October 21st appointment

Well we had our hospital visit this afternoon and unfortunately the doc has decided she now needs to go to the next step with helping the contracture and irritable hip. This means a tenotomy, there are two muscles that come from the groin area, one goes over the top of the thigh and the other along the inside of the thigh (I may have got this a bit wrong - but you get the picture). When he flexes Emma's legs at the knees - frog leg, these tendons and muscles pop out - you can see them like a thick cord under the skin. This is where he says they are too tight.




I noticed the other night while preparing for traction that Emma's left leg was a fair bit shorter then her right, maybe even by 2cm. I also saw that her knees are no longer level. When she is standing she has her right leg bent slightly, she is limping all the time. We also had a little scare coming out of school a few weeks back. Emma suddenly complained of pain in her groin and unable to stand. Then I realised it was her right leg! She remained in pain for the rest of day but we haven't had a repeat episode, so putting it down to overcompensating for her left hip.

We went for the usual x-ray and saw the house doctor first, he asked how she had been and I mentioned the shortening of the leg seemed much greater now, and how she had been running too much. He examined her range of movement and the shortening of her leg then went to view the x-ray. He was a while so I knew he was speaking with the consultant and then they both appeared in the cubicle. The consultant examined Emma then asked the questions, have you been keeping with traction, taking the Nurofen regularly, yes I said and the 5ml each night after dinner. I could see him thinking whether he had advised the right thing on that. He said it was very hard to decide, we needed to go to the next level, we'd tried the other methods and they were not working. He asked if I had any questions, I asked to know what stage and category she was at - they often don't like answering that in case they get it wrong!

He explained the four stages:1. Femoral head becomes more dense with possible fracture of supporting bone; 2. Fragmentation and reabsorption of bone; 3. Reossification when new bone has regrown; and 4. Healing, when new bone reshapes. Emma is still at stage two so her head is very soft and at risk. He didn't answer to what category. He then came to a decision, repeated how hard it is to decide to intervene, but the tenotomy was a simple little operation where they release the tight tendons and muscle. In other parts of the country he said they go for the broomstick plasters after the operation, but he favours the brace which gives a child more movement and can be taken off for washing and swimming. They have to wait for the brace to arrive, about a week, then perform the little op, in about two weeks. She'll have to wear the brace for 23 hours a day poor little love, for two months which is a lot better then 2-3 years I've read about that some still do in the States and elsewhere.

He also said she would need a dye and contrast scan, it's called an arthrogram. They inject some iodine into the joint space and the iodine covers the surfaces inside (I looked this up by the way) then they scan with a low density x-ray and they can see how much of the head is involved. Not sure when they'll do this, but with children it is done under anaesthetic.

He concluded that if this didn't work, she may need to have one of the repositioning operations- at this point I didn't ask anymore.

I have to give Emma three 5ml spoonfuls of nurofen each night - seems a lot doesn't it! I did put Emma in traction again I'm thinking if we are more resilient in making her do it, there maybe a miracle and her tendons release before the D-day.

Emma leopard, school fair