The Limping Adolescent- Hip Joint
Degenerative arthritis ex. the mail carrier
If not correctly healed, what to pt's with Legg-Calve-Perthes disease have an increased chance of when they grow older?
Legg-Calve-Perthes disease Stage 2 of Waldrenstroms pathologic stages - "Crescent sign", and Gages sign (rat bite sign)- the necrotic bone is removed by osteoclasts, forming this sign
What are these called, what disease is it associted with. What stage is this in Waldrenstroms stage, and explain it
Boy around age of 14
What is the typical pt for Slipped Capital Femoral Epiphsyis?
Scottish rite brace- tx for Legg-Calve-Perthes disease
What is this a tx for? What is it called?
Legg-Calve-Perthes disease Happens when the blood supply to the femoral neck is cutt off, but the cartillage can keep growing, but bone dies (necrosis). Causes this Coxa plana (flattening of femoral neck)> One day when kid jumps or something,the head will break
What diesaese is this associated with? Explain what cuased this
Caucasiains, 7-8 yo
What race and age range is most suscetable to Legg-Calve-Perthes disease?
Stage 3: Osteoblasts laying down new cartilage and bone matrix Important to immobilze the kid and keep teh head covered/safe. If you don't keep it covered> takes on a weird shape> DJD can occur in teh future
What stage is vital for the prognosis of Legg-Calve-Perthes disease?
GAleazzi test One femur is shorter> might be a sign of Legg-Calv-Perthes disease
What test is this? What is it a sign of?
Septic arthritis, TS will have normal levels
Which test (septic arthritis or transiet synovitis) has an incrased WBC/ESR
Legg-Calve-perthes
______ Interruption of when one blood supply comes in at the femoral neck, and another at the diaphysis (filling up the a shaft.
Coxa plana Legg-Calve-Perthes disease
______ is flattening of hte femoral neck due to necrosis (lack of B.S.) What disease is this associated with?
Slipped Capital Femoral epiphsysi -Klein line should go through teh femoral neck, if not know its SCFE
dx, and expain this x-ray
Septic Arthritis -High fever -Sleepy- tells u toxic
Case: -10 yo boy -Fever of 102 -Limping with pain in right hip -Laying down on table- very sleepy -Adenopathy
Transient synovitis -Often associated with URI's -
Case: -4 yo boy -Fever of 101 - 2 days no walking -Sick x10 days ago-URI -Pain in anterior groin w/ any motion -Adenopathy present
-Know it cant be growing pains b/ c there's a limp present -No fever- takes out TS and septic arthritis
Case: -8 yo boy, healthy -Limping for 6 months, but now has pain - No trauma -No fever -
Slipped captial Femoral Epiphysis -shows refereed pain to knee
Case: -Sudden onset of sharp left knee pain -Golfing all summer - Severe limp -h/o injuring knee x4 years ago w/ football, sts pain is similar -Lachman's test: Thigh abducts and externally rotates
Growing pains
Case: -Young pt - Bilateral leg pain - Pain only at night when laying down -No limp/pain during day
Females
Do M or F's have a worse prognosis for Legg-Calve-Perthes disease?
Slipped Capital FEmoral Epiphphysis -Femoral neck is displacing. Fx right through the epiphysis -MCL sprain x4 years ago wasnt actually an MCL sprain
Dx?
Hip issue (knee is just refereed pain)
If pt comes in with knee pain, and lachman's test shows thigh abduction and ext rotation, waht is this a sign of?
Cateterall's sign (log roll test) - Test moves hip not knee, so if pt says knee is hurting during the test know ti's an actual hip issue
If pt complains of knee pain, how can you test to make sure the knee pain isn't jsut reffered pain, for an actual hip issue?
