PERTHES’ DISEASE

• Perthes disease is an idiopathic, avascular necrosis of the femoral head. It is an osteochondritis of the epiphysis of the femoral head.
• Children (usually the age between 5 to 1o years) frequently complain of pain which radiates to knee occasionally associated with limping and hip stiffness
• Also known as Coxaplana, Pseudo-coxalgia

• Idiopathic
• May be due to recurrent episodes of ischemia of the head in the susceptible age group (boys in the age 5 to 10 years)
• Traumatic effusion
• Inflammatory conditions, synovitis etc.
• Epiphyseal dysplasia
• Metabolic/ endocrine/ constitutional factors

• Pain in the hip often radiating to knee - insidious onset, pain may fluctuate depending on physical activity
• Pain is often exacerbated by internal rotataion
• Limping or hip stiffness ( Resrtricted range of movements)
• Antalgic gait ( on weight bearing leg)

• O/E – limitation of abduction and internal rotation and shortening of the limb
• FABER test( Flexion , Abduction and External Rotation ) might be positive
• X- ray – Anterio posterior and frog leg positions
  • Collapse and sclerosis of the epiphysis of the femoral head
  • Hip joint space is increased
  • Gage sign
  • Crescent sign
  • Bone scan – decreased uptake by the head of the femur
• MRI

• Preventing head from mis-shapening while the bone is in softening phase
• Conservative methods for head containment – plaster, splint
• Operative – containment osteotomy

Ayurvedic Treatment

Internal medicines

Initially

• Punarnavadi Kashaya
• Lasuna ksheera
• Sahacharadi sevya
• Annabhedi sindhoora
• Nimbamrta eranda

Later

• Panchatikthaka Ksheera Paka
• Guggulutikthaka Ghrita
• Nirgundi eranda
• Gandha taila
• Sahacharadi avarthi
• Asthisamhara choorna
• Laksha guggulu
• Maha kukkutanta taila

Procedure

Initially

• Rukhsha Vasthi- Vaiswanara choorna + Amrutothara Kashaya
• Mild Udwarthana - Kolakulathadi choorna

Later

• Pizhichil- Dhanwanthara taila
• Shashtika pinda sweda
• Matravasthi- Sahacharadi Taila
• Vaitharana Vasthi