Questions about Perthes and X-rays/MRIs

[concernedmom]

Hi,
My 6 year old son began limping about march 06. His pediatrician suggested he go for a consult in April 06 with an Ortho Surgeon. Both doc's took x-rays. The Ortho did some hip rotational exams and watched him walk and run. The x-rays came back normal. He said he didn't see anything wrong with my son's hips other than they were steeply angled more than a kid his age. But due to the continued limp and pain, he suggested an MRI to confirm if it was Perthes or something else he also may not see. Originally we thought my son may have had a case of the "I don't want to go to school blues." But after the Ortho checked him out and did the rotations on his leg, he said my son was not faking it and it was not possible to fake the reactions he was getting from turning his hip this way and that way. So I felt guilty after this but I am still not convinced this is what is going on, due to all the research I have seen on this condition stating this condition is seen in X-rays. His x-rays show nothing! His ortho is really thinking it is Perthes. I haven't heard of anyone having to go beyond just a normal x-ray to diagnose this. I am trying to figure out if we may have possibly caught it early enough that it won't show on x-rays yet or if an MRI is warranted quite yet. By all means, he is having issue's whatever it may be, but are there other tests first we could do? If he needs the MRI, I will have it done for him. My question is has anyone had to go beyond just a normal x-ray to have Perthes diagnosed? Were the x-rays originally normal and the doc decided to do an MRI and that was what found the Perthes? I have also read kids who are smaller than average are more at risk. Is this true?
Thank you and sorry for the length. I am just really curious as to the x-rays vs MRI. I appreciate any help you can give me. H

[concernedmom]

I am really hoping someone will respond to this. I am considering cancelling the MRI because my son has stopped limping. He limps off and on but not all the time. It has been a week since he last limped and I just don't know what to think. If anyone can give me some advice on this disease. Can a child limp for awhile, feel better than begin limping again after a few weeks? Any answers are greatly appreciated.

[juanito]

Hi mum,

if your child is limping, although it is sporadic, you have to keep on eye on that. He should not be limping at any time. You can see whether or not he continues with limp, pain or stiff in the leg and go to the doctor when simtoms shows up.
There are several test to certify Perthes disease, sometimes a simple x-rays is not enough, there is a text called mammagrafy (or smth similar) which is very reliable; but my advice is to make test as you need to confirm disease or not, becuase it's important to start with treatament (if need be) as soon as you can.
kids smaller than average are not more at risk than others. There is no clear reason for the disease nor risks. Many theories and studies have been developed nowadays, but nothing sure.

Hope that help.

[joefriday]

I am really hoping someone will respond to this. I am considering cancelling the MRI because my son has stopped limping. He limps off and on but not all the time. It has been a week since he last limped and I just don't know what to think. If anyone can give me some advice on this disease. Can a child limp for awhile, feel better than begin limping again after a few weeks? Any answers are greatly appreciated.

I understand that in some cases of Perthes, in the very early stages, the Xray will not show any changes. The MRI, on the other hand, will allow the physician to determine whether blood circulation to the femur head is normal or impaired. Since Perthes is an "avascular" condition (loss of blood circulation to the bone) the MRI could allow for earlier diagnosis and treatment. Many kids with Perthes do not limp continually nor do they always report pain.

If it were my child involved, I'd have the MRI done. I'd also insist on regular monitoring until there is a clear diagnosis. Your son is at an age at which Perthes has a very good prognosis with minimal intervention.

[Totoer085]

bump then lurk as soon as possible

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[Corey Bruce]

Hi There,

I know it has been sometime since you posted your message here, but I have only just read it.

I have a 4 year old son who was also diagnosed with Perthes' Disease (11th December 2007) and it was not picked up initially in an xray. We had to have a Bone Scan to diagnose it. The bone scan showed that there was no blood flow to the area and we were sent to an Orthopaedic specialist for review.

We have been attending the Children's Hospital every 3 months since and each time we had an xray. It was definately noticeable by the 2nd xray and has become more prominent of late. We have gone for another bone scan last week and it is still showing that there is no vascular activity in the femoral head and the growth plates are shifting.

Corey is suffering pain on a regular basis now and the limping is getting worse. We are awaiting another appt tomorrow to see what the Specialist will do to treat it for him.
CB
How is your boy now? What was the outcome? Did you go ahead with the MRI??? Did he cope with it?

I hope you don't mind me asking these questions, but I am curious and happy to share any information I can as well.

[chef-deb]

My son had MRI in Oct 07 and it showed early necrosis in both hips but all his x-rays are normal. Dr at Dupont did Bone scan which showed loss of blood flow that was done in Nov. 07 and Dr at Dupont has been doing x-rays every 4-6 months since than. He originally went to Childrens hosp. of Pa and that DR who did the MRI put him in wheelchair indefinitely but when he went to Dupont that Dr said it wasn't needed and we would just keep looking at x-rays. He has been for the most pain free since this past summer but this past week he has been complaining of knee pain. He goes back to Dupont in Apr. so I am hoping all of a sudden his femur head is not starting to break down because we were told he was one of the lucky ones who did not get any bone damage. How is your son doing and what was done for him?