Physiotherapy Diagnosis and Management of Slipped Capital Femoral Epiphysis

Before you begin your read, I want to note that this blog was sparked by a recent patient who came to see me because of their knee pain. We believe a physiotherapist’s philosophy should always revolve around the “why”. In my case, I wanted to know “why” this child was having knee pain - not simply diagnosing them with a knee condition and treating that condition only (Band-aid solution). I referred on straight away for MRI and medical input and the scan revealed that this hip was actually also suffering a loss of blood supply; so effectively the bone was dying. So if this had gone on, this child would have been seriously affected for life. Anyways… Enjoy the read, please share with others if you find it helpful.

Introduction and Outline of Blog

Slipped capital femoral epiphysis (SCFE) is a condition that affects adolescents, typically those aged 10-15 years. It is a condition where the head of the femur (thigh bone) slips off the neck of the femur at the growth plate. This can lead to pain and deformity in the affected hip joint. Early diagnosis and treatment is essential to avoid further complications, if suspected an MRI and specialist medical opinion should be sourced. Physiotherapy plays an important role in the management of SCFE. Once surgical input / care has been provided, it can help to achieve pain relief, improve range of motion, and prevent further displacement of the femoral head. Physiotherapy can also help to improve the strength and function of the affected hip joint.

The purpose of this article is to provide an overview of SCFE, its physiotherapy management, and the importance of early diagnosis and treatment.

What is Slipped Capital Femoral Epiphysis?

Slipped capital femoral epiphysis (SCFE) is a condition that typically affects adolescents aged 10-15 years. It is a condition where the head of the femur (thigh bone) slips off the neck of the femur at the growth plate. The growth plate is the area of cartilage near the end of a long bone in children and adolescents (it is also known as the epiphyseal plate). The growth plate is replaced by bone tissue during adulthood. SCFE usually affects the right hip more often than the left hip, and it is more common in males than females. It can occur in one hip or both hips. SCFE can lead to pain and deformity in the affected hip joint. The most common symptom is knee pain.

Other symptoms may include:

• Hip pain

• Limping

• Groin pain

• Stiffness in the hip joint

• Decreased range of motion in the hip joint

Early diagnosis and treatment is essential to avoid further complications. If SCFE is suspected, an MRI (magnetic resonance imaging) scan and specialist medical opinion should be sought.

How is Slipped Capital Femoral Epiphysis Diagnosed?

A physical examination by a medical professional, such as a physiotherapist, is often the first step in diagnosing a SCFE. This will typically involve palpating (feeling) the hip joint and checking for any tenderness or pain, assessing range of motion (We used our VALD Dynamo) which is usually dramatically reduced and has a harder end feel, strength (We used the VALD forceframe) which is usually very weak and with a thorough subjective assessment to understand any further symptoms that aren’t present during the assessment. We may also check for any signs of deformity, such as the presence of a lump. If SCFE is suspected, an MRI scan will usually be ordered. An MRI scan can provide more detailed information about the condition of the hip joint and surrounding structures. Once SCFE has been diagnosed, treatment can be sought.

What are the Treatment Options for Slipped Capital Femoral Epiphysis?

The treatment options for SCFE will depend on the severity of the condition. For mild cases of SCFE, treatment may involve the use of a brace or cast. This is to immobilise the hip joint and allow the slipped femoral head to relocate itself back into place. This treatment option is typically only successful for very mild cases of SCFE. For more severe cases of SCFE, surgery is typically required. The aim of surgery is to relocate the head of the femur back into its correct position and to stabilise the hip joint. This is usually achieved by inserting screws into the femoral head and neck. These screws act to hold the head of the femur in place and allow it to heal back into its correct position. Once the slipped femoral head has been relocated back into place, a period of physiotherapy rehabilitation will be required. The aim of physiotherapy is to help the individual regain full function of the hip joint and to avoid any further displacement of the femoral head.

What is the Physiotherapy Management of Slipped Capital Femoral Epiphysis?

The physiotherapy management of SCFE will depend on the severity of the condition and the individual’s individual needs and goals. Once the slipped femoral head has been relocated back into place, physiotherapy treatment will typically begin with a period of pain relief. This may involve the use of ice, heat, massage or other modalities. Pain relief will help to reduce swelling and inflammation in the hip joint and surrounding structures. The next stage of physiotherapy rehabilitation will typically involve a gradual increase in range of motion and strengthening exercises. These exercises are designed to improve the function of the hip joint and to prevent further displacement of the femoral head. The final stage of physiotherapy rehabilitation will focus on returning the individual to their full range of activities and daily tasks. This will involve education on how to avoid further injury and advice on how to manage any residual pain. The physiotherapy management of SCFE will be tailored to the individual’s needs and goals. It is important that physiotherapy treatment is started as soon as possible after surgery to ensure the best possible outcome.

Our unique and world class approach to rehab is multifaceted and always includes the cooperation between our performance coaches and physiotherapists. We will always integrate our strength and conditioning program to ensure consolidated results.

Conclusion

Slipped capital femoral epiphysis (SCFE) is a condition that typically affects adolescents aged 10-15 years. It is a condition where the head of the femur (thigh bone) slips off the neck of the femur at the growth plate. SCFE can lead to pain and deformity in the affected hip joint. Early diagnosis and treatment is essential to avoid further complications. If SCFE is suspected, an MRI scan and specialist medical opinion should be sought. The treatment options for SCFE will depend on the severity of the condition. For mild cases of SCFE, treatment may involve the use of a brace or cast. For most other and more severe cases of SCFE, surgery is typically required. Once the slipped femoral head has been relocated back into place, a period of physiotherapy rehabilitation will be required. The physiotherapy management of SCFE will depend on the severity of the condition and the individual’s individual needs and goals. It is important that physiotherapy treatment is started as soon as possible after surgery to ensure the best possible outcome.