Musculoskeletal Disorders

Although some congenital musculoskeletal dysplasias are among the most obvious disorders of the neonate, they are also the most unusual. Congenital absence of all or part of a limb, deformities of the feet or hands, and lesions of the neck and trunk are rarely a diagnostic problem. The most common musculoskeletal dysplasias are among the most difficult to diagnose. Congenital hip dislocation may not be diagnosed even after repeated examination by experienced observers. Musculoskeletal infections complicating sepsis produce few subtle signs and may be easily overlooked. This is further complicated by the general concept that early diagnosis and treatment results in the greatest potential for normal growth and development of the infant. The examination of the musculoskeletal system should include inspection (e.g., looking for anomalies in contour position, and in spontaneous and reflex movement) and palpation (e.g., to determine if there are abnormalities in passive motion) and should be systematic to ensure completeness.

Down Syndrome Chest Xray

Figure 1.1. Chest radiograph showing 11 ribs. The presence of 11 ribs is not an uncommon finding in normal infants but occurs with greater frequency in infants with Down syndrome. Note the cardiac enlargement and enlarged thymus.

Figure 1.1. Chest radiograph showing 11 ribs. The presence of 11 ribs is not an uncommon finding in normal infants but occurs with greater frequency in infants with Down syndrome. Note the cardiac enlargement and enlarged thymus.

Musculoskeletal Disorders
Figure 1.2. Radiograph showing 13 ribs bilaterally in an otherwise normal infant.

Figure 1.3. Lateral radiograph of the spine showing the "bone-in-bone" appearance of the vertebral bodies. This is a striking example of growth arrest but otherwise is a nonspecific finding.

Preterm Newborn Long Bones

Figure 1.4. This figure shows the growth arrest lines in the long bones of a term infant with severe intrauterine growth retardation. Note the lack of the distal femoral and proximal tibial ossification centers, normally appearing at 36 and 38 weeks respectively, also caused by growth retardation. Hypothyroidism is also a consideration.

Figure 1.4. This figure shows the growth arrest lines in the long bones of a term infant with severe intrauterine growth retardation. Note the lack of the distal femoral and proximal tibial ossification centers, normally appearing at 36 and 38 weeks respectively, also caused by growth retardation. Hypothyroidism is also a consideration.

Hypothyroid Radiograph

Figure 1.5. A radiograph of the lower extremities in a term infant showing the growth arrest lines. Note that in this infant the distal femoral tibial and proximal tibial ossification centers are present.

Figure 1.5. A radiograph of the lower extremities in a term infant showing the growth arrest lines. Note that in this infant the distal femoral tibial and proximal tibial ossification centers are present.

Figure 1.6. A radiograph showing faulty segmentation of vertebrae in an infant with rachischisis. This defect may be seen in infants with the VATER syndrome and other congenital anomalies.

Hemivertebrae may occur in the cervical or thoracic spine, and less commonly in the lumbar spine. An isolated hemivertebra may not be recognized clinically but can cause abnormal posture (scoliosis). More commonly, hemivertebrae are multiple and may be associated with other skeletal abnormalities, as in the ribs.

Musculoskeletal Ribs

Figure 1.7. Congenital scoliosis is rare in neonates but may occur in association with structural anomalies of the vertebral spine. In this infant, the congenital scoliosis was associated with abnormal segmentation of vertebrae.

JW"

Figure 1.8. In this infant with caudal regression syndrome, the mother was a class B diabetic. Oligohydramnios was present, but renal function was normal in die infant. Note die arthrogryposis of die lower extremities.

Figure 1.9. Lateral view of the same infant showing the prominent end of the spine and arthrogryposis of the lower extremities.

Figure 1.10. Frontal view of the same infant showing the short lower extremities due to the marked arthrogryposis affecting die hip, knee, and ankle joints. Infants with lumbosacral agenesis clinically adopt the so-called "Buddha" position.

Lumbosacral Dimple

Figure 1.11. The same infant showing the arthrogryposis but note the dimple at the knee. Skin dimples such as this are associated with pressure over a joint and lack of movement.

Figure 1.12. Anteroposterior and lateral radiographs demonstrating the lumbosacral agenesis.

Figure 1.12. Anteroposterior and lateral radiographs demonstrating the lumbosacral agenesis.

Caudal Regression Syndrome
0 0

Responses

  • Bernd
    How to diagnose congenital scoliosis in infants?
    6 years ago

Post a comment