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Shoulder The shoulder actually comprises four joints: Glenohumeral joint (commonly referred to as the shoulder joint) Acromioclavicular joint Sternoclavicular joint Scapulothoracic joint The glenohumeral joint has minimal geometric stability because the relatively small glenoid fossa articulates with the proportionately larger head of the humerus. The low level of intrinsic stability allows for a large range of motion. The rotator cuff muscles help give the glenohumeral joint…

Spinal Deformities A simplified classification of the common spinal abnormalities, scoliosis and kyphosis, is presented in Table 202.1 . TABLE 202.1 Classification of Spinal Deformities Modified from the Terminology Committee of the Scoliosis Research Society, 1975. SCOLIOSIS Idiopathic Infantile Juvenile Adolescent Congenital Failure of formation Wedge vertebrae Hemivertebrae Failure of segmentation Unilateral bar Bilateral bar Mixed Neuromuscular Neuropathic diseases Upper motor neuron disease Cerebral palsy Spinocerebellar…

In newborns and non–weight-bearing infants, the difference between posturing and deformity is important. Posturing is the habitual position in which the infant holds the foot; passive range of motion is normal. Deformity produces an appearance similar to posturing, but passive motion is restricted. Most pediatric foot disorders are painless. Foot pain is more common in older children ( Table 201.1 ). Table 201.1 Differential Diagnosis of…

Torsional (in-toeing and out-toeing) and angular (physiologic bowlegs and knock knees) variations in the legs are common reasons that parents seek medical attention for their child. Most of these concerns are physiologic and resolve with normal growth. Understanding the natural history allows physicians to reassure the family and to identify non-physiologic disorders that necessitate further intervention. Physiologic disturbances are referred to as variations; pathologic disturbances are…

The hip is a ball (femoral head) and socket (acetabulum) joint that is important for skeletal stability. The femoral head and acetabulum are interdependent for normal growth and development. The femoral neck and head, which contain the capital femoral epiphysis, are intraarticular. The blood supply to this region is unique because the blood vessels are extraosseous and lie on the surface of the femoral neck, entering…

Fractures account for 10–15% of all childhood injuries. The anatomic, biomechanical, and physiologic differences in children account for unique fracture patterns and management. Fracture terminology helps describe fractures ( Table 198.1 ). Table 198.1 Useful Fracture Terminology Complete The bone fragments separate completely Incomplete The bone fragments are still partially joined Linear Referring to a fracture line that is parallel to the bone’s long axis Transverse…

It is important to understand the growth and development of the musculoskeletal system as well as common orthopedic terms ( Table 197.1 ). Providers should recognize common mechanisms for congenital and acquired orthopedic disorders ( Table 197.2 ). Table 197.1 Common Orthopedic Terminology ABDUCTION MOVEMENT AWAY FROM MIDLINE Adduction Movement toward or across midline Apophysis Bone growth center that has a muscular insertion but is not…

Chapter 188 Dermatology Assessment Common cutaneous conditions in pediatrics include atopic dermatitis, impetigo, tinea capitis, acne vulgaris, verrucae vulgaris, and seborrheic dermatitis. Obtaining a thorough history including the age of the patient, onset, duration, progression, associated cutaneous symptoms (pain, pruritus), previous treatments, and associated systemic signs or symptoms (fever, malaise, weight loss) is important. Characterizing and describing the primary and secondary skin lesions is important for…

Arthropods are common in the environment. Although many can bite or sting humans, only a few infest humans. Arachnids (mites) are the most common, parasitizing humans and animals by burrowing into the skin and depositing eggs within the skin. Scabies Scabies is caused by the mite Sarcoptes scabiei . The female mite burrows into the epidermis and deposits her eggs, which mature in 10–14 days. The…

Erythema multiforme (EM), reactive infectious mucocutaneous eruption (RIME), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) are acute hypersensitivity reactions characterized by cutaneous and mucosal necrosis. These syndromes represent a hypersensitivity reaction to a precipitating cause, usually infectious organisms or drugs. These disorders were historically thought to represent a spectrum of the same disease process, and inconsistent use of these disease names led to further confusion.…

Vascular anomalies can be divided into two major categories: tumors and malformations. Vascular tumors are characterized by hypercellularity, proliferation, and growth. Vascular malformations, however, are developmental defects derived from the capillary, venous, arterial, or lymphatic vessels. In contrast to hemangiomas, vascular malformations remain relatively static and grow very slowly over time. Differentiating between these entities is important because they have different prognoses and clinical implications. Vascular…

Birthmark is a term that describes congenital anomalies of the skin. It should not be used as a definitive diagnosis because congenital skin lesions vary greatly in their appearance and prognosis. The differential diagnosis of various birthmarks is listed in Table 193.1 . Table 193.1 Common Birthmarks COLOR/LESION BIRTHMARK LOCATION OTHER FEATURES Brown/macule or patch Café-au-lait macule Variable May be associated with genetic syndromes Brown (<40…

Etiology Seborrheic dermatitis is a common, chronic inflammatory disease that has different clinical presentations at different ages. Seborrheic dermatitis classically presents in infants as cradle cap or dermatitis in the intertriginous areas of the axillae, groin, antecubital and popliteal fossae, and umbilicus. It is seen in adolescents as dandruff. The pathogenesis of seborrheic dermatitis is unclear, but it is theorized that there is an abnormal inflammatory…

Etiology and Epidemiology Inflammation in the top layers of the skin, caused by direct contact with a substance, is divided into two subtypes: irritant contact dermatitis and allergic contact dermatitis. Irritant contact dermatitis is observed after the skin surface is exposed to an irritating chemical or substance. Contact dermatitis may occur in any age, and girls are more frequently affected than boys. Allergic contact dermatitis is…

Etiology Atopic dermatitis is a chronic inflammatory disease with no known cure. It is associated with significant psychosocial morbidity and decreased health-related quality of life. For many affected individuals, atopic dermatitis is the skin manifestation of atopy accompanied by asthma and allergic rhinitis. Atopic dermatitis manifests with a defective skin barrier, reduced innate immune responses, and exaggerated immune responses to allergens and microbes. Both genetic predisposition…

Etiology Acne vulgaris (or acne) is a chronic inflammatory disorder that affects areas with the greatest concentration of sebaceous glands, such as the face, chest, and back. Gender, age, genetic factors, and environment are all major contributing pathogenic factors. Stress may trigger acne, possibly by affecting hormone levels. A high glycemic diet and milk intake, low-fat/skim milk in particular, may be associated with acne, although they…

Approximately one in three Americans of any age has at least one recognizable skin disorder at any time. The most common cutaneous diseases encountered in community settings are dermatophytosis, acne vulgaris, seborrheic dermatitis, atopic dermatitis (eczema), verrucae (warts), tumors, psoriasis, vitiligo, and infections such as herpes simplex and impetigo. The most common diagnoses in children attending pediatric dermatology clinics include atopic dermatitis, seborrheic dermatitis, impetigo, tinea…