Orthopedic Conditions

Adopt Special Needs: Special Needs - Orthopedic ConditionsOrthopedic conditions involve diseases, injuries, and other conditions of the musculoskeletal system.

The musculoskeletal system gives us the ability to move using the muscular and skeletal systems. The musculoskeletal system provides form, support, stability, and movement to the body. It is made up of the skeleton, muscles, cartilage, tendons, ligaments, joints, and other connective tissue that supports and binds tissues and organs together. 

Orthopedic conditions can have a wide array of causes and the effect they have on the body can vary significantly.

Below is a list of the most common orthopedic conditions seen in children waiting for forever families. We provide the following information for reference purposes only and cannot attest to the accuracy of the information. We highly recommend speaking with an experienced physician for further details on each condition.

Common Orthopedic Conditions

Amniotic Band Syndrome

Adopt Special Needs: Special Needs - Orthopedic Conditions - Amniotic Band Syndrome


Other common names:

ABS, ADAM complex, Amniotic band sequence, Congenital constriction bands, Pseudoainhum, Intrauterine amputation, Streeter’s dysplasia, TEARS (The Early Amnion Rupture Spectrum) Congenital Transverse Defects or Deficiency, Limb-body Wall Complex

When a baby is developing inside the uterus, he or she is in fluid filled sac called the "amniotic sac." This sac is made up of strong fibers that are usually hard to break. Occasionally, this sac will tear open, and the sticky strands of the amniotic sac can wrap around the developing baby's limbs, head or torso. When this happens, amniotic banding may occur.

Each child with ABS is different. The most common effect of amniotic banding is seen when the fibers wrap around the arms, legs, fingers or toes. The fibers cause deep grooves which may look like the baby had a tight rubber band on that place. If the amniotic banding is severe, it may cause the complete amputation of finger(s), toe(s) or a portion of the limb. A cleft lip may occur when it is wrapped around the face (less common). Clubfeet, fused fingers and toes, and hemangiomasis are also common effects of amniotic banding. ABS is associated with an estimated 31.5% of club feet.

Causes:  
This is a randomly occurring defect; it is not genetic or inherited from the parents nor passed down to future children. Amniotic banding syndrome does not directly affect a child’s cognitive development.

Possible complications:  
ABS does not typically present any significant complications. However, ABS also attributes to numerous miscarriages, such as when a band becomes wrapped around the umbilical cord.

Treatment: 
Treatment depends on which body part the band was wrapped around and the severity of the abnormality it caused.

  • Prosthetics: Prosthetics allow a child to retain some function of the areas of their bodies affected by ABS. How and when these are needed are individual to the child.
  • Splints/Casts: Splints and casts may be used in lieu of surgery to correct club feet. See the description for Club feet for more information on treatment.
  • Physical Therapy: PT will help the child learn to adapt to the use of their prosthetic and improve their gross motor skills. PT will also help children with corrected club feet.  
  • Occupational Therapy: OT can help a child learn to adapt to their limitations in order to care for themselves, as well as improving fine motor skills like pinching, writing, and holding utensils to eat.
  • Surgery: In certain cases, surgery can help increase mobility in the child’s joints. There are several different types of surgery that could be used:
    • Distraction Augmentation Manoplasty – The technique pioneered by Dr. Norman Cowen “grows” up to one inch of bone per month to create palms and lengthen fingers. A contraption of steel rods, pins, and screws is inserted through the existing bone. Screws are turned at an even rate several times a day to achieve growth of up to one millimeter a day. Turning the screws takes up slack and the body responds to this stress by growing bone.
    • Realignment Surgery - Surgery to move affected bones into a better position.
    • If an amniotic band is constricting, doctors may perform a surgery to release the band. The exact method used will depend on details of your baby’s bands, like the number of bands, where they are and how deep and close they are.

Prognosis: 
Most children with this special need have a normal life span and can lead independent lives. However, some children with more serious cases need lifelong help with daily activities. There is excellent long-term outcome for babies with only their limbs affected, even in the case of amputation. 

Resources:

Arthrogryposis


Other common names: 
Athrogryposis multiplex congenita, amyloplasia

Athrogryposis is a condition where the child’s joints are contracted, or have limitations in movement. Each child with Athrogryposis is different. It can affect only a few joints, or in more serious cases multiple or nearly all joints. These joints may have almost normal movement, or they could also be “frozen” and unable to move at all. Joints in the arms and legs are most often affected, but can also happen in the jaw or spine. Children with Athrogryposis also typically have weak muscles in the areas where the contractures occur. The contractures in most forms of Athrogryposis usually involve more than one body area, but are typically non-progressive, meaning it won’t get worse over time. Athrogryposis does not directly affect a child’s cognitive development.

Causes: 
Arthrgryposis occurs when there is limited movement in the womb before a baby is born. This can be caused by the mother having an abnormally-shaped uterus or if there is not enough amniotic fluid.  It could also be caused by a malformed central nervous system or abnormal formation of the muscles or joints. As the joints are developing and they are kept immobile for a long period of time, extra tissue develops which permanently locks the joint. While most cases are not genetic, some doctors estimate that about 30% of cases are genetically related.  

Possible complications:  
When Athrogryposis affects the spine, it can cause scoliosis. This form is progressive, meaning it will get worse over time. In some children, there may also be hip dislocation, clubfeet and hands, facial deformities, abnormalities of the spinal cord, respiratory and cardiac disorders, abnormalities of the genital tract and skin disorders.

Treatment:

  • Physical Therapy: PT uses stretches and exercises to increase the range of motion and muscle strength while working on gross motor skills, like rolling, sitting, crawling, standing and walking.  
  • Occupational Therapy: OT can help a child learn to adapt to their limitations in order to care for themselves, as well as improving fine motor skills like pinching, writing, and holding utensils to eat.  
  • Splints/Casts: PTs and OTs may use splints and casts as part of therapy. These supports can help line up the bones so the child can move better and can also help keep the joints stretched. How and when these are needed are individual to the child. 
  • Speech Therapy: If the joints of the jaw are involved, the child may need speech therapy, which will help improve the use of the muscles in their face.  
  • Surgery: In certain cases, surgery can help increase mobility in the child’s joints. There are several different types of surgery that could be used: 
    • Surgery to cut into or through the bone to change how the bones line up. They may also change the size or position of the bone.  
    • Surgery to stretch or release the muscles or tendons that are restricting movement
    • Surgery for scoliosis, clubfoot or hip dislocation

Prognosis: 
Most children with this special need have a normal life span and can lead independent lives. However, some children with more serious cases need lifelong help with daily activities.

Resources:

Brachial Plexus Injury


Other common names: 
Erb’s palsy, Erb–Duchenne palsy

The brachial plexus is the group of nerves that send signals from the spine to the shoulder, arm and hand.  A brachial plexus injury can affect every child differently. In mild cases, it may cause numbness. In more severe cases, it can impact the arm in various ways from limited use of fingers to limited to no use of the entire arm on the side of the injury. A brachial plexus injury does not directly affect a child’s cognitive development.

Causes: 
A brachial plexus injury can occur when the nerves are stretched or torn by the shoulder being pushed down forcefully when the head is pushed up and away from that shoulder. This injury can be caused during a traumatic birth, as well as during contact sports, vehicular accidents or falls. It may cause weakness or paralysis of the affected arm.

Possible complications: 
A brachial plexus injury can cause stiff joints as well as loss of feeling in that arm, which make movement difficult. Left untreated it can also cause permanent muscle atrophy. 

Treatment:
Treatment options include:

  • Physical Therapy: PT uses stretches and exercises to increase the range of motion and muscle strength while working on gross motor skills, including balance and range of motion.
  • Occupational Therapy: OT can help a child learn to adapt to their limitations in order to care for themselves, as well as improving fine motor skills like pinching, writing, and holding utensils to eat.  
  • Splints/Braces: Splints may be used to prevent the hand from curling in. Braces may be used to help hold the arm in place.
  • Surgery: In certain cases, surgery can help increase mobility in the child’s arm. There are several different types of surgery that could be used:
    • Nerve graft: In this procedure, the damaged part of the brachial plexus is removed and replaced with sections of nerves cut from other parts of the body.
    • Nerve transfer: When the nerve root has been torn from the spinal cord, surgeons can take a less important nerve that's still attached to the spinal cord and hook it into the nerve that's no longer attached. Nerve tissue grows slowly, about an inch a month, so it can take several years to fully recover after surgery. 
    • Muscle transfer: The surgeon will remove a less important muscle or tendon from another part of the body and transfers it to the arm.

Prognosis: 
Most children with this special need have a normal life span and can lead independent lives. Partly because of the risk of muscle atrophy, surgery to repair brachial plexus nerves should ideally occur within three to six months after the injury. The success rate drops greatly if nerve surgery occurs more than a year after the injury. Most of the children being adopted internationally will not have had any sort of treatment.

Resources:

Club Feet

Adopt Special Needs: Special Needs - Orthopedic Conditions - Club Feet
Other common names:
 
Talipes equinovarus

Club foot is a condition that causes one foot (unilateral) or both feet (bilateral) to be twisted inward and often pointing downward. The exact cause of club foot is unknown. An abnormality of the tendons and ligaments in the foot causes an abnormal structure and position of the foot. The affected foot is often smaller and the leg thinner than normal, which may not be as obvious if both feet are affected.  Club foot occurs more often in boys than girls.  Club foot may, in rare instances, be associated with spinal deformities such as spina bifida. 

Treatment:
One method of treatment involves a series of manipulations of the foot, which is held in place with a full leg plaster cast.  This does not hurt the child.  Each cast is left on for 3 - 5 days as the muscles and ligaments relax and the bones grow into the corrected position. The doctor must be specially trained in this method, called the Ponseti Method. This treatment is successful in about 90% of children with club foot. 

Children may need a tenotomy, a surgery that goes hand-in-hand with the castings, to lengthen the Achilles tendon. After surgery or casts the doctor may have the child may wear an adjustable brace in which a pair of special shoes are attached. This brace usually doesn’t interfere with learning to walk.  

Older children who have not had early intervention for club feet may require several surgeries. 

Prognosis:
Most children with club foot can have healthy and pain free feet after treatment. They can walk, run, jump, and play sports like other children.

Resources:

Dwarfism

Adopt Special Needs: Special Needs - Orthopedic Conditions - Dwarfism


Dwarfism is a medical or genetic condition that results in an adult height of 4'10" or shorter. Most occurrences of dwarfism result from a random genetic mutation in either the sperm or the egg rather than either parent's complete genetic makeup.

Most children with dwarfism are born to parents of normal height. There are over 200 forms of dwarfism. The most common form, Achondroplasia, accounts for 70% of all cases. Achondroplasia results in arms and legs that are disproportionate to head and trunk size. In disproportionate dwarfism, children are greater risk for additional health problems including: 

  • Delays in motor skills development, such as sitting up, crawling and walking
  • Frequent ear infections and risk of hearing loss
  • Bowing of the legs
  • Difficulty breathing during sleep (sleep apnea)
  • Pressure on the spinal cord at the base of the skull
  • Excess fluid around the brain (hydrocephalus)
  • Crowded teeth
  • Progressive, severe hunching or swaying of the back
  • In adulthood, narrowing of the channel in the lower spine, resulting in pressure on the spinal cord and subsequent pain or numbness in the legs
  • Arthritis in adulthood
  • Weight gain that can further complicate problems with joints and the spine and place pressure on nerves

Treatment:
Treatment should be symptom-focused based on complications noted above. With some adaptations being made for their height difference, children and adults with dwarfism lead normal lives, even having children of their own.

Resources:

Fibular/Tibular Hemimelia


Fibular/tibular hemimelia is the congenital absence of the fibula and/or tibia and it is the most common congenital absence of long bone of the extremities. Children are usually missing the outside toe and/or have a short or missing fibula (one of the bones between the knee and ankle) on one leg. These children usually have a small foot on the short leg. Often they are missing one or more toes on the outside of the foot.  The ankle and/or hip joint may be affected. Other leg bones or joints may also be involved, including the hip, thigh bone or ankle. 

Funnel Chest/Pigeon Breast


Other common names:
 
Pectus Excavatum, Pectus Carinatum, Chicken chest

Funnel chest, or pigeon breast, is a term that describes a breastbone with a deep depression that may compress the heart or lungs. It may stem from rickets or a genetic defect, but the exact cause is unknown. Pigeon breast is a deformity that pushes the breastbone and rib cage forward, creating a barrel-like appearance. It occurs more often in boys than girls and may not be noticeable until a child grows older.

Hip Dysplasia


Hip dysplasia is the medical name used to describe a problem with formation of the hip joint in children. The location of the problem can be either the ball of the hip joint (femoral head), the socket of the hip joint (the acetabulum), or both. It usually does not cause pain, but can present itself in a variety of ways: a hip joint that feels loose or slips out of place, one leg may seem shorter than the other, extra folds of skin on the inside of the thigh(s), or a hip joint that moves differently than the other. A child who is walking may walk on the toes of one foot with the heel up off the floor or walk with a limp (or waddling gait if both hips are affected).

Treatment:
Treatment for this condition often depends on the age of the child.  When dysplasia is detected at birth, it can usually be corrected with the use of a harness or brace. If the condition is noticed until the child begins walking, treatment can be more complicated and may require surgery.

Prognosis:
If diagnosed and treated early, many children are able to develop a normal hip joint and have no limits in function. If left untreated past the age of two, however, hip dysplasia can lead to pain and arthritis.  It may also produce a difference in leg lengths leading to difficulty walking.  

Resources:

Osteogenesis Imperfecta


Other common names: 
OI, Brittle Bone Disease, Lobstein Syndrome

Osteogensis Imperfecta is a genetic bone disease characterized by bones which are weaker and that break easily. There are eight types of OI, and which type the child has dictates the severity of the symptoms. Children may also may have a blue tint to the whites of their eyes and hearing loss due to weak bones in the inner ear. Children with OI generally have poor dental structure and loose joints. More severe forms of OI may include bowed legs and arms, kyphosis (hunched back) and/or scoliosis.

Possible complications:
A person with mild OI may experience just a few fractures while those with the severe forms may have hundreds in a lifetime.

Treatment:
Most treatment focuses on trying to prevent fractures while helping a child be as mobile as possible.  Treatments include:

  • Physical therapy and non impact exercise such as swimming
  • Casts, splints or wraps for broken bones
  • Braces to support legs, ankles, knees and wrists as needed
  • Orthopedic surgery, often including implanting rods to support the long bones in arms or legs
  • Medications to strengthen bones
  • Mobility aids such as walkers or wheelchairs when needed.

Prognosis:
The prognosis for this condition varies greatly depending on the severity of symptoms.  For children with mild symptoms, life expectancy is not impacted.  For children with more severe symptoms, their life expectancy may be shorter.  Most people with OI however, lead very successful lives.

Resources:

Radial Club Hand


Other common names: 
Radial dysplasia

Radial club hand is a congenital condition in which the radius (the inner bone that connects the elbow to the forearm) did not form correctly in the womb. It may be malformed or completely missing. The arm is usually shorter, with a stiff wrist joint, and the hand curves inward. The thumb will either be small or missing completely. More than half of babies born with a club hand will be affected in both hands. It can occur by itself but is also associated with several genetic syndromes. 

Rickets


Other common names: 
Osteomalacia, Vitamin D deficiency

The most noticeable attributes of rickets include delayed physical growth, short stature and skeletal deformities such as bowed legs, pigeon or funnel chest, and scoliosis. Children may experience pain or tenderness in the bones of their arms, legs, pelvis or spine. They may also have delayed formation of their teeth or defects in the structure of their teeth.

Syndactyly


Other common names: 
Webbed fingers or toes, conjoined fingers or toes

Syndactyly is a condition where a child has finger or toes that are joined together or not formed completely. The fingers and toes can be short or curved or formed together. Children with syndactyly can usually do anything that a child with normal appearing fingers and toes. They may need help learning how to do daily activities like dressing. Syndactyly is the most common congenital hand and foot anomaly. It occurs in about 1 in 3,000 births.

Torticollis

Other common names: 
Wry neck, Loxia

Torticollis means "twisted neck", and if a child has this condition, their will tilt to one side, while the chin tilts to the other. The child will typically have a tightening in the muscles of the neck, which will cause limited movement, and they may also have a lump on one side of the neck. Babies may also develop positional plagiocephaly (asymmetrical head shape) because they will sleep more on one side than the other. 

Resources: