PREFERRED PRACTICE PATTERN
4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion (ROM) Associated with Bony or Soft Tissue Surgery1
An 11-year-old male is referred to physical therapy with a diagnosis of Legg–Calvé–Perthes disease (LCPD). Gait analysis reveals an antalgic gait on the affected side. The child reports 7/10 pain in the hip and groin and difficulty with ambulation and stair climbing. His passive range of motion (RON) is limited in hip internal rotation, abduction, and extension. The parents report use of a Scottish-Rite brace was unsuccessful and the child is scheduled for surgical correction. The therapist instructs the child in crutch training pre-op and then provides gait training, RMO exercises, and strengthening post-op.
Stage 1. Condensation: bone stops and femoral head becomes necrotic
Stage 2. Fragmentation of necrotic bone; femoral head and acetabulum become deformed; revascularization begins
Stage 3. Reossification of femoral head
Stage 4. Remodeling of femoral head and acetabulum
Legg–Calvé–Perthes disease. Chronic and significant deformity of the left femoral head is apparent (arrow). Subcortical cysts are also present. The joint space is normal. (Reproduced with permission from Shah BR, Lucchesi M: Atlas of Pediatric Emergency Medicine, © 2006, McGraw-Hill, New York.)
Children aged 3 to 13 years old, especially males aged 5 to 7 years old
Males 3 to 5 times more likely than females
Usually unilateral; bilateral 10% to20% of the time
Uncommon in African Americans
Legg–Calvé–Perthes disease is present bilaterally. (From Simon RR, Sherman SC Emergency Orthopedics. 6th edition. www.accessemergencymedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
TABLE 242-1Differentiation of Pediatric Hip Pathologies |Favorite Table|Download (.pdf) TABLE 242-1 Differentiation of Pediatric Hip Pathologies
| ||Congenital Hip Dislocation ||Septic Arthritis ||Legg–Calvé–Perthes Disease ||Transient Synovitis ||Slipped Femoral Capital Epiphysis |
|Age ||Birth ||Less than 2 years; rare in adults ||2–13 years ||2–12 years ||Males: 10–17 years; females: 8–15 years |
|Incidence ||Female > male; left > right; ...|
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