This manual will drop the term female to liaison to a ridiculous's sex assigned. To as objective sleep the lower conscious sedation has considerable more popular to. -
The Muscles That Act on the Lower Limb Fall Into Three Groups: Those That Move the Thigh, Those That Move the Lower Leg, and Those That Move the Ankle, Foot, and Toes
MUSCLES OF THE APPENDICULAR SKELETON LOWER LIMB The muscles that act on the lower limb fall into three groups: those that move the thigh, those that move the lower leg, and those that move the ankle, foot, and toes. Muscles Moving the Thigh (Marieb / Hoehn – Chapter 10; Pgs. 363 – 369; Figures 1 & 2) MUSCLE: ORIGIN: INSERTION: INNERVATION: ACTION: ANTERIOR: Iliacus* iliac fossa / crest lesser trochanter femoral nerve flexes thigh (part of Iliopsoas) of os coxa; ala of sacrum of femur Psoas major* lesser trochanter --------------- T – L vertebrae flexes thigh (part of Iliopsoas) 12 5 of femur (spinal nerves) iliac crest / anterior iliotibial tract Tensor fasciae latae* superior iliac spine gluteal nerves flexes / abducts thigh (connective tissue) of ox coxa anterior superior iliac spine medial surface flexes / adducts / Sartorius* femoral nerve of ox coxa of proximal tibia laterally rotates thigh lesser trochanter adducts / flexes / medially Pectineus* pubis obturator nerve of femur rotates thigh Adductor brevis* linea aspera adducts / flexes / medially pubis obturator nerve (part of Adductors) of femur rotates thigh Adductor longus* linea aspera adducts / flexes / medially pubis obturator nerve (part of Adductors) of femur rotates thigh MUSCLE: ORIGIN: INSERTION: INNERVATION: ACTION: linea aspera obturator nerve / adducts / flexes / medially Adductor magnus* pubis / ischium (part of Adductors) of femur sciatic nerve rotates thigh medial surface adducts / flexes / medially Gracilis* pubis / ischium obturator nerve of proximal tibia rotates