Legg-Calve-Perthes Disease in Emergency Medicine Clinical Presentation
- Author: Jessica Hernandez, MD; Chief Editor: Trevor John Mills, MD, MPH more...
Symptoms of Legg-Calvé-Perthes disease usually have been present for weeks because the child often does not complain. Radiographs of the hip should always be considered for a child complaining of thigh or knee pain.
History may reveal the following:
- Hip or groin pain, which may be referred to the thigh
- Mild or intermittent pain in anterior thigh or knee
- Usually no history of trauma
- Progressively increased pain with physical activity, usually relieved by rest.
Some physical examination findings and symptoms may include the following:
- Decreased range of motion (ROM), particularly with internal rotation and abduction
- Painful gait
- Muscle spasm
- Leg length inequality due to collapse of the femoral head
- Thigh, calf, and buttocks muscle atrophy: Circumferences on the involved side may be smaller than on the unaffected side, secondary to disuse.
- Short stature: This result from deformity of the femoral head.
- Roll test: With patient lying in the supine position, the examiner rolls the hip of the affected extremity into external and internal rotation. This test should invoke guarding or spasm, especially with internal rotation.
- Trendelenburg sign: While standing, the patient lifts one leg up at a time; owing to muscle weakness on the affected side, the pelvis drops to the opposite side.
The exact etiology of Legg-Calvé-Perthes disease remains unclear, but it is likely multifactorial and may include genetic predisposition, environmental exposures, and/or socioeconomic factors.
Some specific suggested causes include trauma, an inflammatory process, a disorder of the epiphyseal cartilage, abnormalities in the vasculature, increased blood viscosity such as thrombophilia, abnormalities in growth hormone, maternal smoking, and second-hand smoke exposure.[3, 6]
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