This can potentially cause spinal cord compression, in which the small bones in the neck (vertebrae) press on the spinal cord. In many children with Down syndrome, the muscles and ligaments that support the neck are weak and loose. Many children will continue to walk, while others may experience pain and frequent falls. This instability will cause the knees to look deformed, but may not cause any other symptoms. Due to weak muscle tone, the kneecaps of a child with Down syndrome may slip out of the groove. The kneecap slides up and down within the groove when the knee bends and straightens. The kneecap normally rests in a small groove at the end of the thighbone. Patellofemoral (kneecap) instability is a common musculoskeletal problem in children with Down syndrome. Reproduced with permission from Caird MS, Wills BPD, Dormans JP: Down Syndrome in Children: The Role of the Orthopaedic Surgeon. Over time, this instability may lead to repeated hip dislocations, in which the femur pops completely out of the socket, without any outside force or injury. Because the ligaments and muscles that help hold the bones in place are loose in children with Down syndrome, the femur is more likely to slip out of place. In a normal hip, the ball of the upper end of the femur (thighbone) fits firmly into the acetabulum (socket). Joint InstabilityĬhildren with Down syndrome may have hip, knee, and other joints that slip out of place or become dislocated. This leads to excessive joint flexibility. The most common musculoskeletal effects of Down syndrome include weak muscle tone (hypotonia) and ligaments that are too loose (ligament laxity). A child with Down syndrome will eventually reach the same growth milestones as other children, however, he or she may be slower to turn over, sit, stand, walk, and do other physical activities. Associated cord abnormalities are seen in 12% of cases 5.The severity of developmental delay varies in children with Down syndrome. MR imaging can also reveal associated conditions such as myelomalacia, syringohydromyelia, diastematomyelia, diplomyelia, and Chiari I malformation 4,5. Disc bulge and herniation can be identified that may encroach upon and damage the spinal cord. It is excellent in demonstrating canal stenosis and cord compression. MRI is indicated in patients with neurologic deficits. It is a valuable tool to assess bony anatomy and is very helpful in pre-operative planning. Central canal narrowing is generally associated with secondary degenerative changes. CTĬT is able to better image many of the features seen on plain radiography and in addition may demonstrate canal stenosis. On flexion/extension radiographs, there will be less movement between fused segments, and increased movement between non-fused portions. Vertebral fusion: fused facets and spinous processesĪnteroposterior narrowing of the vertebral bodies ( wasp-waist sign)Īssociated scoliosis and Sprengel deformity 6) grouped by patterns of inheritance, associated anomalies, and the axial level of the most anterior fusion. Type III: cervical fusion with lower thoracic or lumbar vertebral fusionĢ. Type II: fusion of two or three vertebrae with associated hemivertebrae, occipito-atlantal fusion or other cervical spine abnormalities Type I: fusion of many cervical and upper thoracic vertebrae Original classification (described by Maurice Klippel and Andre Feil): three types grouped depending on the extent and location of vertebral fusion as well as associated vertebral abnormalities 2: It is believed to result from faulty segmentation along the embryo’s developing axis during the 3 rd to 8 th weeks of gestation. The classic clinical triad of a short neck, low hairline, and restricted neck motion is considered to be present in <50% of patients with this syndrome. AssociationsĪnomalies of the aortic arch and branching vessels, e.g. Klippel-Feil syndrome has an incidence of 1:40,000-42,000 2. There is a recognized female predilection 1.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |