In violation of the blood supply to the bonefemoral head, resulting in partial necrosis (gangrene) bone. This process is accompanied by pain and lameness, but x-rays at this time may not yet be any change.
In the future, the dead bone sitesundergo resorption. This leads to a change in the shape of the femoral head - from globular it turns into a mushroom, is flattened. Then the femoral head is sclerosing, necrosis process is over and the bone ceases to hurt. Despite this, the pain still remains, because now begins to break down joint cartilage - osteoarthritis develops. The stronger the changed shape of the femoral head, the more pronounced osteoarthritis develops, the more pain and lameness.
The process is more often one-sided, at least -bilateral. The initial stages are asymptomatic. The first symptoms - a slight soreness in the hip joint and lameness, sometimes the disease begins with pain in the knee joint.
Later appear tired during walking, pain in joints, lameness, atrophy of the gluteal muscles, restriction of rotational motions and abduction in the hip joint, limb shortening.
X-ray examination. Depending on the stage of the disease the femoral head can be reduced in size, shape and flattened osteoporotic, or sclerotic fragmented structure.
In the later stages of the head takes mushroomshape. The cervix is shortened, reduced neck-shaft angle. Joint space widened. Radioisotope scanning with 99mTc identifies areas of impaired circulation. MRI reveals necrosis or early stages.
The earliest symptoms of Perthes' diseaseThey are pain and lameness. However, it should be borne in mind that a certain group of patients pain may be absent. Lameness in the beginning of the disease may be a result of pain and joint contractures, and later - a consequence of the weakness of the gluteal muscles, hip subluxation. Muscle atrophy also applies to early and persistent symptoms of the disease. The main clinical symptoms of the disease Perthes expressed more pronounced than at a later age it occurs. A special place in the manifestation of Perthes' disease belongs to vegetative-vascular disorders, which are more pronounced in the one-sided defeat. Clinically, they appear pale feet, her coldness and excessive sweating, decreased heart rate in the fingers, wrinkled skin of the plantar surface of the foot ( "washerwoman skin"). Very rarely Perthes disease begins acutely, there are severe pain in the hip joint, rise in temperature, "inflammatory" blood shifts.