FAQ Category: Child

It does seem a bit odd sometimes, to be told you broke your arm near your shoulder when you fell on your hand. You’d expect the wrist to be broken in many cases.

The reason the upper parts of the bone may break is because of the shock as you land on your hand. The shock moves up the arm and causes the fracture. This is why it’s very important to try to not break your fall with your hands, although it really is an instinct to put that hand out there, isn’t it?

Halos are used for two reasons, to either stabilize the neck so it doesn’t move or to apply traction to the spine. To use a halo, surgeons must make holes in the skull and attach pins to it. The pins come out through the skin and are attached to the halo. The holes are drilled while the patient is under general anesthetic. Pain afterwards is managed with analgesics, or painkillers.

Infection is always a risk with halos, so the areas around the pins must be cleaned properly on a regular basis.

Scoliosis, curving of the spine from side to side, can be mild and left untreated, or it can be severe. If it is severe, treatment is usually needed because the curved back can cause the chest cavity to be too small and there isn’t enough room for the lungs to expand and for the heart.

Bracing is usually the first treatment that is tried but this is usually to stop further curving, it doesn’t usually reverse the curve. Surgery can be done to help straighten the spine. The surgeons use rods, wires and screws to stabilize the spine and keep it from curving further. Because spinal surgery is delicate, doctors are always looking for ways to decrease the risks of complications. One method many surgeons use is traction. Their patients will have traction for a few weeks to try to soften the curve so it’s not as severe. Then, the doctor will do the surgery.

There is debate as to whether using traction before surgery is better than just surgery alone and research is continuing.

It seems that this is one of those times when mom really does know what she’s talking about. Although both skiing and snowboarding can result in broken arms, snowboarding has a risk of almost 50 percent higher. More snowboarders break their humerus, one of the forearm bones, than skiers do.

Behavior can play a role in the breaks, for sure. If you’re careful, your risk of breaking an arm is lower, however, other issues come into play as well. For example, look at how you go down the hill in both sports. A skier is going face down and can often control the direction of the fall. Snowboarders are going down the hill sideways, which makes it more difficult to break the fall. As well, skiers can snap out of their bindings (normally) quite quickly, while snowboarders are locked into their bindings. This results in the snowboarder only having his or her arms to try to help break their fall.

Other types of injuries are more evenly divided between skiing and snowboarding and accidents have gone down overall. Helmets are playing a large roll in this as are better designed pieces of equipment.

Multiple cartilaginous exostoses (MCE) is an overgrowth of bone called exostosis or exostoses (plural form). In MCE, there are many bony projections or exostoses. They are covered or capped by cartilage. The bones affected most often are the long tubular bones of the forearm and lower leg. Sometimes flat bones, vertebrae, ribs, and short tubular bones can be affected, too.

The condition is inherited and is present in childhood. Deformity of the bones in the lower leg is often accompanied by an ankle problem called ankle valgus. Valgus refers to the way the side of the ankle that is closest to the other leg drops down toward the floor. This happens because the tibia (larger of the two lower leg bones) is tapered at the bottom. At the same time, the fibula (smaller bone on the outside of the lower leg) is shortened. When the bones shift in response to these changes, ankle valgus occurs.

In mild cases. MCE occurs as a stand alone problem. But when MCE is severe, there is a problem in the lower leg and deformity of the forearm. the bones in the forearm (radius, ulna) are deformed and/or shortened. These changes can affect motion and function.

If the problem is caught early enough, the ankle (valgus) joint deformity can be corrected. The goal is to prevent ankle arthritis later. Some surgeons try to correct the ankle deformity by performing a partial ankle fusion. The bones on the medial side of the ankle (closest to the other ankle) are fused together. A fusion helps hold the bones in place and stabilize the ankle. The procedure is called a partial epiphysiodesis.

Your pediatrician is a good place to start. Treatment may depend on the severity of the problem. A referral to an orthopedic surgeon may be needed. Your pediatrician will guide you through this process.

Exostosis (plural: exostoses) is the formation of new bone on the surface of a bone. It is an overgrowth of bone. These nodules or bumps on various bones of the body can cause pain and other problems when they press on nearby tissues (especially nerves or blood vessels).

It is a benign condition, meaning that it is not bone cancer. But even one exostosis can cause problems. Symptoms depend on where the nodules are located and what size and shape they are. They can limit movement of joints, causing chronic pain that can be mild to severe and even disabling. In some cases, they must be surgically removed.

There is a hereditary condition seen in children called multiple cartilaginous exostoses (MCE). In MCE, there are many bony projections or exostoses. They are covered or capped by cartilage. The bones affected most often are the long tubular bones of the forearm and lower leg. Sometimes flat bones, vertebrae, ribs, and short tubular bones can be affected, too.

Deformity of the bones in the lower leg is often accompanied by an ankle problem called ankle valgus. Valgus refers to the way the side of the ankle that is closest to the other leg drops down toward the floor. This happens because the tibia (larger of the two lower leg bones) is tapered at the bottom. At the same time, the fibula (smaller bone on the outside of the lower leg) is shortened. When the bones shift in response to these changes, ankle valgus occurs. A second potential problem in MCE is deformity of the forearm bones.

Your daughter may simply have one exostosis that is causing a problem and not the more involved condition of MCE. But if ankle motion is limited, it may be necessary to remove the bony overgrowth. Th would require surgery. If you have had X-rays done, then you are probably under the care of a physician. He or she will be able to assess the full extent of the problem and advise you accordingly.

It may be time for a follow-up exam with her orthopedic surgeon. Depending on the shape and condition of the femoral head, changes can occur as the child grows and matures. Perthes disease is a condition that first affects the hip in children between the ages of four and eight.

The condition is also referred to as Legg-Calve-Perthes disease. The full name is in honor of the three physicians who each separately described the disease. In Perthes disease, the blood supply to the capital femoral epiphysis (growth center of the hip) is disturbed, causing the bone in this area to die. The blood supply eventually returns, and the bone heals.

How the bone heals determines how the condition will affect the child later in life. The main problem with Perthes disease is that it changes the structure of the hip joint. The amount and type of deformity will determine way the hip joint works. The greater the deformity after the condition has healed, the more difficulties the child may have with walking.

Toeing-in or toeing-out is rare with Perthes disease. It occurs because of a hump deformity of the femoral head left over after treatment. Instead of a nice, smooth, round head at the top of the femur (thigh bone), the disease leaves the child with a misshapen
femoral head. It can become more of an oval or egg shape. The leg rotates in (or out) in order to avoid pinching the hump part of the uneven femoral head against rim of the acetabulum (hip socket).

This type of pinching during hip movement is referred to as impingement. If the hump is small enough, no changes occur. But when a large enough anterior hump is present (toward the front of the femoral head), the hump comes up against the rim of the hip socket, thus preventing further hip flexion.

A large hump along the lateral (outside) half of the femoral head limits hip abduction. As the leg moves away from the body, now the laterally located hump bumps up against the acetabulum. Rotating the femur changes the location of the hump in the socket and reduces or eliminates the impingement. In other words, the hump deformity of the femoral head forces the upper part of the femur to adapt to keep motion as normal as possible.

Children who toe-in as a result of Perthes disease are more likely to seem like they are tripping over their own feet. If available, special three-dimensional CT scans can be taken to identify the cause of the problem. The surgeon will be able to advise you regarding further treatment if it’s needed.

Perthes disease (also known as Legg-Calve-Perthes) is a condition that can affect the hip in children between the ages of four and eight. In this condition, the blood supply to the capital femoral epiphysis (growth center of the hip) is disturbed. The head of the femur (thigh bone) starts to die. The blood supply eventually comes back, and the bone heals.

But the smooth, round shape of normal femoral head may end up oval-or egg-shaped. This type of deformity can affect the child later in life.
The large end of the egg-shaped bone forms a hump. If the hump is small enough, no changes occur. But if it’s too large, when the child bends or straightens the hip, the hump can bump up against the rim of the acetabulum (hip socket). The bone can’t slide or glide any further because the hump is in the way.

The hump deformity of the femoral head can force the upper part of the femur to adapt to keep motion as normal as possible. Rotating the femur changes the location of the hump in the socket and reduces or eliminates the impingement. But there can be some loss of hip motion in the process, especially hip flexion, abduction (movement away from the body), and extension.

A medical evaluation may be a good idea. Consider taking her back to the orthopedic surgeon who followed her so closely at the start. Using records from that time and comparing them to more up-to-date X-rays and/or CT scans will help determine the cause of the problem. Treatment will be planned according to the results of the tests.

Schwannoma is a slow-growing benign tumor of the nerve sheath (lining of the nerve). Another term to describe this tumor is neurilemmona. These tumors affect the peripheral nerves. Peripheral nerves are the nerve roots as they leave the spinal cord. Schwannomas/neurilemmonas only affect sensory nerve roots. They usually occur in the head, upper trunk, and extremities (arms and legs).

Benign means the tumor doesn’t spread to other areas of the body. Even though it isn’t considered mlignnant, a benign tumor can cause pain, swelling, loss of motion, weakness, and deceased function of the affected part.

At first, the schwannoma/neruilemmoma grows so slowly there are no symptoms. A painful lump in the arms or upper body may be the first sign. Sometimes there is a mild loss of sensation. Tapping (or bumping) the affected nerve can cause numbness, tingling, or even a shock sensation down the nerve pathway.

Since only sensory nerves and not motor nerves are affected, there usually isn’t a loss of strength or the development of muscle atrophy (wasting). The diagnosis can be delayed by months to years. Many of the tumors are found when X-rays are taken for something else. If they aren’t causing any problems, no treatment is necessary. Surgery may be needed to remove the tumor and reduce symptoms from pressure on the nerve.

Neurilemmomas (also known as schwannomas) occur in the nerve sheath (lining) of peripheral and cranial nerves. These nerves are located in the head (cranial nerves) and upper trunk and extremities (peripheral nerves).

Occasionally, these nerves are classified as intraosseous schwannomas. Intraosseous means within the bone. There are several possible means by which schwannomas can become intraosseous in nature.

The tumor cells may originate in the bone marrow where schwannoma cells are found. Or it could come from the nutrient vessel supplying blood to the bone. Sometimes, the tumor comes from the nerve tissue that erodes (eats) into the bone.

Bones affected most often include the jaw (because of the closeness to the cranial nerves of the head, face, and neck), the fibula (lower leg), and the sacrum. But these tumors can also affect the humerus (upper arm bone), radius, and the bones of the hands and feet.

Pain is not always a helpful predictor of a serious problem. Constant, intense pain certainly gets our attention. Pain or discomfort in growing, active children is often labeled and dismissed as growing pains. But hip pain in children can be caused by infection, tumor, or fracture.

Other conditions such as Perthes disease or Slipped Capital Femoral Epiphysis (SCFE) are also possible causes of hip pain in children. Perthes is a condition that affects the hip in children between the ages of four and eight. The condition is also referred to as Legg-Calve-Perthes disease in honor of the three physicians who each separately described the disease.

In Perthes disease, the blood supply to the growth center of the hip (the capital femoral epiphysis) is disturbed, causing the bone in this area to die. The blood supply eventually returns, and the bone heals. How the bone heals determines how much problem the condition will cause in later life. This condition can lead to serious problems in the hip joint later in life.

SCFE is is a condition that affects the hip in teenagers between the ages of 12 and 16 most often. Cases have been reported as early as age nine years old. In this condition, the growth center of the hip (the capital femoral epiphysis) actually slips backwards on the top of the femur (the thighbone). If untreated this can lead to serious problems in the hip joint later in life. Fortunately, the condition can be treated and the complications avoided or reduced if recognized early. Surgery is usually necessary to stabilize the hip and prevent the situation from getting worse.

Either of these conditions can cause sudden and severe hip pain. The child may not be able to put weight on that leg. Early diagnosis and treatment is important for both of these conditions. Preventing complications and an unstable hip early on can help prevent serious complications later.

If there is no improvement in the child’s symptoms within a day or two, it may be helpful to suggest a visit to the doctor. Your support and interest may be what your sister needs in this situation.

Slipped capital femoral epiphysis (SCFE) is a condition that affects the hip in teenagers between the ages of 12 and 16 most often. Cases have been reported as early as age nine years old. In this condition, the growth center of the hip (the capital femoral epiphysis) actually slips backwards on the top of the femur (the thighbone).

Surgery is usually done right away for this problem. Without good placement of the capital femoral epiphysis, loss of blood supply to the area can result in osteonecrosis (death of bone). In fact, six out of 10 children with an unstable SCFE develop osteonecrosis. The long-term effects of osteonecrosis can be very severe.

The best way to avoid this complication is to release the joint capsule. The procedure is known as a decompressive capsulotomy. It can be done just before or right after the slipped epiphysis is put back in place.
The primary goal of the treatment of SCFE is to stop any further slippage of the capital femoral epiphysis. The less slip, the lower the risk of problems in the hip during the child’s life.

Once the epiphysis has closed, slippage will stop. Epiphysis closure occurs when the two areas of bone–the epiphysis and metaphysis–join, or fuse, into one single bone. At that point there is no cartilage growth plate remaining between the two parts of the femur. Surgery usually speeds up the process of epiphysis closure.

But surgeons have found that doing the surgery isn’t a guarantee that everything will be fine. There are problems and complications that can occur. Sometimes the bone slips again. Ischemia (loss of blood supply) can occur resulting in osteonecrosis even after surgery. When that happens, the head of the femur can break into pieces and/or collapse.

Newer studies may help shed some light on these problems. For example, it was once thought that perhaps the surgery to repair the slipped bone brought on the blood loss. But it’s more likely that a build up of pressure inside the joint after it is reduced or manipulated (put back in place) is the main risk factor. High pressures inside the joint cuts off blood circulation to the bone.

Being strongly right- or left-side dominant has never been linked with scoliosis. Scientists have examined whether or not overloading the spine on one side could lead to a spinal curvature. This has never been proven.

It’s much more likely that a genetic factor is the key player in the development of scoliosis of unknown cause among children and teens. This condition is called adolescent idiopathic scoliosis (AIS). Not all studies support this theory, so researchers keep looking for possible risk factors that might be contributing to the development of AIS.

A recent study from Greece even looked to see if exercise or being involved in organized sports might be a predictive factor. After reviewing the cases of over 2,000 adolescents, there was nothing to indicate a causative link between sports activity and scoliosis.

So, it’s back to the drawing board and more studies to try and sort this all out. Hopefully, modifiable risk factors will be identified and a program of education and prevention put into place to reduce the incidence and severity of this condition.

There is a link between adolescent idiopathic scoliosis (AIS) and low estrogen levels. And low estrogen levels can occur as a result of overexercising and/or eating disorders.

Young female athletes often have delayed maturation and amenorrhea (no menstrual cycle). Too much exercise can have negative effects on the reproductive and skeletal systems. Low body weight and improper nutrition can delay the onset of the menstrual cycle.

Keeping a balance of diet and exercise in the developing teen is always extremely important. Bone density is decreased in girls with eating disorders such as anorexia or bulimia. Estrogen deficiency, low intake of nutrients, low body weight, amenorrhea, low calcium intake, and reduced physical activity are all risk factors for bone loss. This type of reduced bone density is associated with a significantly increased risk of fracture even at a young age.

A new term has been coined (female athlete triad) to describe the combination of disordered eating, amenorrhea, and osteopenia or osteoporosis, a situation that often goes unrecognized and untreated. Having education at an early age is very important. Including this information in your program may help prevent serious health issues in young, female athletes.

Doctors don’t know what causes trigger finger, although they do know that adults who use the same movements frequently can develop it over those who don’t. However, in children, trigger finger is particularly puzzling. At one point, doctors felt that it may be something the child is born with, a congenital problem, but that has since been discounted. Now, there are several other theories, but one is that it is caused by the bent shape most children keep their thumb.

When a child sucks his or her thumb, it is usually kept straight, so it’s unlikely that this would be a cause.

Only your doctor can help you come to that answers, however, there are many doctors who treat trigger finger of the thumb without surgery. Some will watch and wait, only taking action if the finger seems to be getting worse or if there is no change after a year. Other doctors may suggest splinting the thumb, either over night or all the time, and yet other doctors may suggest exercises that will stretch the thumb.

Well baby check ups are done to be sure that your baby is growing and developing on par with other babies the same age. The doctor or nurse will make note of the baby’s weight, length, developmental milestones and so on. Also, just as when older children and adults go to the doctor, the reflexes are checked. When yours are checked, your doctor likely uses a reflex hammer to check around your knee and elbow. What your daughter’s doctor is doing is the same thing but in a different way.

Babies up to two years old have something called the Babinski sign or reflex. When you firmly stroke the bottom of a baby’s foot, the big toe should bend down and the four other toes should fan out. This is normal up to two years. We lose that reflex after two years, but it can return if there is a neurological, or nerve, problem.

The term coxa comes from the Latin and refers to the hip. Vara refers to the angle of the neck at the top of the femur (thigh bone) between the shaft of the long bone and the round head at the top.

The femoral neck angle is usually about 150 degrees at birth. With time, growth and development, and weight-bearing, this angle decreases. By adulthood, it is more in the range of 125 to 135 degrees.

Some experts suggest coxa vara occurs when the angle between the ball and the shaft of the femur is less than 120 degree (in adults). This figure is closer to 110 degrees in children. The condition may or may not be painful but usually results in a limp because one leg is shorter than the other.

Surgery is done to help restore a more normal angle. The hope is to reduce any pain that may be present, improve hip motion, and get rid of the limp. The exact procedure that is done depends on the cause, location, and extent of the problem.

Children with a straightforward coxa vara deformity have a fairly good prognosis. Results improve function and are long-lasting. Prognosis is poor for children with multiple other deformities associated with the coxa vara. Abnormal features of the bone and cartilage cause hip instability in children.

If surgery is done too early, further growth spurts cause the problem to recur (come back). It’s not uncommon for these children to develop degenerative arthritis in early adulthood. You would need further details about your nephew to know what kinds of results are expected. Hopefully, all will go well with a good result. The surgeon will have a better idea what to expect after the operation is completed.

Osteochondrodysplasia is a general term for a disorder in the development (dysplasia) of bone (osteo) and cartilage (chondro). Hip, spine, and limb deformities are commonly linked with this condition.

A common hip problem is coxa vara. Coxa vara refers to the angle of the femur (thigh bone) as it supports the femoral head in the hip socket. The normal femoral neck angle is about 150 degrees at birth.

As the bones grow and develop, the shape changes. By the time we are adults, this angle is about 125 degrees. Less than 110-degrees creates this condition of coxa vara. The opposite (too much angle) is called coxa valga. Coxa valga is very rare with osteochondrodysplasia.

Surgery is advised when there is pain, loss of hip motion, and a leg-length discrepancy. With a loss of femoral neck angulation the femoral neck is short. In some cases, the hip socket is flat. The head of the femur may be in pieces rather than one solid, round feature. All of these changes cause the affected leg to be shorter than the uninvolved limb. The result is often a noticeable limp when walking.

If the coxa valga doesn’t improve and/or if the other symptoms mentioned become a problem, surgery may be needed. Usually, this is put off for as long as possible in order to ensure a successful result. Surgery too early when the bones are still growing and shifting can cause recurrence of the problem and development of arthritis later. The surgeon will use X-rays to measure the angle and keep track of its progress as the child grows and develops.

Fibromyalgia is an autoimmune disease, which means that for some unknown reason, cells in the body are attacking each other. Signs and symptoms of fibromyalgia include generalized pain, joint pain, fatigue, and other problems. There is no definite way to diagnose fibromyalgia, so it’s diagnosed by exclusion, which means that doctors rule out everything else before diagnosing it.

There is also a syndrome called Juvenile Fibromyalgia Syndrome, which is very similar to fibromyalgia in adults, but it affect children, most often in their early teen years. Unfortunately, also like the adult version, doctors don’t know much about it. So, it is quite possible that both your sister-in-law and niece have fibromyalgia.