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Jt ROM in paediatrics

Discussion in 'Pediatrics' started by lucycool, May 10, 2012.

  1. lucycool

    lucycool Active Member


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    Hi,

    Im trying to find the "normal" jt ROMs in paeds as my uni notes with all the info along with my podopaeds book is on a big ship coming from Edinburgh to Melbourne and its driving me crazy that I cant remember!!
    Im sorry if it is on another thread, Ive been looking for an hour and I cant find it..

    If anyone can help me out, Id be very grateful!

    Cheers,

    Lucy
     
  2. Sally Smillie

    Sally Smillie Active Member

    Depends on age of course
    Hips IR/ER 90 degrees each
    ankle d/f 25 degrees
    ... what else do you need/want?? Bit general really

    Most of it is expereince (I only see paeds) and feel of the quality of movement. You very rarely get reduced ROM, nearly always extra. They are NOTHING like adults. What would be super weird for adults is run of the mill for paeds. I raise an eyebrow if I see a kid with less than 90 degrees in ER or IR at hip.
     
  3. As Sally says, its entirely age dependant and range may not be as important as stiffness. An ankle with a DF range of 30 degrees but good stiffness and control may be less clinically significant than a range of 10 degrees with poor control and low tone. And of course there is the issue of repeatability which is poor in adults and shockingly poor in kids.

    And indeed when we are considering ankles, its rather vital to separate the talo crural joint range from the ankle joint complex range. The latter may include the TC, the ST and perhaps even a bit of the CCJ.

    There is no normal and abnormal. Free your mind grasshopper.
     
  4. Sally Smillie

    Sally Smillie Active Member

    too true Robert. Free your mind indeed!
    Paeds are slippery little suckers. I would be far more concerned about feel and tone than range.
    Whats normal for 2 is not the same as what is normal for 4,6,10 or 15.
     
  5. Indeed.

     
    Last edited by a moderator: Sep 22, 2016
  6. Sally Smillie

    Sally Smillie Active Member

    Oh my god Robert - I love you!!! PMSL Sums it up really
     
  7. Thought I'd already sent you that one! Amateur transplants, always hilarious.

    Good one to play the next time you do a paeds lecture.
     
  8. Bug

    Bug Well-Known Member

    Love it and waaay too true.
     
  9. Sally Smillie

    Sally Smillie Active Member

    Hey Cylie,
    how are things down under? How is your PhD chugging along? Nicely I hope. Finally got my DCD research complete (14 days before having a baby), and working on publication.
    Are you still just doing under 12's?
     
  10. RobinP

    RobinP Well-Known Member

    Paeds - stiffness and tone (ie quality of motion) all the way. Normal depends on their symptoms or lack of symptoms.
    ........and of course the parents!

    Normal shnormal in my opinion
     
  11. Bug

    Bug Well-Known Member

    Hey Sally,

    PhD done and marks in last week, now just waiting on the piece of paper - Woot!!

    Have a small paeds caseload now and in research the rest of the time now, again Woot!!

    You can't teases us all though with a throw out line about DCD research......fill us in.

    As for a baby, awesome news, now you have a live one to practice lots of things on. Mine are ready to start charging me sometimes so condition early with the photo's and videos. As a terrible mentor of mine says, "What is the use of having children unless you can exploit them for your research".
     

  12. (Perrie 2012) :D
     
  13. Sally Smillie

    Sally Smillie Active Member

    So, Lucy, do you get the feeling of what we are trying to say? It is a good point and I am glad you asked rather than letting you go along thinking ROM mattered more than it does. Cylie is in Melbourne, so you might want to see if you can get some useful contacts so you can get the chance to hang out in some folks paeds clinics. I still do it any chance I can and I have been at it quite a few years now.

    I have considered exploiting my own child for my own research but a) the sample size is appalingly small, b) ethics wont allow the parent signing consent and lead researcher to be the same person and b) there's not a damn thing wrong with him. My esteemed colleage Robert, however is not against such practices. I recall a super cute photo of his offspring working in his orthotics lab.

    DCD went down ok. We got an initial piece published in the American Journal of Paediatric Physiotherapy on if GAITrite was reliable to measure gait parameters in this population, so I guess that is where we will aim to publish our results. Stewart is doing all the number crunching. Anecdotal results of qualitative gubbins suggested a big reductions in trips and falls across nearly all participants, less frequently noted but equally welcome an increase in endurance of walking time to fatigue on average.

    Exciting news Cylie on the paeds/Research mix. That is what I dream of: 1 day paeds clinical, 2 days paeds research, 5 days pay - that would be my dream!!!
     
  14. lucycool

    lucycool Active Member

    Hi,
    Thank you so much for all your advice. I agree that it is more about the feel of the joint and the tone of the muscle, I had my first biomech paed patient and was worrying about the stuff i had learnt (and forgotten) at uni!
    My Angela Evans book has now arrived off the boat so Im feeling a lot more confident having that - and you guys - to reference or ask questions - so thank you all very much! With all of your help, Im hopefully becoming a better clinician!
    As for seeing some more paeds i would love to! Cylie - would you consider having me in to your clinic to shadow you?

    Thanks again guys!

    Lucy
     
  15. Bug

    Bug Well-Known Member

    Lucy, I have a pretty high student load as am part of a clinical school so it is really difficult. My best advise would be to contact the Vic A.Pod.A and become part of the Paeds special interest group. We are a pretty active bunch. There are a few other key people that you might also be able to spend some time with also but give me a message or say hello at the next meeting and I will introduce you to the gang.

    Robert, that is just hilarious. Can I borrow her to keep us all in line? I think even my boys would bow to her.

    Sally, 5 days pay for 3 days work...my dream also. Currently 2 days paeds, 2 days research, 1 day student coordination. I'm pretty confident that my boos doesn't read here but you know which one I would give up......
     
  16. Sally Smillie

    Sally Smillie Active Member

    Cylie - I can't imagine which you would like to give up??? ;0)

    Lucy/Cylie - apologies, I didn't mean to imply Cylie herself, as a busy girl, but as a useful link for good contacts, which she has given above.

    Robert/Cylie - do you guys have any issues referring for hip xr? I get a few DDH's every year, and I get them XR via back door (it means I can refer to ortho same day if it is a DDH). But because they are seeing me, it means they are subtle ones others have missed, so often it is just the XR that confirms it. My dx rate is 100%, so I am not worried about that, it's just that I am trying to get the protocol established formally that I can refer for hip AP's. How do you deal with this?
     
  17. Bug

    Bug Well-Known Member

    Sally, there is no referring for hip XR here. I just refer them into the paed ortho clinic and they pick them up within 2 weeks and sort it all then and there. If the wait looks longer and I am really worried I ring and they bump them up into the next day it is on.

    An x-ray happens at the same time in that clinic so it's all good. After a yucky pick up of bilateral hip dislocation in a 3 year old, I am hip paranoid and basically anything remotely asymetrical goes to the clinic, is x-rayed and cleared/fixed.
     
  18. If I suspect something nasty, orthopaedic and hip related I refer to the Orthopods via the physiotherapists.
     
  19. RobinP

    RobinP Well-Known Member

    Ditto although I used to work in a clinic where my clinic ran concurrently( sort of joint)and if it came up, I walked through and asked for it, or anything else out of my scope. They were always happy to do it or even review x rays taken to double check
     
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