Term
| Define Legg-Calve-Perthes disease (LCPD) |
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Definition
• a self-limiting disorder resulting in necrosis of the femoral head and possibly all or part of the capital
femoral epiphysis in otherwise normal children
• may cause flattening or collapse of the femoral head
• the necrotic bone is eventually resorbed and then new bone is deposited and remodeled |
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Term
| State the risk factors associated with LCPD |
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Definition
• history of LBW
• delayed skeletal maturity
• boys > girls (girls tend to be diagnosed later)
• children of Northern European or Asian ancestry |
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Term
| Discuss the signs and symptoms of LCPD |
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Definition
• first symptom is usually a painless limp that occurs intermittently after activity
• progresses to a constant limp assoc with mild pain in the groin, medial thigh or medial knee
• disuse atrophy in the gluteal region, thigh and calf
• more sever cases have a Trendelenburg gait and 1-2cm leg length discrepancy after healing and
remodeling |
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Term
| Name the motions which are most limited in LCPD |
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Definition
• hip abduction
• internal rotation
• hip extension may become limited due to muscle spasms and adaptive shortening |
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Term
| Describe the progression of LCPD |
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Definition
| • painless limp > constant limp with mild pain > limited ROM > disuse atrophy > trendelenburg or LLD |
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Term
| Describe the 4 grades of LCPD |
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Definition
1. grade I
• no clear necrosis
• involvement of only the anterior portion of the femoral head
2. grade II
• greater portion of anterior epiphysis involved
• necrosis and subsequent collapse occur
3. grade III
• necrosis and collapse of major portion of femoral head
• normal medial and lateral border
4. grade IV
• necrosis and destruction of entire femoral head and neck
• grade I & II assoc with best prognosis; grade III & IV lateral subluxation most common |
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Term
| Discuss the significance of lateral subluxation in LCPD |
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Definition
| • subluxation places additional stress on the femoral head and may result in greater deformity |
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Term
| Name the position of ‘containment’ of the femoral head |
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Definition
• position of containment allows remodeling of the femoral head with the greatest congruency to the
acetabulum and to maintain full ROM
• debate in literature concerning treatment method with best outcome
• hip abduction and internal rotation with knees extended and feet in neutral
• hip abduction with no rotation, knees not contained
• hip abduction and internal rotation |
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Term
| Name the types of orthoses/casts used in LCPD and the positions of the legs in each |
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Definition
• A-frame or Toronto brace
• hip abduction and internal rotation with knees extended and feet in neutral
• Scottish Rite brace
• hip abduction with no rotation, knees not contained
• Petrie cast
• hip abduction and internal rotation |
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Term
| Describe the medical management of LCPD |
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Definition
• debate re: best treatment method with best results
• conservative treatment (mild cases)
• no treatment, monitor closely by MD with x-rays
• bed rest and traction to decrease muscle spasms and pain
• orthotic
• surgical treatment (grades III & IV)
• varus osteotomy and/or pelvic osteotomy to provide better alignment of femoral head & acetabulum
• post-op spica casting for 6-8 weeks |
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Term
| Discuss the physical therapy management of LCPD |
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Definition
• evaluation
• goniometric measurements of all hip PROM
• strength assessment
• functional skills assessment
• parent education
• gait training
• with orthosis and assistive device
• young children may be able to ambulate with walker depending on type of brace/cast
• older children in braces or Petrie casts ambulation with crutches - one in front, one behind
• PWB or NWB on affected leg
• post-op
• parent education on lifting and positioning child in casts
• mobility training & gait training - scooterboard or w/c
• after cast removal
• increase ROM & muscle strength
• gait training - FWB only recommended with adequate ROM & strength |
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