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An 11-year-old female with a history of progressively worsening right knee pain for the past 5 months was referred to physical therapy. The patient has a body mass index of 24 kg/m2 and her previous medical history is unremarkable. When she was evaluated by the physical therapist, the patient presented with an antalgic gait pattern with the right lower extremity in a slight externally rotated position. Her knee examination was unremarkable and testing did not reproduce her chief complaint of knee pain. However, the patient experienced anterolateral hip pain during examination of her right hip. Right hip flexion and internal rotation range of motion were limited both actively and passively and these motions reproduced her hip and knee pain. Based upon the history and physical examination findings, the physical therapist was concerned about a possible slipped capital femoral epiphysis.

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What examination signs may be associated with the diagnosis of a slipped capital femoral epiphysis?

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What are the examination priorities?

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Based on the patient's suspected diagnosis, what do you anticipate may be the contributing factors to her condition?

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What are the most appropriate physical therapy interventions?

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What is her rehabilitation prognosis?

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IN SITU SURGICAL FIXATION: Standard treatment for a slipped capital femoral epiphysis in which a screw is placed through the physis and epiphysis to prevent further progression of the slip

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KLEIN LINE: Method to assess for a slipped capital femoral epiphysis on the anterior to posterior hip radiograph by drawing a line along the superior border of the femoral neck; in a normal hip, the Klein line intersects a portion of the femoral epiphysis; in the individual with a slipped capital femoral epiphysis, the Klein line is level with, or lateral to, the epiphysis

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SLIPPED CAPITAL FEMORAL EPIPHYSIS: Posterior and inferior displacement of the proximal femoral epiphysis (femoral head) on the metaphysis (femoral neck) through the proximal femoral physis (growth plate)

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STABLE SLIPPED CAPITAL FEMORAL EPIPHYSIS: A slip classification in terms of mechanical stability in which the individual is able to bear weight with or without crutches but may walk with an antalgic gait

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UNSTABLE SLIPPED CAPITAL FEMORAL EPIPHYSIS: A slip classification in terms of mechanical stability in which the slip is too painful and unstable to allow the individual to bear weight even with crutches

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  1. Describe slipped capital femoral epiphysis and identify risk factors associated with this condition.

  2. Identify appropriate diagnostic imaging that should be completed to rule in or rule out slipped capital femoral epiphysis.

  3. Describe the most appropriate physical therapy interventions for a patient with a slipped capital femoral epiphysis.

  4. Describe the prognosis for an individual with a slipped capital femoral epiphysis.

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PT considerations during management of the individual ...

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