Perthes’ Disease

Perthes’ disease affects children, most commonly boys aged between four and ten years old, but can also occasionally occur in younger children and teenagers. Tiredness and groin pain are two common symptoms, and they may have a noticeable limp.

Symptoms Symptoms of Perthes’ disease are usually on one side only and include: • Tiredness and pain in the groin, thigh, and sometimes in the knee • Pain in the knee only, even though the disease affects the hip • Stiffness and reduced range of motion at the hip joint • Walking with a limp • The affected leg may appear shorter than the other leg Diagnosis It is important a medical professional examines any knee or hip pain in children. An early diagnosis is important to avoid long-term complications. A doctor may X-ray the hip to help diagnose the cause of hip pain. However, in the early stages of the disease, X-rays may appear normal. Therefore, your doctor uses other investigations such as MRI or bone scans. What is Perthes’ disease? Perthes’ disease commonly affects children between the age of 4 and ten years old. But can also occasionally occur in older children and teenagers. Another name for Perthes’ disease is Legg–Calvé–Perthes disease. The exact cause of the disease is unknown. It affects the hip joint, where the top of the femur (thigh bone) meets the socket of the pelvis (acetabulum). The blood supply to the head of the femur is disrupted, resulting in necrosis. This is where the bone softens and begins to break down. Once the blood supply returns to normal, bone tissue is laid down and the femoral head reforms and hardens. This occurs over a period of 1 to 3 years. Due to the joint being a ball and socket, one of the main problems is that the re-growth may not form in a spherical shape as before. The severity of deformity of the head of the femur determines the degree of symptoms and if there are likely to be any future problems such as a permanently decreased range of motion at the joint and arthritis. Boys are far more likely to develop this condition than girls, although girls tend to suffer from more severe symptoms and future problems. Symptoms are usually only in one hip, although occasionally can affect both sides. Treatment and management of Perthes’ disease Depending on how severe the disease is will determine whether it requires conservative treatment or surgery. Treatment consists of rest from any aggravating activity or exercise and maintaining range of motion in the hip through mobility exercises. In particular, exercises to maintain abduction of the hip (moving the leg out sideways) and internal rotation of the hip. Treatment will depend on the age of the child and the severity of the condition but may include bed rest, crutches, traction, a plaster cast, leg brace, or surgery in extremely severe cases. Your surgeon performs arthroscopic (keyhole) surgery to remove loose bodies within the joint and repair damaged cartilage (chondroplasty). Perthes’ disease usually resolves over time as the athlete grows, as long as they manage it properly. Athletes can return to sport when they are free of symptoms. With competitive young athletes managing injuries and diseases is important. This may mean changing sporting activity for a while, or reducing the volume of training and focussing on quality. For example, a young soccer player may play once or twice a week and substitute other activities such as swimming, or light technical training. If Perthes’ disease is not managed correctly then long-term complications include arthritis because the surface of the joint is irregular, resulting in faster wear and tear. Content Source: Sportsinjuryclinic

Radial Club Hand Treatment & Management

“Radial Club Hand Syndrome” can be defined as the medical condition in which there are deficiencies in the extremities of the pre-axial and radial side of the arms. Although the deficiencies are confined to the extremities, forearm and hand, the deficiencies may stretch to the whole of the arm. Radial club hand syndrome is usually detected by the radio graphs that are performed on the patient or by the ultrasound imaging of the affected or suspected areas.

Classification: The radial club hand has various kinds of types which need to be handled in different manners. The disease is classified as follows: 1. Type N: Isolated thumb anomaly 2. Type 0: Carpal bone deficiency 3. Type I: Short distal radius 4. Type II: Miniature hypoplastic radius 5. Type III: Absence of distal radius 6. Type IV: Radius being completely absent 7. Type V: Complete absent radius along with proximal humerus manifestations Treatment: Just like stated above the different types of radial club hand requires various kinds of treatments to be rectified most of which usually involve surgical process for rectification. The most common treatments that are applied to children suffering from this condition are: Splinting and Stretching: Splinting and stretching is sufficient in cases where the disease is minimalist and confined to slight abnormality of the wrist. This should be followed by regular exercise which helps in fixing the extension of the wrist and relapse of the condition can be avoided. 1. Centralization: This treatment is usually applied in the severe cases where a notch is used as a replacement in the central position. Centralization is usually done to return the normal functionality of the hand by fixing the position of the ulna. The method is accomplished by the removal of the carpal bones to adjust the ulna which is followed by the wearing of a sling for an extended period of time to hold the position of the rectified bones. Although this method may cause certain damages to the ulna, this process usually cures situations like stiff elbow which helps the patient feed on her own. 2. Radialization: Radialization is a surgical treatment in which the extensors are added to the ulna and the metacarpal is pinned to it for proper movement of the hand. Usually, the ulna is overcorrected to prevent the relapse of the radial club hand syndrome. 3. Vascularized Metatarsophalangeal (MTP)-Joint Transfer: Vascularized metatarsophalangeal (MTP)-joint transfer is the method of transferring the second toe to the ulna on the radial side of the same to provide it with an extra platform which will help in the proper movement of the wrist. These treatment processes along with the proper exercises can help the patient keep radial club hand syndrome at bay and prevent it from relapsing again in the future. At Kids Orthopedics, special attention is given to the various types of radial club hand syndrome that may occur and the treatment and management is done accordingly to achieve the best possible end result.

Hip, Developmental Dysplasia of the, When Your Child Has

Your child has been diagnosed with developmental dysplasia of the hip. Hip dysplasia (also called hip dislocation) is a problem with the hip joint. This condition is congenital, meaning it’s present at birth. It is not often painful. And it is very treatable in young children. If your child has this problem, he or she may see a pediatric orthopedist. This is a doctor specializing in treating bone and joint problems in children. What are the causes of developmental hip dysplasia? Developmental hip dysplasia happens when the rounded top of the leg bone (the femoral head) slips partly or completely out of the hip socket. The hip socket may be too small or too shallow. This problem is more common in female children, in firstborn children, and in children born into families with a history of this condition. It is also more common in babies who are positioned feet first (breech) in the uterus. What are the signs of developmental hip dysplasia? Signs of this problem may be noted at birth. But the hip may also seem fine at birth and not show problems until later weeks. Common signs include: • A hip that is dislocated at birth • A hip that is “loose” (this may get worse as the child grows and becomes more active) • A hip that is less flexible than normal • A shorter leg, or a leg that turns outward (on the side of the dysplasia) • Uneven skin folds on the thighs or buttocks • Limping, walking on the toes, or a waddling “duck-like” gait in children who have begun to walk How is developmental hip dysplasia diagnosed? The condition may be noticed just after birth. Or, it may not be found until later screenings are done. Very mild cases may not be noticed until the child begins to walk. If this problem is suspected, imaging tests such as an ultrasound or an X-ray may be done to confirm the diagnosis. How is developmental hip dysplasia treated? In 1/4 of the children with hip dysplasia, the problem goes away without treatment. If treatment is needed, the options depend on the child’s age: • Infants. A Pavlik harness is used for 2 to 3 months. This harness holds the hip joint in place so the tissues around the joint can tighten and hold the joint in normal position. Once the harness is removed, the child should grow and develop normally. • Children 6 months and older. A procedure called closed reduction may be done. This moves the hip joint into place without surgery. In some cases, surgery may be needed to move the hip joint into place. After either closed reduction or surgery, a cast is put on the leg and hip to hold the joint in place. The cast may stay on for several months. Once the cast is removed, the child should grow and develop normally. What are the long-term concerns? After hip dysplasia goes away on its own or is treated, most children grow normally. But if the dysplasia remains and isn’t treated, long-term joint problems can result. So to be sure there are no lingering problems, your child will likely need to see the doctor regularly for monitoring. This is usually done at ages 6 months, 12 months, 4 to 6, and 14. Content Source: Mount Nittany