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Differential diagnosis

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Title: Differential diagnosis


1
Differential diagnosis
  1. Neck
  2. Back
  3. Extremities
  4. Floppy infant syndrome

2
II. Back pain
  • requires careful evaluation if lasts more than 1
    to 2 weeks (in child)
  • usually the result of a serious underlying
    disorder including psychogenic back pain which is
    often difficult to manage

3
II. Back pain
  • in the past, unlike adults, children were thought
    to uncommonly have back pain related to
    psychogenic causes
  • children with acute or short-lived back pain
    more likely to have muscle and ligamentous strain
    or pain associated with systemic viral infection

4
II. Back pain
  • History should include
  • location
  • duration
  • radiation
  • character of pain
  • illness or activity preceding its onset
  • Interference with normal daily recreational
    activities should be determined

5
II. Back pain
  • Examination should seek other signs such as
  • abnormalities in gait
  • configuration of the back (subtle changes in
    contour may offer localizing clues)
  • tenderness on palpation

6
II. Back pain
  • Skin overlying spine should be carefully
    inspected for
  • dimples
  • tufts of hair
  • hemangiomas
  • other cutaneous changes
  • Any cutaneous changes may denote developmental
    defects

7
II. Back pain
  • Lesions causing back pain may also produce
    neurologic changes in extremities or bladder or
    bowel dysfunction
  • Signs of neuromuscular disease should also be
    sought

8
II. Back pain Most common causes
  • Hyperlordotic mechanical back pain
  • Ligamentous or muscle strain
  • Spondylolisthesis
  • Myalgias
  • Psychogenic
  • Spondylolysis
  • Scheuermann disease

9
II. Back pain Causes not to forget
  • Herniated disc
  • Spinal dysraphism
  • Urinary tract infection
  • Spinal cord tumors
  • Diskitis

10
II. Back pain
Trauma
  • Lordotic mechanical back pain
  • Reputed to be a common cause in adolescent
    athletes
  • Pain
  • only in lumbar area
  • variable hyperextension or hyperflexion testing
  • inability to fully flex the spine forward

11
II. Back pain
Trauma
  • Lordotic mechanical back pain
  • Kyphosis of thoracic spine present in
    compensation for decreased forward mobility of
    lumbar spine
  • Some have suggested contractures at the facet
    joints as site of pain

12
II. Back pain
Trauma
  • Ligamentous or muscle strain
  • History of fall, unusual exercise or other forms
    of trauma should be sought
  • There may be localized tenderness and
    paravertebral muscle spasm
  • Strain probably the most common cause of back
    pain but it should be short-lived

13
II. Back pain
Trauma
  • Prolapse of intervertebral disc
  • Uncommon lesion in children
  • Almost always a history of injury
  • Lower lumbar area usually involved
  • Pain may be local or radiate to the legs
  • Abnormal straight-leg-raising test most common
    physical finding

14
II. Back pain
Trauma
  • Slipped vertebral apophysis
  • May occur after strenuous activity or heavy
    lifting
  • Signs of a herniated disc
  • A small bone fragment, edge of ring apophysis,
    may be seen within spinal canal on imaging
    studies
  • Lower lumbar spine most common site

15
II. Back pain
Infections
  • Myalgias
  • Muscle pain may be associated with a multitude of
    viral and bacterial infections
  • Aches not limited to paravertebral muscles
  • Urinary tract infection
  • Back pain may be the primary complaint
  • A urine culture should be done

16
II. Back pain
Infections
  • Referred pain
  • Other infections must be considered in addition
    to urinary tract infections including
  • pneumonia
  • appendicitis
  • pancreatitis
  • cholecystitis
  • Urinary tract infection
  • Back pain may be the primary complaint
  • A urine culture should be done

17
II. Back pain
Infections
  • Diskitis
  • Aching pain in lower back radiates to flanks,
    abdomen and lower extremities
  • Young child may refuse to walk
  • Illness may be associated with low-grade fever,
    irritability and lethargy
  • Limited back motion

18
II. Back pain
Infections
  • Osteomyelitis of vertebra
  • Localized tenderness present at a specific level
  • Spine held rigid because of muscle spasm
  • Systemic signs often absent
  • Iliac osteomyelitis, sacroiliac joint infection
  • Frequently confused with appendicitis or septic
    arthritis of hip

19
II. Back pain
Infections
  • Tuberculosis
  • Less common cause of back pain today
  • Dull local pain present over involved vertebrae
  • There may be a localized swelling
  • Destruction of vertebrae may cause pressure on
    spinal nerves
  • Stiff gait
  • Back held rigid

20
II. Back pain
Infections
  • Tuberculosis
  • Less common cause of back pain today
  • Dull local pain present over involved vertebrae
  • There may be a localized swelling
  • Destruction of vertebrae may cause pressure on
    spinal nerves
  • Stiff gait
  • Back held rigid

21
II. Back pain
Infections
  • Spinal epidural abscess
  • Generally exquisite pain and tenderness on
    palpation over the site of abscess
  • Rapidly developing signs of spinal cord
    dysfunction such as paraparesis, loss of bladder
    and bowel control and sensory changes

22
II. Back pain
Infections
  • Brucellosis
  • Small abscesses may develop in vertebrae
  • Generally associated with widespread
    lymphadenopathy
  • Acute transverse myelopathy
  • Rare disorder
  • Preceded by upper respiratory infection
  • Back pain may be an early sign
  • Progressive weakness develops in 2 or 2 days

23
II. Back pain
Neoplastic disorders Benign tumors
  • Osteoid osteoma
  • Gradual onset
  • Worse at night
  • Often relieved by aspirin
  • Palpation discloses localized tenderness
  • Radiographs reveal a small translucent area with
    surrounding dense bone

24
II. Back pain
Neoplastic disorders Benign tumors
  • Benign osteoblastoma
  • Symptoms similar to those of osteoid osteoma, but
    larger lesion and less adjacent bone density seen
    on radiograph films
  • Eosinophilic granuloma
  • Usually only one vertebra involved with collapse
  • Intervertebral disc spaces maintained
  • Condition may be asymptomatic
  • May be backache and postural change

25
II. Back pain
Neoplastic disorders Benign tumors
  • Aneurysmal bone cyst
  • Cystic expansile lesion in a vertebra may cause
    neurologic symptoms
  • Neuroenteric cysts
  • Signs of cord dysfunction present

26
II. Back pain
Neoplastic disorders Malignant tumors
  • Spinal cord tumors
  • Symptoms may be subacute or chronic
  • Most common gliomas, neurofibromas, teratomas,
    lipomas
  • Developmental defects may be associated with
    cutaneous changes
  • Signs of cord compression with changes in gait,
    bladder and bowel dysfunction, localized
    tenderness and scoliosis
  • Deformity of foot such as cavus or cavovarus
    frequent presenting complaint

27
II. Back pain
Neoplastic disorders Malignant tumors
  • Ewing sarcoma
  • Osteogenic sarcoma

Neoplastic disorders Metastatic tumors
  • Neuroblastoma
  • Wilms tumor
  • Leukemia and lymphoma
  • Pain not localized and may be fleeting
  • Rarely, spinal cord compression may occur
    producing typical signs of spinal cord tumors

28
II. Back pain
Bone abnormalities
  • Scheuermann disease (vertebral osteochondrosis)
  • Produces a round-back deformity
  • Several vertebrae may be wedged anteriorly
  • Pathophysiologic mechanism thought to be prolapse
    of nucleus pulposis into the vertebrae body,
    possibly due to osteoporosis
  • Pain common, usually located over the apex of
    kyphosis

29
II. Back pain
Bone abnormalities
  • Spondylolisthesis
  • Pain caused by anterior displacement of
    vertebrae
  • Usually L5 slides forward on S1
  • Sciatica, increased lumbar lordosis and tight
    hamstrings often present

30
II. Back pain
Bone abnormalities
  • Spondylolisthesis
  • Pain caused by anterior displacement of
    vertebrae
  • Usually L5 slides forward on S1
  • Sciatica, increased lumbar lordosis and tight
    hamstrings often present

31
II. Back pain
Bone abnormalities
  • Spondylolysis
  • Defect in pars interarticularis without
    vertebral slipping
  • Probably result of a stress fracture
  • Low-back pain common, sometimes with radiation
    down the leg
  • Pain increased by activity

32
II. Back pain
Bone abnormalities
  • Occult fractures
  • Trauma, sometimes minor, may result in fractures
    of pars interarticularis or the transverse or
    spinous processes
  • May not be seen on plain radiographs

33
II. Back pain
Bone abnormalities
  • Osteoporosis
  • Fractures most likely to occur in osteoporotic
    bones present in disorders such as Cushing synd.,
    OI, homocystinuria, Turner synd., malabsorption
    and immobilization
  • Idiopathic juvenile osteoporosis
  • Onset between 8 and 14 years of age
  • Self-limited

34
II. Back pain
Bone abnormalities
  • Scoliosis
  • Almost always a painless disorder
  • When back pain present, underlying problem should
    be sought such as infection, diskitis or tumor

35
II. Back pain
Psychogenic pain
  • Back pain may be associated with reaction to
    stressful situations
  • Should always be considered if patients affect
    is inconsistent with symptoms or if findings are
    unexplainable
  • Careful history must be obtained
  • Psychogenic causes as cause of back pain seem to
    be on the rise

36
II. Back pain
Miscellaneous causes
  • Sickle cell disease
  • Painful crises may be associated with back pain
  • Juvenile rheumatoid arthritis
  • Occasionally, cervical pain may be a presenting
    complaint

37
II. Back pain
Miscellaneous causes
  • Ankylosing spondylitis
  • Usually boys
  • Arthritis in hips or knees and loss of mobility
    of the back may be found
  • Chronic hemolytic anemias
  • Signs of cord compression may result from
    extramedullary hematopoiesis in extradural space

38
II. Back pain
Miscellaneous causes
  • Calcification of intervertebral discs
  • Localized back pain
  • Loss of mobility due to muscle spasm
  • Cause unknown
  • Fluffy calcification in the disc space on
    radiograph films may not appear for 1 to 2 weeks
    following onset of pain

39
II. Back pain
Miscellaneous causes
  • Spinal dysraphism
  • Lesions such as fibrous bands, lipomas, etc., may
    cause a tethered cord gt back pain in addition to
    neurologic findings in lower extremities and
    bladder problems
  • Clues to underlying problem should be sought by
    close examination of the skin over spine for
    cutaneous abnormalities

40
II. Back pain
Miscellaneous causes
  • Diastematomyelia
  • Developmental defect causes a cleft in the cord
    by bone, cartilage or fibrous septum
  • Cutaneous abnormalities over affected area may be
    apparent
  • Low-back pain aggravated by cough or sneeze
  • Bladder dysfunction or slowly progressive
    weakness of legs earlier signs than back pain

41
II. Back pain
Miscellaneous causes
  • Arteriovenous malformation of cord
  • Symptoms usually slow to develop
  • Low-back pain common, with progressive gait and
    bladder or bowel dysfunction
  • May be a cutaneous angioma over the cord lesion

42
II. Back pain
Miscellaneous causes
  • Limb girdle dystrophy
  • Not a single disease entity but a group of
    dystrophies and myopathies
  • Usually with autosomal recessive inheritance
    pattern
  • First symptoms usually appear during 2nd decade
  • Early sign difficulty in climbing stairs or
    rising from the floor - low-back pain may be the
    source of either complaint
  • Pseudohypertrophy sometimes present
  • Deep tendon reflexes difficult to elicit

43
II. Back pain
Miscellaneous causes
  • Paroxysmal cold hemoglobinuria
  • Most commonly seen after viral infections
  • After cold exposure, child experiences back or
    abdominal pain, followed by chills, fever and
    hemoglobinuria
  • Multiple epiphyseal dysplasia
  • Most prominent symptom painful joints usually
    hips, knees and ankles with decreased mobility
  • Frequent back pain
  • Gait may be waddling

44
II. Scoliosis
  • Defined as a lateral curvature of the spine from
    its normal straight position
  • Rotational deformity of spine present as well
  • Many children have an inconsequential curvature
    of less than 10 to 15
  • True scoliosis worrisome because of the
    possibility of progression during growth to a
    degree that might affect cardiopulmonary function
  • Described by the direction of convexity of the
    curve
  • Right thoracic and left lumbar scoliosis most
    common pattern in idiopathic scoliosis

45
II. Scoliosis
  • Prevalence of scoliosis with curves gt10 in
    adolescents estimated to be 2 to 3
  • Idiopathic scoliosis comprises 60 to 80of cases
  • Most children with idiopathic scoliosis require
    no therapy
  • Close follow-up recommended in order to detect
    undue progression of curvature
  • Scoliosis in an adolescent is not necessarily
    idiopathic
  • May be a sign of an occult neuromuscular disorder
    or other pathologic conditions

46
II. Scoliosis
  • Of importance in determining possible causes
  • age at which scoliosis is noted
  • rapidity of development
  • Painful scoliosis should never be considered
    idiopathic in adolescent
  • Adolescent with left thoracic kyphosis should be
    evaluated for underlying pathology
  • Delayed developmental milestones may suggest
    neuromuscular cause

47
II. Scoliosis Most common causes
  • Idiopathic
  • Congenital vertebral defect
  • Leg length discrepancy
  • Neurofibromatosis
  • Neuromuscular disorder

48
II. Scoliosis Nonstructural causes
  • Primary postural scoliosis
  • Condition most commonly seen in children between
    10 and 15 years of age
  • Shoulders may be rounded
  • One hip may seem more prominent than the other
  • Apparent curvature disappears on forward flexion
    or on lying down

49
II. Scoliosis Nonstructural causes
  • Secondary postural scoliosis
  • Curvature a result of other conditions, such as
    leg discrepancy
  • Curve disappears on forward flexion
  • Hysterical scoliosis
  • Unusual type
  • Scoliosis not present on forward flexion

50
II. Scoliosis Structural causes
  • Idiopathic scoliosis
  • Probably genetic cause in 90 of cases
  • Infantile scoliosis
  • Noted in the first 3 years of life
  • Rare in US
  • More common in boys than in girls
  • Curvature lessens with age in most cases

51
II. Scoliosis Structural causes
  • Juvenile scoliosis
  • defined as scoliosis appearing in the 4- to
    10-year-old age group
  • Boys and girls equally affected
  • Adolescent scoliosis
  • Most common type occurring in children gt 10 years
    of age
  • Girls outnumber boys ratio 5-7 1
  • Condition generally unnoticed until adolescent
    growth spurt

52
II. Scoliosis Structural causes
  • Congenital scoliosis
  • May be associated with vertebral anomalies such
    as hemivertebrae, wedge vertebrae, congenital
    bars or failure of vertebrae segmentation
  • Other significant congenital defects may be
    present, such as of the heart of genitourinary
    system or other bony abnormalities
  • May be complicated by diastematomyelia, spinal
    lipomas, etc.

53
II. Scoliosis Structural causes
  • Neurofibromatosis
  • Accounts for approx. 2 of cases of scoliosis
  • A slowly progressive curve similar to idiopathic
    variety develops in half of these cases
  • Significant type with a short, sharply angular
    curve in the thoracic spine
  • Important cutaneous clues
  • Café au lait spots
  • Axillary freckling

54
II. Scoliosis Structural causes Neuromuscular
origin
Neuropathies
  • Cerebral palsy
  • Structural scoliosis occurs in 15 to 25 of
    children with CP
  • More commonly in the more severely affected,
    especially those with spastic quadriplegia

55
II. Scoliosis Structural causes Neuromuscular
origin
Neuropathies
  • Myelomeningocele
  • Lesion may be obvious or occult
  • May be present
  • Overlying skin defects
  • Lower extremity weakness
  • Neurologic changes
  • Bladder and bowel difficulties

56
II. Scoliosis Structural causes Neuromuscular
origin
Neuropathies
  • Spinal cord injury
  • Scoliosis will develop in almost 50 of patients
  • Syringomyelia
  • Scoliosis may be a presenting sign before sensory
    changes are noted

57
II. Scoliosis Structural causes Neuromuscular
origin
Neuropathies
  • Diastematomyelia
  • May be cutaneous defects or changes over the site
    of the bony abnormality
  • Friedreich ataxia
  • Ataxia develops in 1st or 2nd decade
  • Hypoactive deep tendon reflexes
  • Pes cavus and kyphoscoliosis develop in almost
    all patients

58
II. Scoliosis Structural causes Neuromuscular
origin
Neuropathies
  • Charcot-Marie-Tooth disease
  • Atrophy of peroneal muscles gives a stork leg
    appearance
  • Progressive weakness affects lower and, later,
    the upper extremities

59
II. Scoliosis Structural causes Neuromuscular
origin
Neuropathies
  • Juvenile spinal muscle atrophy
  • Onset of weakness ranges from early childhood to
    late adolescence
  • Signs of this disorder often mistaken for
    muscular dystrophy
  • Poliomyelitis
  • Now an uncommon cause
  • Deformity occurs 1-2 years after the acute illness

60
II. Scoliosis Structural causes Neuromuscular
origin
Myopathies
  • Duchenne-type muscular dystrophy
  • Scoliosis occurs later, particularly when patient
    is confined to wheelchair
  • Nemaline myopathy
  • Limb-girdle muscular dystrophy
  • Onset of symptoms later than in the Duchenne type
  • Proximal muscle weakness gt distal

61
II. Scoliosis Structural causes Neuromuscular
origin
Myopathies
  • Arthrogryposis
  • Multiple contractures present at birth
  • Anterior horn cell loss may create muscle
    imbalance gt leading to scoliosis

62
II. Scoliosis Structural causes Neuromuscular
origin
Mesenchymal origin
  • Marfan syndrome
  • Almost 50 of affected children develop scoliosis
    in infancy or early childhood
  • Features
  • dislocated lens
  • spiderlike fingers and extremities
  • high arched palate

63
II. Scoliosis Structural causes Neuromuscular
origin
Mesenchymal origin
  • Ehlers-Danlos syndrome
  • Hyperlaxity of joints and skin
  • Congenital laxity of joints
  • No skin hyperelasticity

64
II. Scoliosis Structural causes Neuromuscular
origin
Trauma
  • Direct vertebral trauma
  • Fractures or wedging of vertebral bodies or
    nerve root irritation may cause scoliosis
  • Irradiation
  • Destruction of the vertebral growth plates
    especially in treatment of Wilms tumor, produces
    curvature later
  • Extravertebral trauma
  • Severe trunk burns or thoracic surgery may result
    in scoliosis

65
II. Scoliosis Structural causes Neuromuscular
origin
Tumors
  • Intraspinal tumors
  • Various types of tumors may result in scoliosis
  • Sensory and motor changes in lower extremities
    and bladder and bowel incontinence may also occur
  • Osteoid osteoma
  • Vertebral body tumors may cause paraspinal muscle
    spasm and resultant scoliosis
  • Pain often worse at night and relieved by aspirin

66
II. Scoliosis Structural causes Neuromuscular
origin
Miscellaneous causes
  • Vertebral body infection
  • Scoliosis may be associated with osteomyelitis,
    diskitis and TB involvement of spine
  • Rickets
  • Scoliosis may develop late if condition untreated
  • Features epiphyseal enlargement, bowing of long
    bones, growth retardation, apathy, muscle
    weakness

67
II. Scoliosis Structural causes
Miscellaneous causes
  • Osteogenesis imperfecta
  • Collapse of vertebrae following fractures may
    result in scoliosis
  • Scheuermann disease
  • Causes adolescent round back deformity
  • Rarely causes scoliosis

68
II. Scoliosis Structural causes
Miscellaneous causes
  • Achondroplasia
  • 25 of affected children will develop scoliosis
    in late childhood
  • Klippel-Feil syndrome
  • Short neck with decreased movement typical
  • Cervicothoracic scoliosis may also be present

69
II. Scoliosis Structural causes
Miscellaneous causes
  • Sprengel deformity
  • Congenital high scapula almost always associated
    with cervical or thoracic spine abnormalities
  • Cleidocranial dyotosis
  • Features hypoplastic or absent clavicles, large
    head with delayed closure of fontanel and a
    narrow chest

70
II. Scoliosis Structural causes
Miscellaneous causes
  • Hyperphosphatasia
  • Condition characterized by fever, pain and bone
    fragility with frequent fractures
  • Short stature
  • Thickened limb bones
  • Bluish sclerae

71
II. Scoliosis Structural causes
Miscellaneous causes
  • Hypervitaminosis A
  • Features include dry skin, thickened bones
  • Often increased intracranial pressure
  • Hypothyroidism
  • Congenital indifference to pain
  • Juvenile rheumatoid arthritis

72
II. Scoliosis Structural causes
Miscellaneous causes
  • Mucopolysaccharidoses
  • In type VII progressive scoliosis may be the
    initial presenting sign
  • Hepatosplenomegaly, short neck and cloudy corneae
    develop gradually
  • Type VI (Maroteaux-Lamy) also has scoliosis as a
    clinical feature

73
II. Scoliosis Structural causes
Syndromes associated with scoliosis
  • Scoliosis has been described in a number of
    malformation syndromes
  • Other features of these syndromes more striking
    than scoliosis

74
Syndromes associated with scoliosis
  • Aarskog synd.
  • Camptomelic dwarfism
  • Cohen synd.
  • Cri du Chat synd.
  • Fetal trimethadione synd.
  • Hallermann-Streiff synd.
  • Larsen synd.
  • Noonan synd.
  • Proteus synd.
  • Rubinstein-Taybi synd.
  • Stickler synd.
  • XXXXY karyotype
  • Basal cell nerve synd.
  • Coffin-Lowry synd.
  • Diastrophic dwarfism
  • Freeman-Sheldon synd.
  • Klinefelter synd.
  • Metaphyseal dysplasia (Pyle disease)
  • Prader-Willi Synd.
  • Rett synd.
  • Seckel synd.
  • (Bird-Headed dwarfism)
  • Turner synd.
  • XXY karyotype

75
II. Scoliosis Transient structural
Inflammation
  • Lateral curvature can be produced by irritation
    from empyema or a perinephric abscess

Torticollis
Sciatic scoliosis
  • Pressure of an intervertebral disk on nerve roots
    may produce a scoliosis

76
II. Kyphosis and lordosis
77
II. Kyphosis and lordosis
  • Curvature of spine may occur in anterior
    (lordosis) posterior (kyphosis) directions
  • Most children with these conditions have postural
    deformities
  • Pathologic or fixed deformities may result from
    various disorders
  • Lordosis normal in young children, but should
    no longer be present my mid-childhood

78
Kyphosis
  • Poor posture
  • Accounts for most cases of kyphosis, especially
    in adolescence when concern about appearance is
    prevalent
  • Postural kyphosis not fixed
  • Can be easily corrected by finding appropriate
    method of encouragement or exercises

79
Kyphosis
  • Scheuermann disease (juvenile kyphosis)
  • Poorly understood disorder
  • Usually develops around puberty
  • Poor posture
  • Apparent round back deformity
  • Fatigue discomfort in area of kyphosis
    common, ? on standing

80
Kyphosis
  • Scheuermann disease (juvenile kyphosis)
  • Full correction cannot voluntarily be obtained
  • On radiographs wedged-shaped appearance of one
    or more vertebrae due to diminished anterior
    height
  • Cause unknown
  • Lumbar lordosis often accentuated

81
Kyphosis
  • Congenital kyphosis
  • Noted in infancy
  • Usually progresses with age, especially when
    child begins to walk stand
  • Caused by a structural abnormality of spine
    apparent on radiographic examination
  • Painless in childhood
  • May become painful during adolescence adulthood
  • Compression of spinal cord may occur

82
Kyphosis
  • Neuromuscular problems
  • Almost any neuromuscular disorder may cause
    spinal deformities in a growing child
  • CP, post traumatic paralysis, spinal muscular
    atrophy, myotonic dystrophy, poliomyelitis
  • Myelomeningocele
  • Kyphotic defects may be present at birth
    secondary to vertebral disruption
  • May develop later associated with muscle weakness

83
Kyphosis
  • Infection
  • Destruction of vertebrae from infectious causes
    may lead to kyphosis
  • Spasm of paravertebral musculature may be
    responsible for abnormality
  • Tuberculosis archetypical cause, but much less
    common today
  • Tuberculosis spondylitis (Pott disease) often
    insidious in onset
  • May affect any level of spine

84
Kyphosis
  • Skeletal dysplasias
  • A host of skeletal disorders may involve
    vertebral column produce kyphosis
  • Radiographic skeletal survey helps to
    differentiate various types

85
Kyphosis - Skeletal dysplasias
  • Spondyloepiphyseal dysplasia
  • Mucopolysaccharidoses
  • Kyphosis especially likely to be a finding in
    Hurler synd. (type I), Morquio synd. (type IV),
    Maroteaux-Lamy synd. (type VI) and type VII

86
Kyphosis - Skeletal dysplasias
  • Diastrophic dwarfism
  • Diaphyseal dysplasia (Engelmann disease)
  • Kniest dwarfism
  • Achondroplasia
  • Cleidocranial dysotosis
  • Cockayne syndrome
  • Neurofibromatosis
  • Noonan syndrome

87
Kyphosis
  • Metabolic endocrine disorders
  • Hypothyroidism
  • Gaucher disease
  • Ehlers-Danlos syndrome
  • Marfan syndrome
  • Homocystinuria
  • O.I.
  • Juvenile osteoporosis

88
Kyphosis
  • Tumors
  • Kyphosis bay be caused by benign or malignant,
    either primary or metastatic tumors
  • Intraspinal tumors must always be considered
  • Iatrogenic kyphosis
  • Radiation therapy
  • damage to vertebral growth plates may follow,
    resulting in kyphosis

89
Kyphosis
  • Iatrogenic kyphosis
  • Surgery
  • Surgical removal of parts of vertebral column may
    lead to kyphosis
  • Miscellaneous
  • Familial dysautonomia
  • Scoliosis kyphosis common
  • Other symptoms signs predominate including
    unexplained fever, aspiration, other signs of
    autonomic nervous system dysfunction

90
Lordosis
  • Physiologic lordosis
  • Exaggerated lumbar lordosis common in toddlers
  • Compensatory posture
  • Compensatory lumbar lordosis frequently
    accompanies kyphotic disorders such as
    Scheuermann disease
  • Pes planus
  • Lordosis may be an adaptive mechanism for
    individuals with flat feet to keep stable stance

91
Lordosis
  • Neuromuscular disorders
  • Lumbar lordosis - prominent progressive in
    muscular dystrophy
  • Often accompanies CP, spinal injuries with
    paralysis, poliomyelitis

92
Lordosis
  • Spondylolisthesis
  • Slipping forward of vertebral column at
    lumbosacral junction can be
  • secondary to congenital sacral defects
  • result of trauma
  • caused by developmental or acquired bone defects
  • Poor posture increased lumbar lordosis may be
    the only complaints
  • Backache, often with radiation don the legs,
    occurs in 2nd 3rd decades

93
Lordosis
  • Bilateral flexion contractures of hips
  • Increased pelvic inclination result of hip
    flexion contractures produces a compensatory
    lumbar lordosis
  • Flexion contractures may occur in juvenile
    rheumatoid arthritis, other hip dysplasias and CP
  • Myelomeningocele
  • Lordosis most common spinal deformity
  • Compensatory in nature

94
Lordosis
  • Inflammatory processes
  • Spasm of paravertebral muscles from inflammatory
    processes in spine may cause accentuated lordosis
  • Common features in diskitis
  • Inflammation of intervertebral disc space
  • Symptoms of backache
  • Pain radiating to the legs
  • Occasionally, lower extremity muscle weakness

95
Lordosis
  • Skeletal dysplasias
  • Achondroplasia
  • Exaggerated lumbar lordosis because of fixed
    flexion of hips and some thoracolumbar kyphosis
  • Cleidocranial dysostosis
  • Major features include a large head with delayed
    closure of anterior fontanel hypoplastic
    clavicles
  • Spondyloepiphyseal dysplasias
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