1. I diagnose the patient as having slipped capital femoral epiphysis. I believe her condition is stable, but will worsening if not treated. She claims that the pains come and go, especially after engaging in physical activity, but two weeks after going to the doctor, she is unable to lift herself out of the pool. She needs assistance from her father. Her lower leg is also laterally rotated. She is a 10 year- old girl who is very active, but still obese for her age, weighing 135 lbs.
“Slipped capital femoral epiphysis is a well known disorder of the hip in adolescents that is characterized by displacement of the capital femoral epiphysis from the metaphysic through the physic… The vast majority of children with a slipped capital femoral epiphysis are obese, which increases the shear stress across the physis” (Loder, Aronsson, Dobbs, & Weinstein, 2000). 2. …show more content…
Tammy has no swelling or discoloration around her knee, and the X-ray shows no fractures in the hip or knee. The hip is not fractures, but the capital femoral epiphysis has been displaced. Her knee pain is a direct result of her injury. The femur is connected to the hip and the patella. If one area is affected or out of sorts, the other will be affected as in. This is an injury of the hip, but she experiences pain in her left knee.
This type of injury often leads to something called referred pain. This means that the pain comes from one source, but is felt somewhere else. In Tammy’s situation, this explains the pain she feels in her knee that is a result of the hip injury. The nerves in her left leg have become irritated, causing her to feel pain in her patella. Knee pain may also result from “patellofemoral syndromes, Osgood-Schlatter disease, patellar tendonitis, or chondromalacia patella, to name a few” (Katz, 2006).
3. The X-rays of both the hip and the knee both prove to be negative for fractures. This would usually mean that the pain she is feeling is just a passing thing, or it is something else. In this case, it is something else. She has no fracture in her hip or knee, which means another type of technique is needed. Most likely, a radiograph was taken when she first went to the doctor. Radiographs can be used to show the dislocation of the epiphysis. However, prior to dislocation, the radiograph will appear normal. “Occasionally, when there is a high index of suspicion for SCFE but the X-ray findings appear normal, a magnetic resonance imaging scan will demonstrate bone edema around the growth plate suggesting a ‘preslip’” (Hart et al., 2007). 4. X-rays are taken of Tammy’s bilateral hips. X-rays are also taken of the pelvis from different viewpoints, which include the anteroposterior and the lateral directions. The X-rays show that when the left femur joins with the left hip joint, it made a different angle than that of the left. Also, Tammy’s left lower limb is laterally rotated, meaning her left leg is turned outwardly, while her right leg is rightly positioned. This information means her left femur isn’t in the position it needs to be in, causing her walking difficulty. The slippage of the femur is due her obesity. Her increased weight is pushing down on the physis. This results in a weak growth plate and the inability of the fibrous network to support the physis. “Mechanical, endocrine, and metabolic disorders of puberty have been postulated to cause the pathological disturbance in the growth plate that ultimately fail mechanically and slip” (Novais & Millis, 2012). 5. Delaying diagnosis and treatment of Tammy could result in her condition worsening. First, he condition will go from stable to unstable. She will not be able to walk, with or without the use of crutches. Her pain will be more consistent. One life long problem she could experience is femoroacetabular impingement. If her the slip isn’t corrected, her hip bones will being to shaped abnormally, causing them to bump against each other. When her epiphyseal plate becomes an epiphyseal line, there will be nothing to do about the issue. Another problem that could occur with poor treatment is avascular necrosis of the femoral head. The death of the bone tissues can lead to breaks or the collapsing of the femoral bone. This could affect other areas of
“Slipped capital femoral epiphysis is a well known disorder of the hip in adolescents that is characterized by displacement of the capital femoral epiphysis from the metaphysic through the physic… The vast majority of children with a slipped capital femoral epiphysis are obese, which increases the shear stress across the physis” (Loder, Aronsson, Dobbs, & Weinstein, 2000). 2. …show more content…
Tammy has no swelling or discoloration around her knee, and the X-ray shows no fractures in the hip or knee. The hip is not fractures, but the capital femoral epiphysis has been displaced. Her knee pain is a direct result of her injury. The femur is connected to the hip and the patella. If one area is affected or out of sorts, the other will be affected as in. This is an injury of the hip, but she experiences pain in her left knee.
This type of injury often leads to something called referred pain. This means that the pain comes from one source, but is felt somewhere else. In Tammy’s situation, this explains the pain she feels in her knee that is a result of the hip injury. The nerves in her left leg have become irritated, causing her to feel pain in her patella. Knee pain may also result from “patellofemoral syndromes, Osgood-Schlatter disease, patellar tendonitis, or chondromalacia patella, to name a few” (Katz, 2006).
3. The X-rays of both the hip and the knee both prove to be negative for fractures. This would usually mean that the pain she is feeling is just a passing thing, or it is something else. In this case, it is something else. She has no fracture in her hip or knee, which means another type of technique is needed. Most likely, a radiograph was taken when she first went to the doctor. Radiographs can be used to show the dislocation of the epiphysis. However, prior to dislocation, the radiograph will appear normal. “Occasionally, when there is a high index of suspicion for SCFE but the X-ray findings appear normal, a magnetic resonance imaging scan will demonstrate bone edema around the growth plate suggesting a ‘preslip’” (Hart et al., 2007). 4. X-rays are taken of Tammy’s bilateral hips. X-rays are also taken of the pelvis from different viewpoints, which include the anteroposterior and the lateral directions. The X-rays show that when the left femur joins with the left hip joint, it made a different angle than that of the left. Also, Tammy’s left lower limb is laterally rotated, meaning her left leg is turned outwardly, while her right leg is rightly positioned. This information means her left femur isn’t in the position it needs to be in, causing her walking difficulty. The slippage of the femur is due her obesity. Her increased weight is pushing down on the physis. This results in a weak growth plate and the inability of the fibrous network to support the physis. “Mechanical, endocrine, and metabolic disorders of puberty have been postulated to cause the pathological disturbance in the growth plate that ultimately fail mechanically and slip” (Novais & Millis, 2012). 5. Delaying diagnosis and treatment of Tammy could result in her condition worsening. First, he condition will go from stable to unstable. She will not be able to walk, with or without the use of crutches. Her pain will be more consistent. One life long problem she could experience is femoroacetabular impingement. If her the slip isn’t corrected, her hip bones will being to shaped abnormally, causing them to bump against each other. When her epiphyseal plate becomes an epiphyseal line, there will be nothing to do about the issue. Another problem that could occur with poor treatment is avascular necrosis of the femoral head. The death of the bone tissues can lead to breaks or the collapsing of the femoral bone. This could affect other areas of