Presentation
Jay Kumar, M.D., Attending, Orthopaedic Surgery August 29, 1995 CLINICAL CASE PRESENTATION ORTHOPAEDIC DEPARTMENT THE ALFRED I. [gait.aidi.udel.edu]
The paediatrician is concerned because most of the disorders present in childhood as a problem in clinical differential diagnosis. [buecher.de]
Unlike previously reported cases with the Ribbing type, the present patients did not have short stature or brachydactyly. This report expands further the phenotypic variations of COMP defects. [link.springer.com]
[…] cartilage and play a role in skeletal development – chondrocytes of this type are rarely found in osteochondrodysplasias), [5] brachydactyly (shortened fingers) and micromelia (undersized, shortened bones). [2] The characteristic “boomerang” malformation presents [checkrare.com]
Study Guide Key Points: MED is a common skeletal dysplasia, inherited in an autosomal dominant fashion, with the most common mutations affecting COMP or Collagen IX Presentation is usually due to joint pain or contractures, and the spine is not affected [posna.org]
Entire Body System
- Short Stature
stature Treatment Treatment will depend on the cause of the short stature. [medicalnewstoday.com]
Joint pain, joint deformity, waddling gait, and short stature are the main clinical signs and symptoms. [malacards.org]
Note moderate short stature, flat facial profile (fetal face–like appearance), short forearms, and small hands. [emedicine.medscape.com]
Unlike previously reported cases with the Ribbing type, the present patients did not have short stature or brachydactyly. This report expands further the phenotypic variations of COMP defects. [link.springer.com]
- Pain
In general, activity that increases pain is to be avoided. For example: Typing can reduce pain from writing. Voice control software or a more ergonomic keyboard can reduce pain from typing. Bent knees or sitting can reduce pain from standing. [en.wikipedia.org]
Joint pain, joint deformity, waddling gait, and short stature are the main clinical signs and symptoms. [malacards.org]
Joint pain is usually worse after physical exercise. Pain and loss of motion in the shoulders may occur in adulthood. [rarediseases.org]
[…] hypermobility COL5A1 or COL5A2 mutation; t ype V collagen (co-expressed with type I collagen) Hypermobility - Type III (hypermobile) autosomal dominant large and small joint hypermobility, recurring joint subluxations/dislocations, velvety soft skin, chronic pain [orthobullets.com]
Study Guide Key Points: MED is a common skeletal dysplasia, inherited in an autosomal dominant fashion, with the most common mutations affecting COMP or Collagen IX Presentation is usually due to joint pain or contractures, and the spine is not affected [posna.org]
- Short Finger
Features include: an average-sized trunk short limbs, especially the upper arms and legs short fingers, possibly with a wide space between the middle and ring fingers limited mobility in the elbows a large head with a prominent forehead and flattened [medicalnewstoday.com]
- Surgical Procedure
Surgical procedures may be recommended to treat abnormalities of the knee. Investigational Therapies A registry for skeletal dysplasias has been set up at the University of California Los Angeles. [rarediseases.org]
Ears
- Hearing Impairment
STICKLER SYNDROME, TYPE II; STL2 Is also known as stickler syndrome, vitreous type 2, stickler syndrome, beaded vitreous type; Related symptoms: Autosomal dominant inheritance Pica Hearing impairment Micrognathia Sensorineural hearing impairment SOURCES [mendelian.co]
Hearing impairment not usual (it is related to fusion of ossicles). Some patients present deformities of larynx and upper airways (laryngo and tracheomalacia). They can develop severe respiratory insufficiency. [gait.aidi.udel.edu]
Musculoskeletal
- Brachydactyly
Unlike previously reported cases with the Ribbing type, the present patients did not have short stature or brachydactyly. This report expands further the phenotypic variations of COMP defects. [link.springer.com]
[…] callosum,hydrocephalus, cardiac defect, kidney malformation AD Type I (most common) Telephone receiver femora, normal skull Lethal Type II Cloverleaf-shaped skull Lethal Achondroplasia Common FGFR3 AD Heterozygous Macrocephaly Rhizomelia Trident hand Brachydactyly [perinatology.com]
[…] heterozygous parents of those with Robinow syndrome do not have brachydactyly. 18, 19 Similarly, heterozygous IHH mutations cause brachydactyly type A1 (BDA1), whereas homozygous mutations cause acrocapital femoral dysplasia (ACFD) with no manifestations [jmg.bmj.com]
EPIPHYSEAL DYSPLASIA, MULTIPLE, WITH MYOPIA AND CONDUCTIVE DEAFNESS; EDMMD Is also known as ;multiple epiphyseal dysplasia-myopia-deafness syndrome Related symptoms: Autosomal dominant inheritance Short stature Hearing impairment Cataract Brachydactyly [mendelian.co]
12.3.4 Brachydactyly.- 12.3.5 Ectrodactyly.- 13. Mucopolysaccharidoses and Other Storage Disorders.- 13.1 MPS I-H(Hurler Syndrome).- 13.2 MPS II(Hunter Syndrome).- 13.3 MPS IV(Morquio Syndrome).- 13.4 Gaucher Disease.- 14. [buecher.de]
- Genu Valgum
Affiliated tissues include bone and eye, and related phenotypes are genu valgum and epiphyseal dysplasia [malacards.org]
SPONDYLOMETAPHYSEAL DYSPLASIA, ALGERIAN TYPE Is also known as spondylometaphyseal dysplasia, schmidt type, spondylometaphyseal dysplasia with severe genu valgum;spondylometaphyseal dysplasia with severe genu valgum; spondylometaphyseal dysplasia, algerian [mendelian.co]
Progressive genu valgum and increased flexion contractures of knees and hips are now compromising the walking ability of the patient. PREVIOUS ORTHOPAEDIC TREATMENT: Feet: bilateral taping and serial casts. PMLR on the left foot (at age 9 months). [gait.aidi.udel.edu]
In rare cases, additional symptoms may occur including a hip deformity in which the thigh bone is angled toward the center of the body (cox vara), bowed legs (genu varum), and ‘knock knees’ (genu valgum), a condition in which the legs bend inward so that [rarediseases.org]
- Arthralgia
The criteria are: Major criteria [ edit ] A Beighton score of 4/9 or more (either current or historic) Arthralgia for more than three months in four or more joints Minor criteria [ edit ] A Beighton score of 1, 2 or 3/9 (0, 1, 2 or 3 if aged 50+) Arthralgia [en.wikipedia.org]
Osteoarthritis Malar flattening Spondyloepiphyseal dysplasia Vitreoretinal degeneration Autosomal recessive inheritance Scoliosis Retinopathy Rare Symptoms - Less than 30% cases Pierre-Robin sequence Anteverted nares Coxa vara Short palm Pectus carinatum Arthralgia [mendelian.co]
Affected individuals also experience early onset of inflammation, pain and stiffness in affected joints (early-onset arthritis) that can develop into chronic joint pain (arthralgia). [rarediseases.org]
- Severe Short Stature
GH-IGF-1 axis and GH treatment in skeletal dysplasias Most patients with skeletal dysplasia show severe short stature. [intechopen.com]
He had a waddling gait since he started walking (at 1 year), short limbs with severe short stature, bowing of lower limbs, and severe lumbar lordosis. At 13 years of age, he underwent bilateral osteotomy of both proximal tibiae for severe bowing. [jmg.bmj.com]
- Coxa Valga
valga, scoliosis, and short trunked short stature associated with amelogenesis imperfecta (see this term) of both primary and permanent dentition. [mendelian.co]
Delayed femoral head appearing, coxa valga or, on the contrary, coxa vara are common findings. Valgus deformity of the knees, associated to flexion contracture, is another common finding. [gait.aidi.udel.edu]
Face, Head & Neck
- Round Face
Hernia Delayed skeletal maturation Abnormal facial shape Increased serum beta-hexosaminidase Increased serum iduronate sulfatase activity Abnormality of the rib cage Ptosis Membranous vitreous appearance Limitation of joint mobility Anterior rib cupping Round [mendelian.co]
Neurologic
- Waddling Gait
Joint pain, joint deformity, waddling gait, and short stature are the main clinical signs and symptoms. [malacards.org]
Waddling gait was noted when he began walking at approximately 1 year of age. [jmg.bmj.com]
Workup
[…] each elbow >10° (1 point each) forward flexion of trunk with palms on floor and knees fully extended (1 point) Imaging Radiographs look for joint dislocations/subluxations kyphoscoliosis Echocardiogram cardiac evaluation with echo is mandatory in the workup [orthobullets.com]
Clinical Testing and Workup Basic x-rays (radiographs) can help to establish a diagnosis by revealing abnormal epiphyses and other characteristic skeletal findings. Molecular genetic testing can support a diagnosis of multiple epiphyseal dysplasia. [rarediseases.org]
Treatment
The reader learns of pediatric orthopedic deformity in relation to normal and abnormal developmental biology, the worsening of untreated disease with growth, and the diagnostic and treatment interventions required based on the stage of progression. * [books.google.de]
The patient may receive treatment to control chronic conditions, such as heart disease, lung disease, and arthritis. Treatment for DSS As DSS often stems from a genetic disorder, treatment focuses mainly on the complications. [medicalnewstoday.com]
Waiting for new, more effective and specific treatments in patients with ACH, r-hGH treatment may be beneficial in the treatment of short stature in achondroplasia. [intechopen.com]
TREATMENT: Literature data are not enough to evaluate the orthopaedic treatment of this disease. Prevention and treatment of contractures, dislocations as well as spinal and foot deformities should be the goal of the orthopedist. [gait.aidi.udel.edu]
Our registered charity Number is : 326161 The Association Aims to to aid research to find a universal treatment for children with Perthes disease and hopefully a cure. [perthes.org.uk]
Prognosis
Molecular analysis is likely to expand the clinical spectrum of MED and may also provide data relevant to prognosis and future therapeutic intervention. The overall incidence of MED is estimated to be 1 in 10,000 births. [egl-eurofins.com]
[…] absent radius in TAR syndrome, multiple epiphyseal centres in the patella I some form of diastrophic dysplasia) Soft tissue : wasting or excessive soft tissues, contractures and calcifications should be looked for, as they are involved in patient’s prognosis [intechopen.com]
Etiology
雑誌 Pediatr Pathol Mol Med 22:53-75 (2003) 文献 PMID: 11891674 著者 Unger S, Hecht JT タイトル Pseudoachondroplasia and multiple epiphyseal dysplasia: New etiologic developments. [genome.jp]
Etiology: The genetic basis for this disorder is now reasonably well understood. MED is a heterogeneous disorder. [posna.org]
Epidemiology
Epidemiology: Clinical Findings: Patients typically present later in childhood with joint pain in the lower extremities, decreased range of motion, gait disturbance, or angular deformities of the knees, such as genu varum or valgum. [posna.org]
Epidemiology [ edit ] Hypermobile joints occur in about 10 to 25% of the population. [2] See also [ edit ] Ligamentous laxity References [ edit ] ^ Federman CA, Dumesic DA, Boone WR, Shapiro SS. [en.wikipedia.org]
Benli IT, Akalin S, Boysan E, Mumcu EF, Kis M, Türkoglu D: Epidemiological, clinical and radiological aspects of osteopoidilosis. J Bone Joint Surg 74B:504-6,1992. [orthopaedicsone.com]
Based on the epidemiological and clinical aspects, skeletal dysplasias can be further subdivided in order to simplify the diagnostic approach [ 26, 27 ]: Depending on the neonatal lethality: Usually fatal Achondrogenesis Thanatophoric dysplasia Short [intechopen.com]
Prevention
JAN-FEB 2003; 22 (1) : 53-75Smith-RKW; Birch-HL; Goodman-S; Heinegard-D; Goodship-AEThe influence of ageing and exercise on tendon growth and degeneration - hypotheses for the initiation and prevention of strain-induced tendinopathiesCOMPARATIVE-BIOCHEMISTRY-AND-PHYSIOLOGY-A-MOLECULAR-AND-INTEGRATIVE-PHYSIOLOGY [malattierare.regione.veneto.it]
Early intervention can prevent future problems in many cases. Normally, at 8 years of age, a child's arm span is around the same as their height. [medicalnewstoday.com]
[…] recalcitrant to non-operative management technique soft tissue procedures are unlikely successful in hypermobile joints posterior spinal fusion indications progressive scoliosis (most common in Kyphoscoliosis Type) technique longer fusions needed to prevent [orthobullets.com]
Prevention and treatment of contractures, dislocations as well as spinal and foot deformities should be the goal of the orthopedist. CASE HISTORY: O.A. female. DOB 2-6-91. Product of a normal gestation. Two healthy half-sisters. [gait.aidi.udel.edu]
Medical care for individuals with skeletal dysplasia should be directed at preventing neurologic and orthopedic complications due to spinal cord compression, joint instability, and long bone deformity. [emedicine.medscape.com]