Presenting Complaints:
Ammara, a 9-month-old female infant, was brought to the pediatric clinic by her parents due to concerns about her hip health. They noticed that her left hip appeared less mobile compared to the right, and she seemed uncomfortable when her legs were moved.
History of Presenting Complaints:
Ammara’s parents mentioned that they had observed this limitation of movement in her left hip for the past few months. Initially, they thought it was a normal variation in infant development. However, they noticed that she would cry or show discomfort when they attempted to change her diaper or move her legs.
Chief Complaints:
Limited movement and discomfort in the left hip.
Concerns about potential hip problem affecting Ammara’s growth and mobility.
Past Medical and Surgical History:
Ammara was born full-term and had no significant medical or surgical history.
Family History:
There was no known family history of developmental dysplasia of the hip.
Socioeconomic Status:
The family belongs to the middle socioeconomic class.
Present and Pre-Morbid Functional Status:
Ammara is an otherwise healthy and active infant who has been meeting developmental milestones appropriately.
General Health Status:
Ammara’s general health is good; there are no signs of acute illness.
Vitals:
Vital signs are within the normal range for an infant.
Aggravating Factors:
Movements involving the left hip, such as diaper changes or being lifted by the legs, appear to aggravate Ammara’s discomfort.
Easing Factors:
Rest and minimal manipulation of the left hip seem to ease Ammara’s discomfort.
Examination:
Upon examination, there was an observable asymmetry in the range of motion between the left and right hips. The left hip exhibited limited abduction and internal rotation compared to the right side. There was no obvious leg length discrepancy.
Sleep and 24-Hour Pattern:
No specific sleep disturbances related to the hip condition were reported.
Duration of Current Symptoms:
Symptoms of limited hip movement and discomfort have been present for approximately 4 months.
Mechanism of Injury/Current Symptoms:
No specific injury was reported. The symptoms seem to have developed gradually over time, with limited hip movement and discomfort being the main presenting symptoms.
Progression Since the Current Episode:
The symptoms have shown some progression, as observed by the parents’ increased concern about Ammara’s discomfort and limited hip mobility.
Significant Prior History:
No significant prior history is reported as Ammara is an infant.
Previous Treatment:
No prior treatment has been attempted for the hip condition.
Diagnostic Test/Imaging:
A hip ultrasound was performed, revealing abnormal hip joint morphology consistent with developmental dysplasia of the hip (DDH).
Differential Diagnosis:
Developmental dysplasia of the hip (DDH)
Legg-Calvé-Perthes disease
Septic arthritis
Transient synovitis
Postural Observation:
Observation of Ammara’s posture does not reveal any significant abnormalities.
Precaution and Contraindications:
Ammara’s caregivers were advised to avoid forceful abduction of her hips and to maintain a safe hip position during diaper changes and carrying.
Functional Movement Analysis (Sign):
Ammara displayed asymmetrical hip movement during abduction and internal rotation, raising concerns for DDH.
Quick Screening Tests/Clearing of Additional Joint Structures:
Barlow and Ortolani tests were performed to assess hip stability and to rule out dislocation.
Range of Motion (ROM):
Limited abduction and internal rotation were observed in the left hip compared to the right.
Special Test:
Hip ultrasound confirmed the presence of hip dysplasia.
Assessment:
Ammara is a 9-month-old infant with limited hip mobility and discomfort in the left hip. Diagnostic imaging indicates developmental dysplasia of the hip.
Problem List/Complaints:
Limited hip mobility and discomfort in the left hip.
Developmental dysplasia of the hip confirmed via ultrasound.
Treatment:
Orthopedic referral for further evaluation and management.
Implementation of safe hip positioning techniques to prevent exacerbation of the condition.
Possible use of a Pavlik harness for treatment.
Prognosis:
With early intervention and proper management, the prognosis for developmental dysplasia of the hip is generally favorable. Early treatment can lead to improved hip development and reduced long-term complications.
Goals:
Improve hip joint alignment and mobility.
Minimize discomfort and improve quality of life.
Prevent long-term complications related to DDH.
Interventions:
Orthopedic consultation for further assessment and treatment planning.
Educating caregivers about safe hip positioning and handling techniques.
Potential use of a Pavlik harness or other orthopedic devices as recommended by the orthopedic specialist.
Patient Education:
Caregivers will be educated about proper hip positioning, signs of discomfort or worsening of the condition, and the importance of regular follow-up with the orthopedic specialist.
Patient/Family Education:
Ammara’s parents will be educated about DDH, its management, and the significance of early intervention for optimal outcomes.
Discharge Plan for Patient :
Continue following the orthopedic specialist’s recommendations for treatment.
Implement safe hip positioning techniques during daily activities.
Attend scheduled follow-up appointments to monitor progress and make any necessary adjustments to the treatment plan.