History and Physical Examination
The earliest sign of Legg-Calvé-Perthes disease (LCPD) is an intermittent limp (abductor lurch), especially after exertion, with mild or intermittent pain in the anterior part of the thigh. LCPD is the most common cause of a limp in the 4- to 10-year-old age group, and the classic presentation has been described as a painless limp. The patient may present with limited range of motion of the affected extremity. The most common symptom is persistent pain.
Hip pain may develop and is a result of necrosis of the involved bone. This pain may be referred to the medial aspect of the ipsilateral knee or to the lateral thigh. The quadriceps muscles and adjacent thigh soft tissues may atrophy, and the hip may develop adduction flexion contracture. The patient may have an antalgic gait with limited hip motion.
Pain may be present with passive range of motion and limited hip movement, especially internal rotation and abduction. Children with LCPD can have a Trendelenburg gait resulting from pain in the gluteus medius.
Laboratory studies and radiography may supplement medical history-taking and physical examination in the assessment of a child with a limp. [6]
Differential diagnoses include osteomyelitis, pyogenic arthritis, transient synovitis, abscess of the psoas muscle, juvenile rheumatoid arthritis, hemophilia, slipped capital femoral epiphysis, infection, and neoplasm.
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Image from 8-year-old boy with Herring type C Legg-Calvé-Perthes disease shows evidence of lateral extrusion. Symptoms began 18 months before this view was obtained. Image courtesy of Dennis P Grogan, MD.
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Anteroposterior radiograph from 9-year-old boy with Legg-Calvé-Perthes disease. Image courtesy of Dennis P Grogan, MD.
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Frog-leg lateral radiograph of same 9-year-old boy with Legg-Calvé-Perthes disease as in previous radiograph. Image courtesy of Dennis P Grogan, MD.
