Musculoskeletal Diseases: Presented by Group 5

Musculoskeletal
Diseases
Presented by Group 5
Anatomy and Physiology of
Musculoskeletal System
Talipes Equinovarus (Club Foot)
TOPICS TO BE Hip Dysplasia
DISCUSSED Fractures
Muscular Dystrophy
Scoliosis Lateralis
Musculoskeletal
ANATOMY &
PHYSIOLOGY
ANATOMY & PHYSIOLOGY
The musculo-skeletal system consists of the muscles,

tendons, bones and cartilage together with the joints.
The system which provides form, support, stability and
movement to the body.
It is subdivided into two broad systems:
Muscular System
Skeletal System
MUSCULAR SYSTEM
The muscular system is an organ system composed of specialized contractile
tissue called the muscle tissue. There are three types of muscle tissue, based on
which all the muscles are classified into three groups:
Cardiac muscle, which forms the muscular layer of the heart (myocardium)
Smooth muscle, which comprises the walls of blood vessels and hollow
organs
Skeletal muscle, which attaches to the bones and provides voluntary
movement.
Based on their histological appearance, these types are classified into striated
and non-striated muscles; with the skeletal and cardiac muscles being grouped
as striated, while the smooth muscle is non-striated. The skeletal muscles are
the only ones that we can control by the power of our will.
MUSCLES
Bundles of fibrous tissues which has the ability to contract,
produces movements and maintains the position of the body
parts.
Three types of muscles exist in the body

1. Skeletal Muscles- Voluntary and striated
2. Cardiac muscles- Involuntary and striated
3. Smooth/Visceral muscles- Involuntary and NON-striated
SKELETAL MUSCLES
The skeletal muscles are the main functional units of the muscular system. There
are more than 600 muscles in the human body.
The skeletal muscles of the human body are organized into four groups for
every region of the body:
1. Muscles of the head and neck, which include the muscles of the facial expression, muscles of
mastication, muscles of the orbit, muscles of the tongue, muscles of the pharynx, muscles of the
larynx, and muscles of the neck
2. Muscles of the trunk, which include the muscles of the back, anterior and lateral abdominal
muscles, and muscles of the pelvic floor
3. Muscles of the upper limbs, which include muscles of the shoulder, muscles of the arm, muscles
of the forearm and muscles of the hand
4. Muscles of the lower limbs, which include hip and thigh muscles, leg muscles and foot muscles
STRUCTURE
The skeletal muscles are composed of the skeletal muscle cells which are
called the myocytes (muscle fibres, or myofibrils).
They are elongated, cylindrical, multinucleated cells bounded by a cell

membrane called sarcolemma.
STRUCTURE
STRUCTURE
The cytoplasm of skeletal muscle fibers (sarcoplasm), contains

contractile proteins called actin and myosin.
These proteins are arranged into patterns, forming the units

of contractile micro-apparatus called sarcomeres.
Muscle fiber is enclosed with a loose connective tissue sheath

called endomysium.
STRUCTURE
Perimysium
Multiple muscle fibers are
grouped into muscle Perimysium
fascicles or muscle bundles,
which are encompassed by
their own connective tissue
sheath.
STRUCTURE
Epimysium
Epimysium.
A group of muscle fascicles
comprises a whole muscle
belly which is externally
enclosed by another
connective tissue layer.
STRUCTURE
Skeletal muscle tissue four main physiological properties:
Excitability - the ability to detect the neural stimuli (action potential);
Contractibility - the ability to contract in response to a neural stimulus;
Extensibility - the ability of a muscle to be stretched without tearing;
Elasticity - the ability to return to its normal shape after being

extended.
MUSCLE CONTRACTION
The most important property of skeletal muscles is its ability to contract.

Muscle contraction occurs as a result of the interaction of myofibrils inside
the muscle cells. This process either shortens the muscle or increases its
tension, generating a force that either facilitates or slows down a movement.
There are two types of muscle contraction:
-Isometric and Isotonic. A muscle contraction is deemed as isometric if
the length of the muscle does not change during the contraction, and
isotonic if the tension remains unchanged while the length of the muscle
changes.
Muscles contracts and Muscles contracts but
shortens does not shorten
Isotonic Contraction Isometric Contraction

There are two types of isotonic contractions:
Concentric contraction, in which the

muscle shortens due to generating
enough force to overcome the
imposed resistance.
Eccentric contraction, in which the

muscle stretches due to the
resistance being greater than the
force the muscle generates.
The sequence of events that results in the contraction of a
muscle cell begins as the nervous system generates a signal
called the action potential.
This signal travels through motor neurons to reach the

neuromuscular junction, the site of contact between the motor
nerve and the muscle.
A group of muscle cells innervated by the branches of a single

motor nerve is called the motor unit.
TENDONS
Tough bands of fibrous connective tissues which connects
muscles to bones.
TENDONS
Tendons are found at the distal
and proximal ends of muscles,
binding them to the periosteum
of bones at their proximal (origin)
and distal attachment (insertion)
on the bone.
As muscles contract, the tendons

transmit the mechanical force to
the bones, pulling them and
causing movement.
TENDONS
Being made of dense regular connective tissue, the tendons have an
abundance of parallel collagen fibers, which provide them with high
tensile strength (resistance to longitudinal force).
The collagen fibers within a tendon are organized into fascicles, and
individual fascicles are ensheathed by a thin layer of dense connective
tissue called endotenon. In turn, groups of fascicles are ensheathed by
a layer of dense irregular connective tissue called epitenon.
Finally, the epitenon is encircled with a synovial sheath and attached to

it by a delicate connective tissue band called mesotenon.
Functions of the Muscular system
The main function of the muscular system is to produce movement of the body.
Some of the most important ones include:
Flexion and extension: An example of flexion is bending the leg at the knee
joint, whereas extension would be straightening knee from a flexed position.
Adduction and abduction: Abduction of the arm at the shoulder joint

involves moving the arm away from the side of the body, while adduction
involves bringing it back towards the body.
Functions of the Muscular system
The main function of the muscular system is to produce movement of the

body. Some of the most important ones include:
Rotation: internal rotation involves rotating the segment towards to the

midline, while external rotation involves moving it away from the midline.
Supination and pronation- These movements are also sometimes used to

describe movements in the ankle and foot, in which supination means
rolling the foot outwards, while pronation means rolling the foot inwards.
Many muscles and their tendons pass over joints and thereby
stabilize the articulating bones and hold them in position.
In addition, the muscles also play an important role in maintaining

posture. While the movements occur mainly due to muscles
intermittently contracting and relaxing, the posture is maintained by
a sustained tonic contraction of postural muscles.
Another important function of muscles is heat production.
Muscle tissue is one of the most metabolically active tissues in the

body, in which approximately 85 percent of the heat produced in the
body is the result of muscle contraction.
SKELETAL SYSTEM
The adult human skeleton is composed of 206 bones and their associated
cartilages where as children and their human skeleton is composed of 300 bones
these eventually fuse (grow together) to form the 206 bones that adults have.
Some of a baby's bones are made entirely of a special material called cartilage.
The bones are supported by ligaments, tendons, bursae, and muscles. The bones
of the body are grouped within the two distinct divisions:

Axial skeleton, that includes the bones along the long axis of the body. The
axial skeleton consists of the vertebral column, bones of the head and bones
of the thoracic cage.
Appendicular skeleton, that involves the bones of the shoulder and pelvic
girdle, as well as the bones of the upper and lower extremities.
Functions of the skeletal system
The bones give the shape to the body and provide the site of attachment to
muscles, tendons, ligaments and cartilage. These tissues function together as
a whole to generate a force that provides the biomechanical basis of
movement.
Due to its structural integrity, the skeletal system protects the internal organs
Moreover, the skeletal system serves several metabolic functions. The bones
are the storage site of important minerals, most notably calcium and
phosphorus.
Lastly, the bone marrow found in spongy bone is the site of hematopoiesis,
which is a process of production of new blood cells.
BONES
Variously classified according to shape,
location and size
FUNCTION:
1. Locomotion
2. Protection
3. Support and Lever
4. Blood Production
5. Mineral deposition
STRUCTURE OF THE
BONES
CORTICAL BONE
the strong and compact type of bone found on

the outer layer of the long bones and makes up
about 80% of the skeleton.
STRUCTURE OF THE
BONES
CANCELLOUS TISSUE
also known as cancellous bone, spongy bone or

trabecular bone, is characterized by its
spongy, porous, honeycomb-like structure and
is typically found at the ends of long bones
such as your femur, or thigh bone
STRUCTURE OF THE
BONES
MEDULLARY CANAL
the central area of a bone, containing marrow.

TYPES OF BONES
FLAT BONES
Made up of a layer of spongy bone between two thin layers of

compact bone. They have a flat shape, not rounded. Flat
bones have marrow, but they do not have a bone marrow
cavity. Examples include the skull and rib bones.
TYPES OF BONES
LONG BONES
a bone that has a shaft and 2 ends and is

longer than it is wide. Long bones have a
thick outside layer of compact bone and
an inner medullary cavity containing bone
marrow. Examples are your tibia, fibula,
femur, metatarsals, and phalanges
TYPES OF BONES
SHORT BONES
include the carpal bones of the hands that allow movement of

the wrist, and the tarsal bones of the feet that allow movement
of the ankle. Short bones are shaped roughly as a cube and
contain mostly spongy bone. Examples are you carpals and your
tarsals
TYPES OF BONES
IRREGULAR BONES
Vary in shape and structure and therefore do not fit into any
other category. They often have a fairly complex shape, which
helps protect internal organs. For example, the vertebrae,
irregular bones of the vertebral column, protect the spinal cord.
TYPES OF BONES
SESAMOID BONES
A small bone that is commonly
found embedded within a muscle or
tendon near joint surfaces, existing
as focal areas of ossification and
functioning as a pulley to alleviate
stress on that particular muscle or
tendon. Examples are your patella
in your kneecap and your Pisiform
found in your carpals.
CELLULAR COMPONENTS
OSTEOBLASTS
Cells that "build" bone. These cells are directly responsible for osteogenesis.
OSTEOCYTES
Osteocytes are bone cells that regulate mineral content, maintain bone tissue, and respond
to mechanical stress.
OSTEOCLASTS
Osteoclasts are bone cells that break down and resorb bone tissue to regulate the balance between
bone formation and resorption.
CARTILAGES
Cartilage is a flexible connective tissue found in multiple

organ systems of the body. Cartilage is composed of
specialized cells called chondrocytes, collagen fibers and
abundant ground substance rich in proteoglycan and elastin
fibers.
JOINTS
joints provide a fulcrum to the
bones, on which they pivot and
thereby allow movements of body
parts.
The part of the Skeleton where two
or more bones are connected
CLASSIFICATION OF
JOINTS
SYNOVIAL JOINTS
are the freely mobile joints in which the
articulating surfaces have no direct contact
with each other. The movement range is
defined (i.e., limited) by the joint capsule,
supporting ligaments and muscles that cross
the joint. Most of the upper and lower limb
joints are synovial.
ANATOMY & PHYSIOLOGY CLASSIFICATION OF
JOINTS
FIBROUS JOINTS
are far simpler and less mobile. The articulating edges of bones are
attached by fibrous connective tissue. Motion at these joints is
negligible.
CLASSIFICATION OF
JOINTS
CARTILAGINOUS JOINTS
are chiefly characterized by the fact that
they connect with neighboring bones via
cartilage. They exhibit a range of motion
that falls between synovial and fibrous
joints. There are two types of cartilaginous
joints, synchondrosis and symphysis joints.
CLASSIFICATION OF
JOINTS
SYNCHONDROSIS JOINTS
also called primary cartilaginous joints –
are joints in which hyaline cartilage meet
with bone. These highly immobile joints can
be observed at the costochondral joints of
the anterior thoracic cavity and at the
epiphyseal plates of long bones.
CLASSIFICATION OF
JOINTS
SYMPHYSIS JOINTS
are the second group of cartilaginous joints.
They are found primarily along the midline of
the body. The joint features include adjacent
bone surfaces lined with hyaline cartilage
and connected by fibrous tissue with some
degree of mobility.
TYPES OF JOINTS
HINGE JOINTS
a type of joint that allows movement primarily in one
direction, similar to the movement of a hinge on a door.
PIVOT JOINTS
a type of joint that allow rotational movement around a
central axis.
TYPES OF JOINTS
CONDYLAR JOINTS
are a type of joint that allow movement in multiple directions,
including flexion/extension, abduction/adduction, and circumduction.
SADDLE JOINTS
a type of joint that allow movement in two planes, such as
flexion/extension and abduction/adduction, similar to the
movement of a rider on a saddle.
TYPES OF JOINTS
BALL AND SOCKET JOINTS
a type of joint that allow movement in multiple directions, including
rotation, flexion/extension, and abduction/adduction.
PLANE JOINTS
are a type of joint that allow sliding or gliding movements
between flat surfaces of bones.
CARTILAGES
Hyaline cartilage- Elastic cartilage- Fibrocartilage-

Abundant type of cartilage found in found in structures such as Examples of fibrocartilage include
joints (articular cartilage), as well as the pinna of the ear, auditory intervertebral discs, pubic and other
the nose, larynx, trachea and ribs tube and epiglottis symphyses.
ARTICULAR
CARTILAGE
a type of specialized connective tissue present in synovial joints. It is

composed of hyaline cartilage with a dense extracellular matrix and
scattered specialized cells of the cartilage known as chondrocytes.
The main function of the articular cartilage is to provide an optimal

surface for enabling movement in the joint. More specifically, it
prevents friction between the bones and facilitates the transmission of
loads to the underlying bone.
LIGAMENTS
Strong, dense and flexible bands
of fibrous tissue connecting TWO
BONES OR CARTILAGES IN A JOINT.
In the musculoskeletal system,
ligaments stabilize the
articulating bones and reinforce
the joints.
In the musculoskeletal system, ligaments stabilize the articulating
bones and reinforce the joints. Depending on their anatomic position
relative to the joint capsule, ligaments are classified into:
Capsular ligaments are essentially thickenings of the joint

capsule that form either elongated bands or triangular structures.
These ligaments serve to reinforce the integrity of the joint
capsule.
Intracapsular ligaments are the ligaments that lie internal to the

joint capsule.
Extracapsular ligaments are ligaments that lie outside the joint
capsule. These ligaments provide the most stability to the
articulating bones, and are important for preventing
dislocations.
2 TYPES OF EXTRACAPSULAR LIGAMENTS
Proximate ligaments - pass over at least two joints, close to

their capsules. They are found only in the leg. An example is the
fibular collateral ligament which passes over the knee and the
ankle joint.
Remote ligaments - are ligaments that connect bones that are

not adjacent to each other and are a bit more distant from the
joint capsule. Most of these ligaments are yellow ligaments.
Vertebral ligaments are an example.
BURSAE
Bursae are small sac-like
outpouchings of the joint cavity
lined by synovial membrane. They
are found around the joints,
providing cushioning of the
associated bones, tendons and
muscles and reducing friction
between adjacent structures.
Musculoskeletal Diseases
TALIPES EQUINOVARUS
Presented by Andrea Golucino and Mizuki Saito
TALIPES EQUINOVARUS (CLUB FOOT)
A condition in which one or both feet are twisted into an abnormal
position at birth.
EQUINUS: plantar flexed

(talus pointing down)
VARUS: deviation of the
heel (calcaneus) and
forefoot (inward)
SUPINATION: foot rests of
outer side (upward rotation)
TALIPES EQUINOVARUS (ANATOMY)
Normal Foot Club Foot Anomalies of the Foot
Navicular
Talus
Calcaneus
TALIPES EQUINOVARUS (ANATOMY)
Hindfoot
Forefoot
Subtalar
joint
Normal Foot Talipes

CAUSATIVE AGENT
One most common cause of CTEV (Congenital Talipes Equinovarus) is
idiopathic/unknown.
Other than idiopathic is secondary CTEV and POSTURAL which is associated
with underlying cause
IDIOPATHIC Theories Regarding Secondary Clubfoot

Diagnosed when child has normal
Cause Diagnosed when deformity forms
upper and lower extremities, spine Primarily germ plasm part of another health conditions
and neurological status apart from defect of talus Neuropathic- deformity in
club foot Contractile association with neurological
Can be detected by 16 weeks myofibroblastic abnormalities or spina bifida
gestation tissue in the Syndromic- clubfoot in
Combination of genetic and misculotendinous association with other
environmental factors are units syndromes
involved
CAUSATIVE AGENT
Syndromes Producing CTEV
Streeters dysplasia- Amniotic band syndrome, an uncommon disorder that

presents at birth as constriction rings primarily affecting distal regions of the
upper and lower limb.
Arthrogryposis- refers to the development of multiple joint contractures
affecting two or more areas of the body prior to birth. A contracture occurs
when a joint becomes permanently fixed in a bent or straightened position.
Edwards syndrome- trisomy 18 - a genetic disorder caused by the presence
of a third copy of all or part of chromosome 18. Many parts of the body are
affected. Babies are often born small and have heart defects. Other features
include a small head, small jaw, clenched fists with overlapping fingers, and
severe intellectual disability.
CAUSATIVE AGENT
Postural
Evidence for genetic contribution:

Mechanical Factor in Utero.
Prevalence varies among ethnic
groups Oldest theory proposed by
Twin studies showing higher HIPPOCRATES suggesting foot was
concordance in monozygotic than held in equino varus by external
in dizygotic twins uterine compression.
Runs in families Some investigator opine diminution
Evidence for environmental factors: of amniotic fluid as cause of club
Smoking foot
epidemiology
Talipes equinovarus, also known as clubfoot,

is a relatively common congenital foot
deformity that affects approximately 1 in
1,000 live births worldwide. The condition is
more common in males than females, with a
male-to-female ratio of about 2:1.
The prevalence of clubfoot varies among

different populations and geographic regions.
The highest incidence rates have been
reported in certain parts of Africa, where the
condition affects as many as 1 in 150 live
births. In contrast, the incidence rates in
North America and Europe are lower, with
estimates ranging from 1 in 1,000 to 1 in 2,000
live births.
CLINICAL FEATURES
The primary problem of a clubfoot is that the foot can not be placed flat on the ground so
that the child can walk on the sole of the foot.
The condition is not painful to the child
The heel is smaller than normal, and the Achilles
The Three Classical signs of clubfeet are: tendon is tight
Fixed plantar flexion (equinus) of the The foot is shorter than normal
ankle, characterized by the drawn up The calf muscles are underdeveloped
position of the heel and inability to bring The affected foot may be smaller than the other
to foot to a plantigrade (flat) standing foot
position. This is caused by a tight achilles The affected foot may be more rigid and less
tendon flexible than the other foot
Adduction (varus), or turning in of the The affected foot may be harder to move or walk
on
heel or hindfoot
The top of the foot may be convex, and the sole
Adduction (turning under) of the forefoot may be concave
and midfoot giving the foot a kidney- The affected foot may be rotated inward, making it
shaped difficult to wear shoes
CLINICAL FEATURES
Diagnostic procedures
Physical X-rays
Examination
MEDICAL TREATMENT
Because your newborn's bones, joints and tendons are very flexible,
treatment for clubfoot usually begins in the first week or two after
birth. The goal of treatment is to improve the way your child's foot
looks and works before he or she learns to walk, in hopes of
preventing long-term disabilities.
Treatment options include:

Stretching and casting (Ponseti method)
Surgery
GOAL OF CASTS AND CARE
Ponseti method
The Ponseti method is a systematic series of casting and orthotic
bracing treatments that permanently and non surgically correct
clubfoot in young children. It lasts about two to three months. The
pliable tissues of a newborn's foot, including tendons, ligaments,
joint capsules, and certain bones, will yield to gentle manipulation
and casting of the feet at weekly intervals.
STAGES OF THE PONSETI METHOD
The treatment phase – during which time the deformity is corrected
completely, should begin as early as possible, optimally within the first
week of life. Gentle manipulation and casting are performed on a
weekly basis. Each cast holds the foot in the corrected position,
allowing it to gradually reshape. Generally, 5 to 6 casts are required to
fully correct the alignment of the foot and ankle.
The maintenance phase – during which time a brace is utilized to

prevent recurrence.The final cast remains in place for 3 weeks, after
which the infant's foot is placed into a removable orthotic device. The
orthosis is worn 23 hours per day for 3 months and then during naps
and night-time until 5 years of age.
How does the Ponseti method work?
FIRST CAST
Before treatment: The marked The initial Ponseti cast. Note After the first cast, the foot
curvature of the foot, called a the positioning of the forefoot is straight and the cavus
cavus deformity, is characterized to align with the heel, with the and crease are no longer
by a visible crease in the midfoot. outer edge of the foot tilted evident.
The foot is tilted down due to even farther downward due to
tightness of the Achilles tendon. Achilles tendon tightness.
How does the Ponseti method work?
SECOND CAST THIRD CASTING FINAL CASTING
The second cast is applied The third Ponseti cast. The The foot and ankle are then
with the outer edge of the Achilles tendon is stretched, casted in the final, corrected
foot still tilted downward bringing the outer edge of the position. When the final cast is
and the forefoot moved foot into a more normal position applied, the Achilles tendon is
slightly outward. as the forefoot is turned further stretched farther with the
outward. forefeet pointed upward.
MAINTENANCE
Upon removal of the final cast, the infant is placed into foot
abduction orthosis (FAO) also known as a Ponseti brace.
The FAO consists of Ponseti shoes (also called Ponseti boots)
mounted to a bar. This maintains the feet in a corrected
position, with the forefeet set apart and pointed upward.
The brace is worn 23 hours per day for the first 3 months
following casting. The child will then continue to wear it at
night while sleeping until 5 years old. Multiple studies have
demonstrated the high risk for recurrence of clubfoot if the
brace is not worn according to these guidelines. It is not
known why. Regardless of the cause, recurrence of clubfoot
appears to be close to zero when the bracing regimen is
followed stringently.
GOAL OF NEUROVASCULAR ASSESSMENT
The neurovascular assessment

of the extremities is performed
to evaluate sensory and motor
function (“neuro”) and peripheral
circulation (“vascular”). The
components of the
neurovascular assessment
include pulses, capillary refill,
skin color, temperature,
sensation, and motor function.
GOAL OF NEUROVASCULAR ASSESSMENT
Delays in recognising
neurovascular compromise
can lead to permanent deficit,
loss of limb and even death,
therefore, assessment of
neurovascular status is
essential for the early
recognition of neurovascular
deterioration or compromise.
GOAL OF splints
The brace keeps the "fixed"

clubfoot (or feet) in the
corrected position so it
doesn't twist back to where
it was before the casting
phase. Both feet are braced,
even if the clubfoot is only on
one side.
complications
Clubfoot typically doesn't cause any problems until your child starts to stand and
walk. If the clubfoot is treated, your child will most likely walk fairly normally. He or
she may have some difficulty with:
Movement. The affected foot may be slightly less flexible.
Leg length. The affected leg may be slightly shorter, but generally does not
cause significant problems with mobility.
Shoe size. The affected foot may be up to 1 1/2 shoe sizes smaller than the
unaffected foot.
Calf size. The muscles of the calf on the affected side may always be smaller than
those on the other side.
NURSING DIAGNOSIS
Disturbed body image related to permanent

alteration in structure and/or function.
NURSING INTERVENTION
Promote acceptance of body image. Acknowledge and accept an
expression of feelings of frustration, dependency, anger, grief, and
hostility; support verbalization of positive or negative feelings about the
actual or perceived loss; and be realistic and positive during treatments, in
health teaching, and in setting goals within limitations.
NURSING DIAGNOSIS
Deficient knowledge related to the condition,

prognosis, treatment, self-care, and discharge needs.
Provide health education. Include the parents in creating the teaching
plan, beginning with establishing objectives and goals for learning at the
beginning of the session; provide clear, thorough, and understandable
explanations and demonstrations; and render positive, constructive
reinforcement of learning.
NURSING DIAGNOSIS
Risk for impaired skin integrity related to cast

application, traction or surgery
Protect skin integrity. Monitor site of impaired tissue integrity at least once daily
for color changes, redness, swelling, warmth, pain, or other signs of infection;
monitor patient’s skin care practices, noting type of soap or other cleansing
agents used, temperature of water, and frequency of skin cleansing; and provide
gloves or clip the nails if necessary to avoid damaging the skin with scratches.
HIP DYSPLASIA
Presented by Michael John Logarta
HIP DYSPLASIA
Hip dysplasia is a developmental disorder that
affects the hip joint's formation, where the ball
and socket do not fit together correctly.
The hip joint is a ball-and-socket joint made up of
the afemoral head and the acetabulum of the pelvis.
The femoral head is a rounded ball at the top of the
femur, and the acetabulum is a socket in the pelvis
that holds the femoral head.
In hip dysplasia, the socket may be too shallow,
allowing the femoral head to slide in and out of the
socket or even become dislocated.
CAUSATIVE AGENT
The exact cause of hip dysplasia is unknown. Still, several

factors, including genetics, Family History, being the first child,
maternal hormones, and breech positioning during pregnancy, may
contribute to its development. Additionally, the condition may be
related to certain metabolic and connective tissue disorders,
such as Down syndrome, Marfan syndrome, or Ehlers-Danlos
syndrome.
CAUSATIVE AGENT
Regarding genes, The exact genetic mechanism behind hip dysplasia is not yet
fully understood, but studies have identified several genes that may be
involved. One of the most commonly studied genes associated with hip
dysplasia is COL2A1, which encodes for type II collagen, a major component of
cartilage. Mutations in this gene have been linked to hip dysplasia, as well as
other skeletal disorders.
Other genes include GDF5, which encodes for a growth factor involved in bone
and joint development, and MATN3, which encodes for a protein found in
cartilage.
EPIDEMIOLOGY
Hip dysplasia is more common in infants and young

children, but it can also occur in adults. It affects
1-3% of newborns and is more common in girls than
boys. It is more prevalent in certain populations,
such as Native Americans and in people with a family
history of the condition.
CLINICAL MANIFESTATIONS
In infants and young children, hip dysplasia may present as:

Clicking or popping sound when the hip is moved: This can be felt or heard by
the parent or caregiver and may indicate that the hip joint is not properly
aligned.
Limited range of motion in the hip: The child may not be able to move the hip
joint through its full range of motion.
Uneven skin folds on the thigh or buttocks: This may be an indication of hip
joint instability.
Walking with a limp or waddling gait: This may be a sign of hip joint pain or
instability.
COMPLICATIONS
OSTEOARTHRITIS
Hip dysplasia can cause early onset osteoarthritis, which is a
degenerative joint disease that leads to joint pain, stiffness, and
reduced range of motion. This can lead to a significant reduction in
mobility and quality of life.
Joint Damage
Hip dysplasia can cause the hip joint to wear down faster than normal,
leading to joint damage and possible bone deformities. This can make it
difficult to perform daily activities, such as walking, standing, and
climbing stairs.
COMPLICATIONS
Hip Labral Tears

The hip labrum is a ring of cartilage that surrounds the hip joint, and
it can be torn due to the instability caused by hip dysplasia. Hip labral
tears can cause pain, clicking, and catching in the hip joint, and may
require surgical intervention to repair.
Hip Impingement
Hip dysplasia can cause abnormal bone growth around the hip joint,
which can lead to hip impingement. This condition occurs when the
bones of the hip joint rub against each other, causing pain and damage
to the joint.
COMPLICATIONS
pain
Hip dysplasia can cause chronic hip pain, especially in the groin, hip,
and thigh area. This pain can be exacerbated by physical activity and
can limit the individual's ability to engage in daily activities.
Reduced Mobility
Hip dysplasia can limit a person's ability to move freely and perform
daily activities. This can impact their ability to work, participate in
social activities, and maintain a healthy lifestyle.
COMPLICATIONS
nerve damage
In severe cases of hip dysplasia, the hip

joint may be so unstable that it causes
nerve damage. This can cause numbness,
tingling, and weakness in the leg, and may
require surgery to correct.
DIAGNOSTIC PROCEDURES
I. Imaging Test
X-ray Ultrasound CT scan or MRI
The Barlow Maneuver
The Barlow's maneuver is a medical technique used to diagnose
hip dysplasia in infants. It involves applying gentle pressure to
the infant's hips while flexing and adducting the legs to feel for
any instability in the hip joint. The Barlow's maneuver is
typically performed on infants between the ages of one and three
months.
The Ortolani Maneuver
The Ortolani's maneuver is a medical technique used to diagnose
developmental dysplasia of the hip (DDH) in infants. It involves
gently abducting the infant's hips while applying pressure to
the greater trochanter to feel for any "clunk" or slipping of the
femoral head out of the acetabulum. The Ortolani maneuver is
typically performed on infants between the ages of one and three
months as part of a routine physical examination.
What is the difference between the
two?
The main difference between the two maneuvers is their

purpose and the direction of movement involved. The Barlow's
maneuver is used to test for hip joint instability by adducting
and flexing the hips with gentle pressure, whereas the
Ortolani's maneuver is used to test for hip joint dislocation
or subluxation by abducting the hips with gentle pressure.
MEDICAL TREATMENTS
Harnesses Physical
Therapy
Surgery Pain
Management
MEDICAL TREATMENTS
Harnesses
Pavlik Harness
a specialized device made of straps and bands that

holds the baby's hips in a flexed and abducted
position, which helps to keep the hip joint stable
and properly aligned. The harness is worn
continuously for several weeks or months,
depending on the severity of the condition.
MEDICAL TREATMENTS
Harnesses
Frejka Pillow
a small, padded pillow that is placed between

the baby's legs to keep the hips flexed and
abducted. It is usually used for infants with
mild hip dysplasia.
MEDICAL TREATMENTS
Harnesses
Rhino Cruiser
a device similar to the Pavlik harness, but it

has additional straps that wrap around the
baby's torso for added stability. It is often
used for infants with more severe hip
dysplasia.
MEDICAL TREATMENTS
Harnesses
Craig Splint
a larger, more rigid brace that is used for

older children and adults with hip dysplasia.
It immobilizes the hip joint to allow it to
heal properly after surgery.
MEDICAL TREATMENTS
Harnesses
von Rosen Splint
consists of a padded brace that is worn

around the baby's waist and lower torso, with
two straps that attach to the legs to hold
them in a stable, abducted position.
MEDICAL TREATMENTS
Harnesses
Ilfeld Splint
The Ilfeld splint is often used as a post-operative

treatment following closed reduction or other
surgical procedures to correct hip dysplasia, as it
helps to immobilize the hip joint and promote
proper healing. It can also be used as a non-surgical
treatment option for infants and young children
with mild to moderate hip dysplasia
MEDICAL TREATMENTS
Harnesses
Hip Spica Cast
The hip spica cast is typically used as a post-

operative treatment following surgical procedures
to correct hip dysplasia or other hip conditions, as
it helps to immobilize the hip joint and promote
proper healing. It may also be used as a non-surgical
treatment option for infants and young children
with severe hip dysplasia
MEDICAL TREATMENTS
Harnesses
Hip Abduction Orthosis

Brace
a brace that is worn on the outside of the leg

and holds the hip joint in a stable, abducted
position. It is often used for older children
and adults with hip dysplasia.
MEDICAL TREATMENTS
Surgical Procedures
Closed Reduction Surgery
A minimally invasive surgery used in infants

and young children, in which the hip joint is
manually manipulated to realign it and held in
place with a cast or brace.
MEDICAL TREATMENTS
Surgical Procedures
Periacetabular osteotomy
(PAO)
A surgical procedure that involves cutting and

repositioning the bones around the hip joint
to improve its alignment and stability.
MEDICAL TREATMENTS
Surgical Procedures
Femoral osteotomy
A surgical procedure that involves cutting and

repositioning the femur (thigh bone) to
improve the alignment of the hip joint.
MEDICAL TREATMENTS
Surgical Procedures
Total hip replacement
A surgical procedure that involves replacing

the damaged hip joint with an artificial joint.
This is typically used in older adults with
severe hip dysplasia or other hip conditions.
Nursing Diagnosis: Nursing Interventions:
Impaired Physical Mobility Allow all age-appropriate activities
that promote mobility, and encourage
related to Musculoskeletal the infant to crawl.
impairment as evidenced by
Imposed movement restriction
by the splint, harness, cast, or Discourage activity restrictions unless
ordered; allow and assist if possible in
traction. performing daily activities; administer
pain medication prior to the activity.
Keep body alignment during bed rest,

do position changes every two (2)
hours or as needed; provide a drawing
for the child to follow for the position
and area to lie in bed.
Encourage and assist the child in
Impaired Physical Mobility muscle-strengthening exercises and
related to Musculoskeletal passive stretching exercises as
impairment as evidenced by appropriate.
Imposed movement restriction
by the splint, harness, cast, or Facilitates rest with periods of mobility.
traction.
Teach and/or encourage
parents/guardians the use of brace as
indicated as well as the following
interventions mentioned above.
Provide exposure to other children by
Impaired Social Interaction moving the bed near areas of activity
related to physical mobility or near a window; wheel on a
restrictions as evidenced by stretcher, wheelchair, or stroller; allow
to walk with a cast or brace if
inability to engage in usual permitted.
activities for the age group
Encourage age-appropriate toys to be
used in bed while in a prone or sitting
position depending on the type of
treatment and degree of
immobilization.
Position toys and other items within the

reach of the child.
Encourage parents to allow as much
Impaired Social Interaction independence or self-care by the child
related to physical mobility as possible.
restrictions as evidenced by
inability to engage in usual
Teach parents to incorporate
activities for the age group infant/child in the family activities.
FRACTURES
Presented by: Aleck Renzel Buctuan
ANATOMY AND PHYSIOLOGY
Fractures are classified by their
complexity, location, and other features.
Common types of fractures are
transverse, oblique, spiral, comminuted,
impacted, greenstick, open (or
compound), and closed (or simple).
Healing of fractures begins with the
formation of a hematoma, followed by
internal and external calli.
CAUSATIVE AGENT
A fracture is a partial or complete break

in the bone. There are many different
types of fractures. Bone fractures are often
caused by falls, trauma, or as a result of a
direct blow or kick to the body. Overuse or
repetitive motions can cause stress
fractures.
EPIDEMIOLOGY
Children between 10 and 14 years of age have the highest

risk of having fractures. Overall, forearm fractures were the
most common pediatric fractures. Most pediatric fractures
can be treated on an outpatient basis, with only 1 of 18
fractures requiring hospitalization or observation.
CLINICAL FEATURES
EDEMA AND SWELLING
Description:
Disruption or penetration of skin or soft
tissues by bone fragments, or bleeding
into surrounding tissues
Significance:
Unchecked bleeding and swelling in
closed space can occlude blood vessels
and damage nerves (e.g., increased
risk of compartment syndrome).
CLINICAL FEATURES
PAIN AND TENDERNESS
Description:
Muscle spasm due to involuntary reflex
action of muscle, direct tissue trauma,
increased pressure on nerves,
movement of fracture fragments.
Significance:
Pain and tenderness encourage the
patient to splint muscle around fracture
and reduce motion of injured area.
CLINICAL FEATURES
LOSS OF FUNCTION
Description:
Disruption of bone or joint, preventing
functional use of limb or part.
Significance:
Fracture must be managed properly to
ensure restoration of function to limb or
part
CLINICAL FEATURES
CREPITATION
Description:
Grating or crunching of bony
fragments, producing palpable or
audible crunching or popping sensation
Significance:
Crepitation may increase chance for
nonunion if bone ends are allowed to
move excessively
complications
Complications of fractures fall into two categories: early and delayed.
1. Early complications include wound healing problems, shock, fat embolism,

compartment syndrome, deep vein thrombosis, thromboembolism (pulmonary
embolism), disseminated intravascular coagulopathy, and infection.
2. Delayed complications include delayed union and nonunion, avascular necrosis of

bone, reaction to internal fixation devices, complex regional pain syndrome, and
heterotrophic ossification.
DIAGNOSTIC PROCEDURE
X-RAYS
X-rays usually confirm whether a
person has a broken bone and where
any loose bony pieces may be. Other
diseases of the bone can also show up
on an x-ray, such as osteoporosis and
Paget's disease.
BONE MINERAL DENSITY TEST (BMD)

One of the first tests a healthcare
professional will order is a bone mineral
density (BMD) test. Results from a BMD
test (usually of the hip, spine, wrist, or
heel bone) can show if you have
osteoporosis or weaker bones.
FRAX TOOL
The FRAX® tool has been developed to predict the
risk of a fracture. It offers a personalized score to
predict the 10-year risk of a person having a major
fracture. The tool combines your individual risk factors
for fractures and your bone density scores. You may
need to talk about this tool with your healthcare
professional.
BLOOD TESTS
Kidney function tests
Thyroid and other hormone levels
Calcium levels
Vitamin D levels
Other blood tests to check for certain
diseases, such as celiac disease, Paget’s
disease, or multiple myeloma, if any of
these diseases are possible
Additional blood tests and X-rays may also
be ordered if surgery is needed.
MEDICAL TREATMENT
Broken bones heal by themselves – the aim of medical

treatment is to make sure the pieces of bone are lined up
correctly. The bone needs to recover fully in strength,
movement and sensitivity. Some complicated fractures
may need surgery. Depending on where the fracture is
and how severe, treatment may include:
MEDICAL TREATMENT
splints – to stop braces – to support

movement of the the bone
broken limb
MEDICAL TREATMENT
Plaster cast – to surgically inserted

provide support metal rods or plates –
and immobilize the to hold the bone
bone pieces together
MEDICAL TREATMENT
Traction is usually applied to the
arms and legs, the neck, the
backbone, or the pelvis. It is used
to treat fractures, dislocations,
and long-duration muscle spasms,
and to prevent or correct
deformities. Traction can either be
short-term, as at an accident
scene, or long-term, when it is
used in a hospital setting.
MEDICAL TREATMENT
Traction serves several purposes:
it aligns the ends of a fracture by pulling the limb into a straight
position
it ends muscle spasm
it relieves pain
it takes the pressure off the bone ends by relaxing the muscle
There are two main types of traction: skin traction and skeletal
traction. Within these types, many specialized forms of traction have
been developed to address problems in particular parts of the body.
MEDICAL TREATMENT
Skin Traction
Skin traction uses five-to seven-pound weights attached to the skin to
indirectly apply the necessary pulling force on the bone. If traction is
temporary, or if only a light or discontinuous force is needed, then skin
traction is the preferred treatment. Because the procedure is not invasive,
it is usually performed in a hospital bed.
Skeletal Traction
Skeletal traction requires the placement of tongs, pins, or screws into the
bone so that the weight is applied directly to the bone. This is an invasive
procedure that is done in an operating room under general, regional, or
local anesthesia.
Risk for infection - due to the Provide sterile pin or wound care
according to protocol and exercise
presence of open wounds and meticulous handwashing.
fractures, which can provide .
an entry point for bacteria Administer medications, as indicated:
IV and topical antibiotics
and other pathogens. Tetanus toxoid
Provide wound or bone irrigations and

apply warm or moist soaks as
indicated.
Impaired Skin Integrity - Massage skin and bony prominences.
Keep the bed linens dry and free of
due to immobility and wrinkles. Place water pads or padding
decreased physical activity, under elbows or heels, as indicated.
which can lead to pressure
ulcers and other skin Reposition frequently. Encourage the
use of a trapeze if possible.
breakdown.
Plaster cast application and skincare

through frequent cleaning.
MUSCULAR
DYSTROPHY
Presented by: Myke Ramos
MUSCULAR DYSTROPHY
Muscular dystrophy is a category of
hereditary illnesses that cause
gradual muscular weakening and
atrophy.
Muscular dystrophy affects all ages
and has its own inheritance pattern,
severity, and age of start.
Muscular dystrophy has no cure, but
there are therapy options to reduce
symptoms and improve quality of life.
CAUSATIVE AGENT
Muscular Dystrophy may be caused by:
The prevalence and incidence of muscular dystrophy may vary
from country to country, ethnic group to ethnic group, and gender
to gender. Due to its rare and inherited nature, support groups,
genetic counseling, and early diagnosis and intervention are
critical for individuals and families affected by muscular dystrophy.
In most cases, muscular dystrophy (MD) runs in families. It usually

develops after inheriting a faulty gene from one or both parents.
MD is caused by mutations (alterations) in the genes responsible
for healthy muscle structure and function.
EPIDEMIOLOGY
Muscular dystrophy (MD) is a rare, inherited genetic disorder that affects the
muscles, leading to weakness, disability, and reduced life expectancy. The most
common type is Duchenne muscular dystrophy, with a global incidence of 1 in
5000 male live births and a prevalence of 20 in 100,000 males.
Limb-girdle muscular dystrophy (LGMD) is estimated to have an incidence of

approximately 1 in 14,000 individuals, although its prevalence can vary
significantly based on the specific LGMD subtype and geographic location.
1. Duchenne Muscular Dystrophy (DMD):
Progressive muscle weakness that usually
begins in the legs and pelvis before
progressing to other parts of the body.
Difficulty in walking and running.
Frequent falls and difficulty in standing up
from a lying or sitting position.
Enlarged calf muscles.
Weakness in the heart and lungs muscles
leading to breathing difficulties and heart
problems.
2. Becker Muscular Dystrophy (BMD):
Like DMD but milder and less severe.

Progressive muscle weakness that usually
begins in the legs and pelvis before
progressing to other parts of the body.
Breathing difficulties and heart problems in
advanced stages.
3. Myotonic Dystrophy:
Progressive muscle weakness and muscle
wasting.
Difficulty in relaxing muscles after
contraction.
Muscle cramps and stiffness.
Weakness in the facial muscles.
Abnormal heart functions and conduction
problems.
4. Limb-girdle Muscular Dystrophy (LGMD):
Progressive weakness and wasting of the
pelvic and shoulder girdle muscles.
Falls and difficulty in getting up from a
sitting or lying position.
Weakness in the arm, leg, and facial muscles.
Respiratory muscle weakness in advanced
stages.
5. Congenital Muscular Dystrophy (CMD):
Muscular weakness at birth or early infancy.
Delay in motor development.
Joint deformities and contractures.
Breathing difficulties and feeding problems.
In summary, the clinical features of muscular

dystrophy can vary greatly based on the type of
MD a patient has.
COMPLICATIONS
Complications of Muscular Dystrophy can
include:
Respiratory Cardiac
Complications Complications Scoliosis
COMPLICATIONS
Complications of Muscular Dystrophy can
include:
Muscular dystrophy is a
life-threatening and
debilitating disease
that can lead to
psychological and
social problems, but
early diagnosis,
treatment, and therapy
can improve outcomes.
Contractures Nutritional issues

I. Physical examination III. Genetic testing
II. Blood tests IV. Electromyography (EMG)

V. Muscle biopsy VI. MRI scans
MEDICAL TREATMENT
Unfortunately, there is currently no cure

for muscular dystrophy (MD). However,
there are various medical treatments
available that can help manage symptoms
and improve quality of life for people with
MD. The following are some of the medical
treatments available for MD:
MEDICAL TREATMENT
I. Physical Therapy III. Assistive devices
II. Medications IV. Respiratory support

MEDICAL TREATMENT
V. Surgery VI.Gene therapy
Treatment for MD is individualized and

involves a multidisciplinary team of
healthcare professionals.
Assess the patient’s level of functional
Impaired physical mobility related mobility and ability to perform ADLs.
to weakness of muscles secondary
Assist the patient during exercises
to muscular dystrophy as and when performing activities of
evidenced generalized weakness, daily living.
inability to do activities of daily Ensure the safety of the environment. Check
living (ADLs) as normal, and that the call bell is within reach, the bed rails
are up when the patient is on the bed, the bed is
verbalization of overwhelming in the lowest level, the room is well-lit, the floor
tiredness. is not slippery, and that important things like
phone and eyeglasses are easy to reach.
Encourage the patient to perform range of
motion (ROM) exercises in all extremities.
Administer oxygen as needed.
Refer to the physiotherapy and

occupational therapy team.
Assess the patient’s degree of fatigability by
Fatigue related to muscle asking to rate his/her fatigue level (mild,
weakness secondary to muscular moderate, or severe). Explore activities of
daily living, as well as actual and perceived
dystrophy as evidenced by limitations to physical activity. Ask for any
generalized weakness, irritability, form of exercise that he/she used to do or
and verbalization of overwhelming wants to try.
tiredness Encourage activity through self-care and
exercise as tolerated Alternate periods of
physical activity with rest and sleep.
Encourage enough rest and sleep and provide
comfort measures.
Teach deep breathing exercises and
relaxation techniques. Provide adequate
ventilation in the room.
Refer the patient to physiotherapy /

occupational therapy team as required.
SCOLIOSIS
LATERALIS
Presented by Darling Mae G. Plaza
SCOLIOSIS LATERALIS
Scoliosis is an abnormal lateral
curvature of the spine.
It is most often diagnosed in

childhood or early adolescence.
People with scoliosis have a spine

that curves too much. The spine
might look like the letter C or S.
SCOLIOSIS LATERALIS
SCOLIOSIS LATERALIS
The spine's normal curves occur at
the cervical, thoracic and lumbar
regions in the so-called “sagittal”
plane.
Scoliosis is often defined as spinal

curvature in the “coronal” (frontal)
plane. While the degree of
curvature is measured on the
coronal plane, scoliosis is actually a
more complex.
SCOLIOSIS LATERALIS
Three-dimensional problem which
involves the following planes:
Coronal plane
Sagittal plane
Axial plane
Scoliosis is defined by the Cobb's angle
of spine curvature in the coronal plane
and is often accompanied by vertebral
rotation in the transverse plane and
hypokyphosis in the sagittal plane.
SCOLIOSIS LATERALIS
These abnormalities in the spine,
costal-vertebral joints, and the
rib cage produce a ‘convex’ and
‘concave’ hemithorax.
The rotation component starts

when the scoliosis becomes more
pronounced. This is called a
torsion-scoliosis, causing a
gibbus.
TYPES OF SCOLIOSIS
SCOLIOSIS LATERALIS
Most of the time, the cause of scoliosis is unknown. This is
called idiopathic scoliosis. It is the most common type. It is
grouped by age.
In children age 3 and younger, it is called infantile

scoliosis.
In children age 4 through 10, it is called juvenile
scoliosis.
In children age 11 through 18, it is called adolescent
scoliosis.
CAUSATIVE AGENT
Scoliosis may be caused by:
Certain neuromuscular conditions, such as cerebral palsy or
muscular dystrophy.
Birth defects affecting the development of the bones of the spine.
Previous surgery on the chest wall as a baby.
Injuries to or infections of the

Spinal cordspine.
abnormalities
Spinal cord abnormalities.

EPIDEMIOLOGY
Scoliosis affects 2-3 percent of the population, or an estimated six to nine million
people in the world.
Scoliosis can develop in infancy or early childhood.
The primary age of onset for scoliosis is 10-15 years old, occurring equally among
both genders.
Females are eight times more likely to progress to a curve magnitude that requires
treatment.
Every year, scoliosis patients make more than 600,000 visits to private physician
offices, an estimated 30,000 children are fitted with a brace and 38,000 patients
undergo spinal fusion surgery.
head not centered over the body
shoulders that are uneven, or one shoulder
blade that sticks out more than the other
waist creases that are uneven
unusual gaps between one arm and the trunk
one hip higher than the other
an obvious exaggerated curve of the spine
back pain or discomfort
shortness of breath
bowel or bladder problems
a posture that is unusual or uneven, or
leaning to the side
COMPLICATIONS
Complications of scoliosis can include:
Breathing problems Back problems Appearance

I. Physical examination
II. Imaging Test
X-ray Spinal Radiograph CT scan or MRI
III. Adam's Forward Bend Test
MEDICAL TREATMENT
Braces Surgical Treatment

MEDICAL TREATMENT
Physical Therapy Management Exercise

Ineffective Breathing Pattern Assist the child in doing deep
related to Musculoskeletal breathing exercises.
impairment as evidenced by
Increased work of breathing, Elevate the head of the bed or use
pillows to support the chest and
use of accessory muscles. facilitate breathing.
Assist the child in using incentive

spirometry.
Administer bronchodilators if indicated.
Administer oxygen as needed.

Ineffective Breathing Pattern Educating the child and their family on
related to Musculoskeletal proper breathing techniques, the
importance of maintaining good
impairment as evidenced by posture, and the need to seek medical
Increased work of breathing, attention promptly if any respiratory
use of accessory muscles. symptoms occur.
Instruct with the use of
Impaired Physical Mobility nonpharmacologic pain management
related to Musculoskeletal techniques, such as imagery,
impairment, pain, and relaxation, touch, and music.
discomfort as evidenced by
Malaise. Encourage the child to perform active
range-of-motion exercises.
Encourage regular postural exercises.
Teach and encourage the use of brace

as indicated.
Collaborate with the physical therapist

as indicated.
Instruct with the use of
Impaired Physical Mobility nonpharmacologic pain management
related to Musculoskeletal techniques, such as imagery,
impairment, pain, and relaxation, touch, and music.
discomfort as evidenced by
Malaise. Encourage the child to perform active
range-of-motion exercises.
Encourage regular postural exercises.
Teach and encourage the use of brace

as indicated.
Collaborate with the physical therapist

as indicated.
THANK YOU FOR
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Musculoskeletal

Talipes Equinovarus (Club Foot)

TOPICS TO BE Hip Dysplasia

The musculo-skeletal system consists of the muscles,

Three types of muscles exist in the body

They are elongated, cylindrical, multinucleated cells bounded by a cell

The cytoplasm of skeletal muscle fibers (sarcoplasm), contains

These proteins are arranged into patterns, forming the units

Muscle fiber is enclosed with a loose connective tissue sheath

Excitability - the ability to detect the neural stimuli (action potential);

Contractibility - the ability to contract in response to a neural stimulus;

Extensibility - the ability of a muscle to be stretched without tearing;

Elasticity - the ability to return to its normal shape after being

The most important property of skeletal muscles is its ability to contract.

Isotonic Contraction Isometric Contraction

Concentric contraction, in which the

Eccentric contraction, in which the

This signal travels through motor neurons to reach the

A group of muscle cells innervated by the branches of a single

As muscles contract, the tendons

Finally, the epitenon is encircled with a synovial sheath and attached to

Adduction and abduction: Abduction of the arm at the shoulder joint

The main function of the muscular system is to produce movement of the

Rotation: internal rotation involves rotating the segment towards to the

Supination and pronation- These movements are also sometimes used to

In addition, the muscles also play an important role in maintaining

Muscle tissue is one of the most metabolically active tissues in the

the strong and compact type of bone found on

also known as cancellous bone, spongy bone or

the central area of a bone, containing marrow.

Made up of a layer of spongy bone between two thin layers of

a bone that has a shaft and 2 ends and is

include the carpal bones of the hands that allow movement of

Cartilage is a flexible connective tissue found in multiple

Hyaline cartilage- Elastic cartilage- Fibrocartilage-

a type of specialized connective tissue present in synovial joints. It is

The main function of the articular cartilage is to provide an optimal

Capsular ligaments are essentially thickenings of the joint

Intracapsular ligaments are the ligaments that lie internal to the

Proximate ligaments - pass over at least two joints, close to

Remote ligaments - are ligaments that connect bones that are

EQUINUS: plantar flexed

Normal Foot Talipes

IDIOPATHIC Theories Regarding Secondary Clubfoot

Streeters dysplasia- Amniotic band syndrome, an uncommon disorder that

Evidence for genetic contribution:

Talipes equinovarus, also known as clubfoot,

The prevalence of clubfoot varies among

Treatment options include:

The maintenance phase – during which time a brace is utilized to

SECOND CAST THIRD CASTING FINAL CASTING

The neurovascular assessment

The brace keeps the "fixed"

Disturbed body image related to permanent

Deficient knowledge related to the condition,

Risk for impaired skin integrity related to cast

The exact cause of hip dysplasia is unknown. Still, several

Hip dysplasia is more common in infants and young

In infants and young children, hip dysplasia may present as: