Tag Archives: Hip

Perthes’ disease

Alternative Names: Legg-Calve-Perthes’ disease, ischemic necrosis of the hip, coxa plana, osteochondritis and avascular necrosis of the femoral head, Legg–Perthes Disease or Legg–Calve-Perthes Disease (LCPD).

Definition:
Perthes’ disease  is a degenerative disease of the hip joint, where growth/loss of bone mass leads to some degree of collapse of the hip joint and to deformity of the ball of the femur and the surface of the hip socket. The disease is characterized by idiopathic avascular osteonecrosis of the capital femoral epiphysis of the femoral head leading to an interruption of the blood supply of the head of the femur close to the hip joint. The disease is typically found in young children, and it can lead to osteoarthritis in adults. The effects of the disease can sometimes continue into adulthood.

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Perthes’ disease  affects the top of the femur (thigh bone) where it meets the hip bone. The blood supply to the growth plate of the bone (epiphysis) becomes inadequate. As a result, the bone softens and breaks down – a process called necrosis.

This happens gradually over several weeks. Then, as the blood supply recovers, the bone reforms and hardens. This takes 18 to 36 months and may lead to a deformed shape, with flattening of the ball-shaped head of the femur that normally fits into the round socket of the hip joint.

Recent research has suggested Perthes’ may be linked to a subtle problem with blood clotting.

Perthes’ most commonly affects children between the ages of four and eight, but younger children and teenagers can also develop the condition.

It affects around one in 20,000 children and is up to five times more common in boys. It’s also more common among Caucasians.

In ten to 20 per cent of cases, both hips are affected.

It is named for Arthur Legg, Jacques Calvé and Georg Perthes  and was first described by Karel Maydl.

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Symptoms:
The first symptom is often limping, which is usually painless. Sometimes there may be mild pain that comes and goes.

Other symptoms may include:

•Hip stiffness that restricts movement in the hip
•Knee pain
•Limited range of motion
•Persistent thigh or groin pain
•Shortening of the leg, or legs of unequal length
•Wasting of muscles in the upper thigh

Causes:
Legg believed trauma to be the cause, Calve ricketts, and Perthes infection. Presently, a number of factors have been implicated including heredity, trauma, endocrine, inflammatory, nutritional, and altered circulatory hemodynamics.

Although no-one has identified the cause of Perthes disease it is known that there is a reduction in blood flow to the joint. It is thought that the artery of the ligamentum teres femoris closes too early, not allowing time for the medial circumflex femoral artery to take over.  For example, a child may be 6 years old chronologically but may have grown to 4 years old in terms of bone maturity. The child may then engage in activity appropriate for a child of 6 but may not yet have the bone strength of an older child, leading to flattening or fracture of the hip joint. Genetics do not appear to be a determining factor, but it has been suggested that a deficiency of some blood factors used to disperse blood clots may lead to blockages in the vessels supplying the joint, but these have not been proven. There is also a deficiency of proteins C and S which act as blood anticoaglants and their deficiency may cause clot formation in ligamentum teres femoris artery and hinder blood supply to the femoral head

Risk factors:
Perthes disease can affect children of nearly any age, but it’s most common among boys ages 2 to 12. In fact, it’s up to five times more common in boys. When girls develop Legg-Calve-Perthes disease, it tends to be more severe.

In addition, Perthes disease is most common in Asians, Eskimos and whites. The disease may be more likely in physically active children who are small for their age and in those who are exposed to secondhand smoke.

Complications:
*Permanent hip deformity. Perthes disease may cause a permanently deformed hip joint — especially if the condition develops after ages 6 to 8.

*Osteoarthritis may develop later in life. Early recognition and proper treatment of  Perthes disease may minimize this complication.

Diagnosis:
X-Rays of the hip confirm the diagnosis. X-rays usually demonstrate a flattened, and later fragmented, femoral head. A bone scan or MRI may be useful in making the diagnosis in those cases where x-rays are inconclusive. Neither bone scan nor MRI offer any additional useful information beyond that of x-rays in an established case. If MRI or bone scans are necessary, a positive diagnosis relies upon patchy areas of vascularity to the capital femoral epiphysis (the developing femoral head).

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Treatment :
The goal of treatment is to keep the ball of the thighbone inside the socket and  to avoid severe degenerative arthritis. Your health care provider may call this “containment.”

Physical therapy and anti-inflammatory medicine (such as ibuprofen) can relieve stiffness in the hip joint. When the hip is painful, or the limp gets worse, restricting activities such as running may help reduce the inflammation. Nighttime traction may also help.

Health care providers no longer recommend several months of bedrest.

Orthopedic assessment is crucial. Younger children have a better prognosis than older children.

Treatment has traditionally centered on removing pressure from the joint until the disease has run its course. Options include traction (to separate the femur from the pelvis and reduce wear) braces (often for several months, with an average of 18 months) to restore range of motion, physiotherapy, and surgical intervention when necessary because of permanent joint damage. To maintain activities of daily living, custom orthotics may be used. These devices internally rotate the femoral head and abduct the leg(s) at 45 degrees. Orthoses can start as proximal as the lumbar spine (LSO), and extend the length of the limbs to the floor. Most functional bracing is achieved using a waist belt and thigh cuffs derived from the Scottish-Rite Orthosis. These devices are typically prescribed by a physician and implemented by a certified orthotist. For older children, the distraction method has been found to be a successful treatment, using an external fixator which relieves the hip from carrying the body’s weight. This allows room for the top of the femur to regrow. Many children need no intervention at all and are simply asked to refrain from contact sports or games which impact the hip. The Perthes Association has a “library” of equipment which can be borrowed to assist with keeping life as normal as possible, newsletters, a helpline, and events for the families to help children and parents to feel less isolated.

Modern treatment focuses on removing pressure from the joint to increase blood flow, in concert with physiotherapy. Pressure is minimized on the hip through use of crutches or a cane, and the avoidance of running-based sports. Swimming is highly recommended, as it allows exercise of the hip muscles with full range of motion while reducing the stress to a minimum. Cycling is another good option as it also keeps stress to a minimum. Physiotherapy generally involves a series of daily exercises, with weekly meetings with a physiotherapist to monitor progress. These exercises focus on improving and maintaining a full range of motion of the femur within the hip socket. Performing these exercises during the healing process is essential to ensure that the femur and hip socket have a perfectly smooth interface. This will minimize the long term effects of the disease. Use of zoledronic acid has also been investigated.

Perthes disease is self limiting, but if the head of femur is left deformed there can be a long-term problem. Treatment is aimed at minimizing damage while the disease runs its course, not at ‘curing’ the disease. It is recommended not to use steroids or alcohol as these reduce oxygen in the blood which is needed in the joint. As sufferers age, problems in the knee and back can arise secondary to abnormal posture and stride adopted to protect the affected joint. The condition is also linked to arthritis of the hip, though this appears not to be an inevitable consequence. Hip replacements are relatively common as the already damaged hip suffers routine wear; this varies by individual, but generally is required any time after age 50.

Prognosis:
The Prognosis depends on the child’s age and the severity of the disease. In general, the younger the child is when the disease starts, the better the outcome.

Children younger than 6 have the best prognosis since they have time for the dead bone to revascularize and remodel, with a good chance that the femoral head will recover and remain spherical after resolution of the disease.  Children who have been diagnosed with Perthes’ Disease after the age of 10 are at a very high risk of developing osteoarthritis and Coxa Magna.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/001264.htm
http://en.wikipedia.org/wiki/Legg%E2%80%93Calv%C3%A9%E2%80%93Perthes_syndrome
http://www.mayoclinic.com/health/legg-calve-perthes-disease/DS00654
http://www.bbc.co.uk/health/physical_health/conditions/perthes2.shtml
http://orthoinfo.aaos.org/topic.cfm?topic=A00070

http://www.concordortho.com/patient-education/topic-detail-popup.aspx?topicID=8de6c8d126950dbbae6601bda872854b

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Bursitis

Definition:
A bursa is a fluid-filled sac that usually overlays a bone or a joint and acts as a shock absorber. There are two types:

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Anatomical bursae normally occur around the body where tendons cross bones or joints. The complex knee joint has 15 bursae, for example.

•Adventitious bursae are not part of the normal body structure but develop when the soft tissue overlying a bone suffers repeated friction or trauma. An example of this type is over the pelvic bone in the buttock muscles because someone has been sitting on a hard chair for several hours a day.

Bursitis is inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin, or between a tendon and bone. Certain occupations predispose people to this. The condition may be acute or chronic.
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Causes:
The most common causes of bursitis are trauma, infection, and crystal deposits.

Trauma
Trauma causes inflammatory bursitis from repetitive injury, which results in widening of the blood vessels. This allows proteins and extracellular fluid into the bursae and the bursae react against these “foreign” substances by becoming swollen.

•Chronic: The most common cause of chronic bursitis is minor trauma that may occur to the shoulder (subdeltoid) bursa from repetitive motion, for example, throwing a baseball. Another example is prepatellar bursitis (in front of the knee) from prolonged or repetitive kneeling on a hard surface to scrub a floor or lay carpet.

Acute brusits: A direct blow (let’s say you accidentally bang your knee into a table) can cause blood to leak into the bursa. This rapid collection usually causes marked pain and swelling, most often in the knee.

Infections:
Bursae close to the surface of the skin are the most likely to get infected with common organisms; this is called septic bursitis. These bursitis-causing bacteria are normally found on the skin: Staphylococcus aureus or Staphylococcus epidermis. People with diabetes or alcoholism and those undergoing steroid treatments or with certain kidney conditions, or who may have experienced trauma may be higher risks for this type of bursitis. About 85% of septic bursitis occurs in men.

Crystal deposits
People with certain diseases such as gout, rheumato:id arthritis, or scleroderma, for example, may develop bursitis from crystal deposits. Little is known about how this process happens. Uric acid is a normal byproduct of daily metabolism. People who have gout are unable to properly break down the uric acid, which crystalizes and deposits in joints-a mechanism for causing bursitis.
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Symptoms:
Bursitis causes pain and tenderness around the affected bone or tendon. The bursae sacs may swell, often making movement difficult. The most commonly affected joints are the shoulder, elbow, wrist and hand, knee, and foot.

Shoulder…...click & see

The subacromial (subdeltoid bursa) separates the major tendon (known as the supraspinatus tendon) from the overlying bone and deltoid muscle. Inflammation of this bursa is usually a result of injury to surrounding structures-most commonly the rotator cuff. This is often referred to as “impingement syndrome.” It is often difficult to tell the difference between this type of bursitis pain and a rotator cuff injury. Both cause pain in the side or front of the shoulder.

•Overhead lifting or reaching activities are uncomfortable.

•Pain is often worse at night.

•The shoulder will usually have decreased range of active motion and be tender at specific spots.

Elbow. click & see

Olecranon bursitis is the most common form of bursitis. Goose-egg-like, tender red swelling may appears just behind the elbow. This area is at the top of one of the forearm bones called the ulna and is known as the olecranon process.

•The pain may increase if the elbow is bent because tension increases over the bursa.

•This bursa is frequently exposed to direct trauma (bumping your arm) or repeated motions from bending and extending the elbow (while painting, for example).

•Infection is common in this bursa.

Knee....click & see

•Kneecap (prepatellar) bursitis: Swelling on the front of the kneecap is usually associated with either chronic trauma (from kneeling) or an acute blow to the knee. Swelling may occur as late as 7-10 days after a single blow to the area, usually from a fall.

•Anserine bursitis: The anserine bursa is fan shaped and lies among 3 of the major tendons at the knee. The name anserine (gooselike) comes from the shape of the swollen bursa. When restrained by the 3 tendons, the bursa looks like a goose’s foot.

This type of bursitis is most often seen in people with arthritis, especially overweight middle-aged women with osteoarthritis.

*The pain is typically produced when the knee is bent and is particularly troublesome at night. People often seek comfort by sleeping with a pillow between their thighs.

*The pain can radiate to the inner thigh and midcalf and usually increases on climbing stairs and at extremes of bending and extending.

*The area of tenderness is on the middle part of the knee.

*Anserine bursitis also occurs as an overuse or traumatic injury among athletes, particularly long-distance runners.
Ankle.click & see

Retrocalcaneal bursitis occurs when the bursa near the Achilles tendon in the ankle becomes inflamed. This is commonly caused by local trauma associated with wearing a poorly designed shoe (often high heels) or prolonged walking. It can also occur with Achilles tendonitis.

Bursitis in this part of the body often occurs as an overuse injury in young athletes, ice skaters, and female adolescents transitioning to higher heels. The pain is usually on the back of the heel and increases with passive extension or resisted flexion.

Buttocks....click & see

Ischiogluteal bursitis causes inflammation of the ischial bursa, which lies between the bottom of the pelvic bone and the overlying gluteus maximus muscle (one side of the buttocks). Inflammation can come from sitting for a long time on a hard surface or from bicycling.

•The pain occurs when sitting and walking.

•There will be tenderness over the pubic bone, which may be made worse by bending and extending the leg.

•The pain may radiate down the back of the thigh.

•Direct pressure over the area causes sharp pain.

•The person may hold the painful buttock elevated when sitting.

•The pain is worse when person is lying down and the hip is passively bent.

•The person may have difficulty standing on tiptoe on the affected side.

Hip click & see

The iliopsoas bursa is the largest in the body and lies in front of, and deep to, the hip joint. Bursitis here is usually associated with hip problems such as arthritis or injury (especially from running).

•The pain of iliopsoas bursitis radiates down the front and middle areas of the thigh to the knee and is increased when the hip is extended and rotated.

•Extension of the hip during walking causes pain so the person may limit the stride on the affected side and take a shorter step.

•There may be tenderness in the groin area.

•Sometimes a mass may be felt resembling a hernia. The person may also feel numbness or tingling if adjacent nerves are compressed by the inflamed bursa.

Thigh click & see

The trochanteric bursa, part of the thigh, can be associated trochanteric bursitis, which occurs most frequently in overweight, middle-aged women.

•It causes deep, aching hip pain along the side of the hip that may extend into the buttocks or to the side of the knee.

•Pain is aggravated by activity, local pressure, or stretching.

•Pain is often worse at night.
Diagnosis:
Exams and Tests:

•History: The doctor will usually take a detailed history about the onset of symptoms and will want to know what movement or activity makes you feel more or less pain. You will need to report other medical problems you may have.

•Fluid removal: The doctor may remove synovial fluid from the joint with a needle (aspiration) and send it to the lab for analysis for possible infection. Bursitis in the knee and elbow are especially prone to infection.

•X-rays: They are usually not helpful, but the doctor may get them if any other disease process is suspected such as a fracture or dislocation. MRI and CT scans are obtained only to exclude other causes.

•Blood testing: The doctor may take blood from your arm for lab testing to rule out infection or other conditions such as rheumatoid arthritis or hyperthyroidism.
Treatment:
The doctor will probably recommend home care with P-R-I-C-E-M: protection, rest, ice, compression, elevation, and medications .

At first  doctor may recommend temporary rest or immobilization of the affected joint.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may relieve pain and inflammation. Formal physical therapy may be helpful as well.

If the inflammation does not respond to the initial treatment, it may be necessary to draw out fluid from the bursa and inject corticosteroids. Surgery is rarely required….

Exercises for the affected area should be started as the pain resolves. If muscle atrophy (weakness or decrease in size) has occurred. Your health care provider may suggest exercises to build strength and increase mobility.

Bursitis caused by infection is treated with antibiotics. Sometimes the infected bursa must be drained surgically.

Prognosis:
The condition may respond well to treatment, or it may develop into a chronic condition if the underlying cause cannot be corrected.

Complications:
Chronic bursitis may occur.
Too many steroid injections over a short period of time can cause injury to the surrounding tendons.

Prevention:
Avoid activities that include repetitive movements of any body parts whenever possible.

You may Click to see :List of Burn Centers in  US

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/bursitis.shtml
http://healthtools.aarp.org/adamcontent/bursitis?CMP=KNC-360I-GOOGLE-HEA&HBX_PK=bursitis&utm_source=Google&utm_medium=cpc&utm_term=bursitis&utm_campaign=G_Diseases%2Band%2BConditions&360cid=SI_148893841_6495451981_1
http://www.emedicinehealth.com/bursitis/article_em.htm
http://www.medicalook.com/Joint_pain/Bursitis.html
http://activemotionphysio.ca/article.php?aid=246
http://www.bursitisinshoulder.com/
http://www.bursitis.ws/Knee-Bursitis.html

http://www.aidmybursa.com/foot-ankle-bursitis.php

http://www.sportlink.co.uk/hip_bursitis.php

http://www.bursitistreatment.info/ischial-bursitis_8.html

http://www.steadyhealth.com/articles/Hip_Bursitis___Trochanteric_Bursitis_a246.html

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Support Your Triangle

The yoga basic can stand a tune-up with the help of a wall.

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If you practice yoga on a regular basis, you’re probably familiar with the classic position called triangle pose. But it’s a good idea, every once in a while, to practice this pose with the back of your body against a flat wall, so you can check the position of your shoulders and hips for correct alignment.

Stand against a wall in a wide stance with your arms extending out to the side at shoulder level. Turn your left foot in slightly, and turn your right foot out, so that your right big toe points to the right.

Shift your pelvis to the left as you lean your torso to the right, resting your right hand on your shin, ankle or floor. Keep your shoulders and hips and top arm in contact with the wall throughout the entire pose. Feel your chest opening wide, with your hips in line with your shoulders. Breathe fully in this pose for 20 to 30 seconds. Return to the start position and repeat on the other side.

Source: Los Angeles Times

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Basic Yoga Pose

This is a  fundamental pose to get your yoga practice in gear.

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If you’re new to yoga and not limber yet, here’s a safe and simple way to get started. With this pose, you’ll develop flexibility in your hip, thigh and back muscles so you can progress to more advanced poses.

Begin by kneeling on a level, padded surface. Place your left foot flat on the floor, with your knee bent and your toes pointed to the left. Make sure your left heel is directly across from your right inner knee. Rest your left elbow on your left thigh. On an inhale, reach your right arm overhead with your palm facing inward. Exhale and lean your torso toward your left knee. Keep your left shoulder forward. Focus on feeling the stretch along the right side of your body and in your left inner thigh. Hold and breathe in this position for three to six breaths.

When your body feels ready, move deeper into the stretch by placing your left fingertips on the floor in front of your left foot. Do not allow your right hip to move backward. Hold this position for three to six breaths. Switch legs and repeat on the other side.

Source: Los Angeles Times

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Shape Your Lower Body for Summer

Here’s a simple yet challenging way to firm and tighten your buttocks and thighs. If you start to incorporate this move into your exercise routine now, you can help get your lower body in shape for the summer.

Step-1. Lie on a padded, flat surface and place your feet hip-width apart atop a round 36-inch foam roller. Make sure that your feet are flat, with your heels and toes on the same level. Extend your arms straight alongside your body with your head resting on the floor.

Step-2. On an exhale, push down evenly with both feet on the roller. Do not allow the roller to move, and be sure to keep the soles of your feet facing the floor throughout the exercise. Raise your hips, waist and mid-back off the floor. Pause for 10 seconds at the top of the lift while balancing on your upper back and both feet. Concentrate on squeezing the muscles in your buttocks and backs of your thighs. Slowly lower your hips to the floor, then repeat three to five times.

Source: Los Angeles Times

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