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    Irro Asentista Cabello
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    Giles 2018 PDF

    Uploaded by

    Irro Asentista Cabello

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    © All Rights Reserved
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    of 6
    ‘What additional findings are likely with this patient? Lp to 20% of chicren with congenital torticolis have congenital, cysolasa of the hips. In many instances, these infants wil also ‘resent with facial asymmetries and plagocephaly or Hattening of the sll MANAGEMENT ‘What is the most effective management ofthis patient? Congenital torticolis ¢ usualy tested with nonoperative intervention for 12-24 months belore consideing surgical intervention Pharmacological intervention may include nonstericel_ ant inflammatory drugs (NSAIDS), benzodiazenines an other muscle relaxants, anticoliergxs. and. local intramuscular imections ‘of botuinum torin or phenol, Physical therapy includes famiy/ Caregiver education and teaching, passive stretching exercises 0 the Slermoceidomastvs and upper trapenus muscles, massage, local heat, analgesics, sensory bioleedback, and transcutaneous electra nerve stimulation (TENS) Active range of mation wth subsequent stengthening is aio indicated to corect the infant's postioning of ther head. Famiy traning «extremely beneficial i thee Eersistency with handling and oroper sosttonng during teesing and sleeping orger to promote svetch and active motion oF the Sternoceidomastid muscle If consenatie treatment fais, surgical intervention will const of unipolar sterecleiomastoid release, bipolar sternecledomastod release or selective denervation, Prysicalterapyiinciatedater surgery and should incluce manual stretching othe neck to manta the overcorectec postion Manual stretching shouldbe comtiued three times day for 3-6 months. Cervical clr may be used forthe st 612 weeks ate surgery ‘What home care regimen should be recommended? The family must continue with the stretching program and the correct handing techniques that are recommended by the therapist. The family wll need to include prope positioning fr the infant's sleep and alert times n order to maximize the berets of theintervenvon OUTCOME What isthe likely outcome of a course of physical therapy? Stules indicate that between 85-90% of patients with congenital {ortcalis respond to conservative treatment ana passive stretching within the fst year of fe. The best resuls for conservative ‘management require the hid to have had conservative treatment ror othe age of one surgical intervention is required, physical therapy wil De required after surgery with an expected positive ‘tcome forthe patent ‘What are the long-term effects of the patient's condition? if a chlo (5 left untreated, congenital tortcolis could have detrimental eects inclusing the impairment of normal growth and develooment, The vast majonty of children with congenital torticos that receive conservative management are expected to fully ecover and ive a normal ite COMPARISON What are the distinguishing characteristics of a similar condition? Torticlis can also be acquired at an older age and presents in erent forms. Acute wryneck isa term to describe a commen type of toticolis that develops overnight without provocation It is _2selhimiting process and usually the symptoms subside within one Totwo weeks infectious terticals may occur when the surrounding tissues become infected such as with a retropharyngeal abscess, nasopharyngeal abscess, tonsils, and sinusitis Scenario One 1 three-week-old infant is referred to outpatient physica: theraoy wath a moderate right tortcollis. Ther is 9 mass felt cover the sterocleidomastois muscle belly. The parents are concerned with this lagnosis and are very eager to assist with the infants arogram. The mathe is at home during the day ‘ang they have three other children at home. Scenario Two A chid i referred to ohysical therapy status post unipolar sternocleidomastoid release two weeks ag0. The child is 18 ‘months old and was unsuccessful with conservative treatment {or sgrticat let trtalis. The child resides with his foster mother ina stuck apartment. The mother works full-time and the child partiipates in ful-time daycare DIAGNosIs What condition produces a patient's symptoms? A total hyp arthroplasty (THA) may be warranted secondary to Progressive and severe osteoarthnts oF mheumatod artis in the hip jm, develoomental dysplasia of the hip, tumors, failed ‘reconstruction of the hip or other Np conations that produce ‘acopacitating pain and disabiity. A THA may also be required ‘secondary to trauma, avascular necrosis oa nonunion fracture, ‘An injury was most likely sustained to which structure? Artis causes the hip joint to undergo a degenerate process Including destruction of articular cartlage that results in Bone-o- ‘bone contact Degenerative changes are usually apparent in Doth the acetabulum and the femoral head requring a THA, however, it the acetabulum does not exhibit degenerative changes then only ‘the ternoral head wil be replaced in a hemarthropasty procedure INFERENCE What is the most likely contributing factor in the ‘development ofthis condition? Intra-articula disease or the destruction of articular cartiage may come from arts, repetiive microtrauma, obesity, nutitonal imbalances, falls or abnormal int mechanics incications for THA include osteoarthritis, rheumatod arthritis, avascular necross, eveloomental dysplasia osteomyelitis, alec fixation of atractue, ankylosing spondyitis, and faled conservative management CONFIRMATION What is the most likely clinical presentation? ‘A patient that requires a THA wil present with decreased range of ‘motion, pared mobility skis, and persstent pain that increases with motion and weight bearing, The patients usualy over 55 years fof age ang has experenced consistent pain that isnot reieved through conservative measures and limits the patient's funchonal mobility on a consistent basi. What laboratory or imaging studies would confirm the diagnosis? Xray, comoutea tomography, and magnetic resonance maging procedures may be used to view the itegity ofthe joint. These procedures are also used to rule outa fracture ora tumor. ‘What additional information should be obtained to ‘confirm the diagnosis? Patent history, current functional status, and level of pain and

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