Transcript Differential diagnosis

Differential diagnosis
I.
Neck
II. Back
III. Extremities
IV. Floppy infant syndrome
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
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
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
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
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
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
II. Back pain – Most common causes
Hyperlordotic mechanical back pain
 Ligamentous or muscle strain
 Spondylolisthesis
 Myalgias
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Psychogenic
 Spondylolysis
 Scheuermann disease
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II. Back pain – Causes not to forget
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Herniated disc
Spinal dysraphism
Urinary tract infection
Spinal cord tumors
Diskitis
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
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
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
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
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
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
II. Back pain
Infections
 Referred pain
 Other infections must be considered in addition to urinary tract
infections including:
• pneumonia
• appendicitis
 Urinary tract
infection
• pancreatitis
 Back pain may
be the primary complaint
• cholecystitis
 A urine culture
should be done
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
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
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
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
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
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
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
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
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
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 bowe
dysfunction, localized tenderness and scoliosis
 Deformity of foot such as cavus or cavovarus – frequent
presenting complaint
II. Back pain
Neoplastic disorders – Malignant tumors
 Ewing sarcoma
 Osteogenic sarcoma
Neoplastic disorders – Metastatic tumors
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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
II. Back pain
Bone abnormalities
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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
II. Back pain
Bone abnormalities
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Spondylolisthesis
Pain caused by anterior displacement of vertebrae
Usually L5 slides forward on S1
Sciatica, increased lumbar lordosis and tight hamstrings –
often present
II. Back pain
Bone abnormalities
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Spondylolisthesis
Pain caused by anterior displacement of vertebrae
Usually L5 slides forward on S1
Sciatica, increased lumbar lordosis and tight hamstrings –
often present
II. Back pain
Bone abnormalities
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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
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
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
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
II. Back pain
Psychogenic pain
 Back pain may be associated with reaction to stressful
situations
 Should always be considered if patient’s 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
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
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
II. Back pain
Miscellaneous causes
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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
II. Back pain
Miscellaneous causes
 Spinal dysraphism
 Lesions such as fibrous bands, lipomas, etc., may cause a
tethered cord => 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
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
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
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
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
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
II. Scoliosis
 Prevalence of scoliosis with curves >10° in adolescents
estimated to be 2% to 3%
 Idiopathic scoliosis comprises 60% to 80%of 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
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
II. Scoliosis – Most common causes
Idiopathic
 Congenital vertebral defect
 Leg length discrepancy
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Neurofibromatosis
 Neuromuscular disorder
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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
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
II. Scoliosis – Structural causes
 Idiopathic scoliosis
 Probably genetic cause in 90% of cases
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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
II. Scoliosis – Structural causes
 Juvenile scoliosis
 defined as scoliosis appearing in the 4- to 10-year-old age
group
 Boys and girls equally affected
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Adolescent scoliosis
Most common type occurring in children > 10 years of age
Girls outnumber boys ratio 5-7 : 1
Condition generally unnoticed until adolescent growth spurt
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.
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
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
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
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
II. Scoliosis – Structural causes
Neuromuscular origin
Neuropathies
 Diastematomyelia
 May be cutaneous defects or changes over the site of the bony
abnormality
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Friedreich ataxia
Ataxia develops in 1st or 2nd decade
Hypoactive deep tendon reflexes
Pes cavus and kyphoscoliosis develop in almost all patients
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
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
II. Scoliosis – Structural causes
Neuromuscular origin
Myopathies
 Duchenne-type muscular dystrophy
 Scoliosis occurs later, particularly when patient is confined to
wheelchair
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Nemaline myopathy
Limb-girdle muscular dystrophy
Onset of symptoms later than in the Duchenne type
Proximal muscle weakness > distal
II. Scoliosis – Structural causes
Neuromuscular origin
Myopathies
 Arthrogryposis
 Multiple contractures present at birth
 Anterior horn cell loss may create muscle imbalance =>
leading to scoliosis
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
II. Scoliosis – Structural causes
Neuromuscular origin
Mesenchymal origin
 Ehlers-Danlos syndrome
 Hyperlaxity of joints and skin
 Congenital laxity of joints
 No skin hyperelasticity
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
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
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
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
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
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
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
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`
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
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
Syndromes associated with scoliosis
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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
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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
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
II. Kyphosis and lordosis
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
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
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
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
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
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
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
Kyphosis
 Skeletal dysplasias
 A host of skeletal disorders may involve vertebral column &
produce kyphosis
 Radiographic skeletal survey helps to differentiate various
types
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
Kyphosis - Skeletal dysplasias
 Diastrophic dwarfism
 Diaphyseal dysplasia (Engelmann disease)
 Kniest dwarfism
 Achondroplasia
 Cleidocranial dysotosis
 Cockayne syndrome
 Neurofibromatosis
 Noonan syndrome
Kyphosis
 Metabolic & endocrine disorders
 Hypothyroidism
 Gaucher disease
 Ehlers-Danlos syndrome
 Marfan syndrome
 Homocystinuria
 O.I.
 Juvenile osteoporosis
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
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
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
Lordosis
 Neuromuscular disorders
 Lumbar lordosis - prominent & progressive in muscular
dystrophy
 Often accompanies CP, spinal injuries with paralysis,
poliomyelitis
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
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
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
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