Friday, 27 February 2015

Legg-Calvé-Perthes Disease

Legg-Calvé-Perthes disease is a hip condition that affects young children, mainly seen in boys, between the ages of 3 and 12 years. It occurs when there is a reduced blood supply to the head of the femur, that is, the ball at the top of the thigh bone that fits into the hip joint (a ball and socket joint). The exact cause of the reduced blood supply is not known. The result of this reduced blood supply is that the bone starts to die, becoming brittle. This causes the hip joint to collapse, as the head of the femur loses its ball shape.
 

Signs and Symptoms
The most common sign is that the child may gradually develop a limp, which may not necessarily be accompanied by pain. However, mild hip and knee pain is common and can last for months; this pain is usually related to activity. Often the pain is referred into the groin area. There is a loss of range of movement in the hip joint. As a result of the limp, loss of muscle mass may occur in the thigh. The affected leg may also become shorter, due to the lack development as a result of not placing full weight on the leg. If a child in this age group starts to limp and develop pain in the hip area, that is unexplained, this condition must be suspected and one must contact a medical practitioner for further investigation.

Management
The primary goal is to ensure that the ball stays in the socket, so that the child does not dislocate the hip joint. Depending on the severity of the disease, this may require immobilization of the hip with the use of a brace. Bed rest may be necessary initially to reduce acute symptoms. Some activities may need to be adjusted in order to avoid placing too much weight on the hip joint. In some cases, crutches may also be used to assist in weight-bearing. Physical rehabilitation is necessary later on to rebuild muscles surrounding the hip joint and to regain range of motion in the hip joint. Surgery may only be required in very severe cases.

Prognosis
It is important that children with this disease see their medical practitioner regularly to monitor the healing process. Generally, children who develop this condition under the age of 6 years and who receive the appropriate treatment, recover fully. Those who develop it after the age of 6 years may develop a deformed hip joint and are more susceptible to developing arthritis later in life.

References
Foundations of Athletic Training: Prevention, Assessment and Management

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