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Please wait while the page loadsAnatomy & Physiology · Children's & Adult Nursing
Bones, joints, and muscles from growth plate to old age — the paediatric conditions, adult degenerative disease, and bedside checks that come up in both branches.
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Student note
The growth plate (physis) is the site of bone growth in children and closes in the late teens. Sarcopenia means age-related muscle loss. A fragility fracture is a fracture caused by a fall from standing height or less — the kind of fall that would not normally break a healthy bone. Compartment syndrome is dangerous pressure build-up inside a muscle compartment, usually after a fracture or tight cast.
Growth plate rule
The physis is the weakest point in a child’s skeleton until it fuses. Injuries near a joint can fracture through it.
Limp rule
A limp in a child is never assumed to be growing pains until DDH, Perthes, SUFE, infection, and safeguarding have been considered.
Hot joint rule
A hot, swollen, acutely painful single joint is septic arthritis until ruled out – it is an emergency, not a routine flare.
5 Ps rule
Pain, pallor, pulselessness, paraesthesia, paralysis – check these distal to any fracture or cast, every time.
What is bone actually made of, and how is it different across a lifespan?
Bone types
Bone tissue
Growing bone (child)
Ageing bone (adult)
Clinical pearl
A child’s bone is not just a smaller adult bone. The growth plate is the weakest part of a child’s skeleton, so injuries near a joint that would sprain an adult can fracture a child through the growth plate instead.
How are joints classified, and what actually lets them move?
Fibrous & cartilaginous
Synovial joint anatomy
Types of movement
Joints across the lifespan
How do muscles generate movement, and how does tone differ by age and condition?
Muscle types
How contraction works
Tone & posture
Muscle across the lifespan
Clinical pearl
Sarcopenia is not just “getting older and weaker.” It is a measurable loss of muscle mass and strength that raises the risk of falls, fractures, and loss of independence – and it accelerates fast during illness, immobility, or a hospital stay.
Which hip, bone, and growth-plate conditions come up again and again in children’s nursing?
Hip conditions
Fracture patterns
Why growth plates matter
Safeguarding awareness
Red flags
Clinical pearl
A limp in a child is never “just growing pains” until something more serious has been ruled out. DDH, Perthes, SUFE, septic arthritis, and safeguarding concerns can all present as a limp, so a full history and examination matter every time.
What are the degenerative and inflammatory conditions that come up most in adult care?
Osteoarthritis
Rheumatoid arthritis
Osteoporosis
Fractures in older adults
Red flags
Clinical pearl
A hot, swollen, acutely painful joint is a medical emergency until septic arthritis has been ruled out, because untreated joint infection can destroy the joint within days. It is not automatically “just a flare of arthritis.”
What should you actually check at the bedside, and how do you keep movement safe?
Paediatric screen (pGALS)
Adult MSK & falls check
Moving & handling
Immobility risks
Red flags
Clinical pearl
The 5 Ps of a neurovascular check – pain, pallor, pulselessness, paraesthesia, paralysis – are a quick way to remember what to check distal to a fracture or cast. Severe pain out of proportion to the injury, especially with pain on passive stretch, should make you think of compartment syndrome and escalate immediately.
| Bone type | Examples | Role |
|---|---|---|
| Long bones | Femur, humerus, tibia, radius | Provide leverage for movement and bear weight. Contain the growth plate in children. |
| Short bones | Carpals, tarsals | Provide stability with some limited movement, mostly in the wrist and ankle. |
| Flat bones | Skull, ribs, sternum, scapula | Protect underlying organs and provide broad surfaces for muscle attachment. |
| Irregular bones | Vertebrae, facial bones | Complex shapes suited to their specific protective or structural job. |
| Sesamoid bones | Patella | Sit within a tendon and reduce friction over a joint. |
| Joint type | Examples | Movement allowed |
|---|---|---|
| Ball and socket | Hip, shoulder | Widest range of movement: flexion, extension, abduction, adduction, rotation, circumduction. |
| Hinge | Elbow, knee | Flexion and extension in one plane only. |
| Pivot | Atlas/axis (neck) | Rotation around a single axis. |
| Saddle | Base of thumb | Flexion, extension, abduction, adduction – but not full rotation. |
| Gliding (plane) | Carpals, tarsals | Small gliding movements between flat bone surfaces. |
A synovial joint: cartilage cushions the bone ends, the capsule seals the joint space, and synovial fluid lubricates movement
| Condition | Typical age | Key features | Management |
|---|---|---|---|
| Developmental dysplasia of the hip (DDH) | Newborn – screened at birth and 6–8 week check | Asymmetrical skin creases, unequal leg length, clunk on Ortolani/Barlow testing, limited hip abduction. | Pavlik harness for younger infants; bracing or surgery if diagnosed later or harness is unsuccessful. |
| Perthes disease | Usually 4–8 years, more common in boys | Gradual-onset limp, hip or referred knee pain, reduced hip movement, no clear injury. | Ranges from monitoring to bracing or surgery depending on severity; aims to protect the femoral head while it revascularises. |
| Slipped upper femoral epiphysis (SUFE) | Typically adolescent, often peri-pubertal and overweight | Limp with hip, groin, thigh, or knee pain; leg often held externally rotated. | Urgent orthopaedic referral – surgical fixation to stabilise the growth plate and prevent further slip. |
Clinical pearl
DDH, Perthes, and SUFE can all present as a limp with no clear injury — the difference is usually age. DDH is picked up in infancy through screening, Perthes typically presents around 4–8 years, and SUFE typically presents in overweight adolescents around puberty.
| Fracture type | What it looks like | Clinical note |
|---|---|---|
| Greenstick fracture | The bone bends and partially breaks on one side, like a green twig, without breaking all the way through. | Reflects the flexibility of a child’s bone compared with an adult’s. |
| Buckle (torus) fracture | The bone compresses and bulges outward without a clear break line. | Usually stable and often needs simple splinting rather than a full cast. |
| Growth plate (Salter-Harris) fracture | The fracture line runs through or near the growth plate (physis). | Needs careful assessment and follow-up because it can affect future bone growth. |
| Complete fracture | The bone breaks all the way through into two or more pieces. | Seen in children and adults; management depends on displacement and stability. |
| Feature | Osteoarthritis | Rheumatoid arthritis |
|---|---|---|
| Underlying cause | Mechanical wear and cartilage breakdown over time | Autoimmune inflammation of the synovium |
| Typical pattern | Weight-bearing joints, often asymmetrical | Small joints of hands and feet, usually symmetrical |
| Morning stiffness | Usually under 30 minutes | Often over an hour |
| Pain pattern | Worse with activity, better with rest | Can be present at rest, worse after inactivity |
| Systemic features | Uncommon | Fatigue, malaise, low-grade fever can occur |
| Risk factor | Why it matters |
|---|---|
| Age and menopause | Bone density falls with age and drops more quickly after menopause as oestrogen falls. |
| Long-term steroid use | Corticosteroids reduce bone formation and increase bone breakdown over time. |
| Low body weight and inactivity | Less mechanical loading on bone is linked to lower bone density. |
| Smoking and excess alcohol | Both are associated with lower bone density and higher fracture risk. |
| Family history and previous fragility fracture | A prior fragility fracture is one of the strongest predictors of another. |
| Step | What you do | What you are looking for |
|---|---|---|
| Gait | Watch the child walk normally, then on heels and toes if able. | Limp, asymmetry, toe-walking, or reluctance to bear weight. |
| Arms | Check shoulders, elbows, wrists, and hands for movement and grip. | Reduced range of movement, swelling, or pain on movement. |
| Legs | Check hip, knee, and ankle movement, and look for swelling or deformity. | Reduced hip abduction, knee swelling, or leg-length asymmetry. |
| Spine | Check posture from behind and ask the child to bend forward. | Scoliosis, abnormal curvature, or reduced spinal movement. |
Exam tip
pGALS stands for paediatric Gait, Arms, Legs, Spine — a quick screening examination used to pick up joint or musculoskeletal problems in children. It is not a substitute for a full assessment if something looks abnormal, but it is a useful structure to describe in an OSCE.
Assess before you move
Use equipment, not muscle
Communicate every step
Reassess afterwards
Clinical pearl
Immobility affects the whole body, not just muscles and joints. Pressure injury risk, muscle wasting, and venous thromboembolism risk can all rise within days of reduced movement, which is why safe, early mobilisation is a nursing priority in both paediatric and adult care wherever it is appropriate.
DDH, Perthes, SUFE
Infant screening → ages 4–8 → overweight adolescent – age is the key differentiator
Fracture patterns
Greenstick and buckle reflect flexible young bone; watch growth-plate fractures closely
OA vs RA
OA: activity-related, under 30 min stiffness. RA: symmetrical, over 1hr stiffness
5 Ps
Pain, pallor, pulselessness, paraesthesia, paralysis – check distal to any injury
Sources & References
Waugh A & Grant A (2018) — Ross and Wilson Anatomy and Physiology in Health and Illness (13th edn)NICE (2022) — Osteoarthritis in over 16s: diagnosis and management (NG226)NICE (2018) — Rheumatoid arthritis in adults: management (NG100)NICE (2021) — Osteoporosis – prevention of fragility fractures (Clinical Knowledge Summary)Royal College of Nursing — Moving and handling guidanceAlso practice with