legg calve perthes disease
what is the etiology of legg calve perthes disease and what age/gender is affected mostly
blood supply interrupted to the femoral head
age of onset between 2-13 years
four times greater in males than females
what is the etiology and onset age/gender
femoral head is displaced posteriorly and inferiorly in relation to the femoral neck and within the confines of the acetabulum
onset in males 10-17 years with average age of 13
onset in females 8-15 average age of 11
two times greater incidence in males>females
what is the etiology
mechanical dysfunction resulting in traction apophysitis of the tibial tubercle at the patellar tendorn insertion
what is the another name for sever's disease
calcaneal apophysitis
what is the etiology of sinding-larsen
traction apophysitis at the patella-patellar tendon junction, overuse injury due to repeated stresses, can occur after significant growth spurt and or increase in activity
what would we see during a clinical exam
characteristic psoatic limp due to weakness of psoas major; moves in ER, flexion, and adduction
gradual onset of aching pain at hip, thigh, and knee
AROM limited in abduction and extension (collapse of subchondral bone at femoral neck/head)
what are some clinical presentations? what would plain film imaging show
AROM restricted in abduction, flexion, and internal rotation
patient describes pain as vague at knee, thigh, and hip
in chronic conditions, may demonstrate a trendelenburg gait
plain fim imaging shows positive displacement of upper femoral epiphysis
how can you dx
plain film findings demonstrate irregularities of the epihphyseal line and/or clinical examination
what is the etiology
most common cause of heel pain in growing childre, occurs before or during peak growth spurt
caused by repetitive microtrauma due to increased traction by the achilles tendon on its insertion
NSAIDs, temporary cessation of activity
what are some general tx options like medications
medications include acetaminophen for pain, NSAIDs for pain and/or inflammation
cast for 4-6 weeks, surgery if needed
what are some tx options like surgical and medications
tx: operative internal fixation- prevention of complications such as avascular necrosis
medications: acetominophen for pain, NSAIDs for pain
what is the tx medications
acetaminophen for pain, NSAIDs for pain and inflammation
occasionally surgery is indicated
what percent cases has bilateral involvement
what are some PT goals for sinding-larson johannsons disease
stretching and strengthening exercises and activity modification
what are some non postsurgical interventions we can apply in the PT clinic
joint/bone protection strategies
maintain/improve joint mechanics and connective tissue functions
implementation of aerobic capacity/endurance conditioning activities or reconditioning such as aquatic programs
what are some nonsurgical interventions we can implement
joint/bone protecion strategies
maintain/improve joint mechanics and connective tissue functions
implentation of aerobic capacity/endurance conditioning or reconditioning
what are some PT goals
modify activities to prevent excessive stress to irritated sit
what are some treatment options
NSAIDs
temporary cessation of running, jumping activities, heal lifts/heel cups
what is the etiology for grwoing pains (benign nocturnal pains of childhood)
could be due to muscular fatigue, poor posture, stress, etc.
no evidence linking growing pains and growing
can affect 20% of children most likely between ages 3-5 and 8-11
what are some postsurgical interventions we can apply
regaining functional flexibility; improving strength, endurance, coordination, and gait training
postsurgical intervention includes
regaining functional flexibility; improving strength, endurance, coordination, and gait training
why is flexibility important
flexibility is important especially for prevention
what are some PT goals
stretching and strengthening exercises
what are some clinical presentations and what is the tx
increased pain at night, typically bilateral leg pain
not associated with redness, temperature, swelling, and tenderness
treatment primarily related to managing pain