ICD-10: M93.02

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.02, is a condition primarily affecting the hip joint in adolescents. This condition is characterized by a displacement of the femoral head due to slippage at the growth plate (physis) of the femur. Below is a detailed clinical description and relevant information regarding this diagnosis.

Clinical Description

Definition

Chronic slipped upper femoral epiphysis (M93.02) refers to a gradual displacement of the femoral head, which occurs nontraumatically. This condition typically manifests in children and adolescents during periods of rapid growth, often between the ages of 10 and 16 years, and is more common in males than females[1].

Pathophysiology

The condition arises from a disruption in the normal growth of the femoral head, leading to slippage. The growth plate, which is responsible for the longitudinal growth of the bone, becomes weakened, allowing the femoral head to slip posteriorly and inferiorly. This slippage can be stable or unstable; in the case of M93.02, it is classified as stable, meaning that the displacement does not change significantly over time[2].

Symptoms

Patients with chronic SUFE may present with:
- Hip or groin pain, which can be referred to the knee.
- Limited range of motion in the hip joint.
- A limp or altered gait.
- Symptoms may develop gradually, often leading to a delay in diagnosis as they may be attributed to other causes[3].

Diagnosis

Diagnosis typically involves:
- Clinical Examination: Assessment of hip range of motion and pain.
- Imaging Studies: X-rays are the primary diagnostic tool, revealing the degree of slippage. In stable cases, the displacement may be less pronounced compared to unstable cases[4].
- MRI: In some cases, MRI may be used to assess the condition of the cartilage and surrounding structures.

Treatment Options

Non-Surgical Management

In stable cases, non-surgical management may include:
- Activity modification to reduce stress on the hip joint.
- Physical therapy to strengthen surrounding muscles and improve range of motion.

Surgical Intervention

Surgical options are often considered to prevent further slippage and complications, especially if the condition is progressive. Common procedures include:
- In situ fixation: Involves the placement of screws to stabilize the femoral head without attempting to reduce the slippage.
- Osteotomy: In more severe cases, realignment of the femur may be necessary[5].

Prognosis

The prognosis for patients with chronic SUFE is generally favorable, especially when diagnosed early and managed appropriately. However, complications such as avascular necrosis of the femoral head or early osteoarthritis can occur if the condition is left untreated or if there is significant slippage[6].

Conclusion

Chronic slipped upper femoral epiphysis (ICD-10 code M93.02) is a significant orthopedic condition in adolescents that requires careful diagnosis and management. Understanding the clinical presentation, diagnostic methods, and treatment options is crucial for healthcare providers to ensure optimal outcomes for affected patients. Early intervention can help mitigate long-term complications and improve the quality of life for those diagnosed with this condition.

References

1. Slipped upper femoral epiphysis (nontraumatic) - ICD-10-CM Codes.
2. Chronic slipped upper femoral epiphysis, stable - ICD-10-CM Codes.
3. Pediatric ICD-10-CM Updates.
4. 2023 ICD-10 Code Updates.
5. Billing and Coding: Outpatient Physical Therapy.
6. Other osteochondropathies - ICD-10-CM Codes.

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.02, is a condition primarily affecting adolescents, characterized by a displacement of the femoral head due to slippage at the growth plate. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management.

Clinical Presentation

Age and Demographics

Chronic slipped upper femoral epiphysis typically occurs in children and adolescents, most commonly between the ages of 10 and 16 years. It is more prevalent in males than females, with a ratio of approximately 2:1 to 3:1. The condition is often associated with obesity, as increased body weight can contribute to the mechanical stress on the hip joint[1][2].

Symptoms

Patients with chronic SUFE may present with a variety of symptoms, which can develop gradually over time. Common symptoms include:

• Hip Pain: Patients often report pain in the hip, groin, or knee. The pain may be dull and persistent, worsening with activity.
• Limited Range of Motion: There may be a noticeable decrease in the range of motion of the hip joint, particularly in internal rotation.
• Limping: Affected individuals may exhibit a limp, which can be attributed to pain or mechanical instability in the hip joint.
• Referred Pain: Pain may also be referred to the knee, which can sometimes lead to misdiagnosis[3].

Signs

Upon physical examination, several signs may be observed:

• Decreased Internal Rotation: A significant limitation in internal rotation of the hip joint is a hallmark sign of chronic SUFE.
• External Rotation: The affected leg may be held in an externally rotated position, which can be noted during the examination.
• Tenderness: There may be tenderness over the hip joint, particularly in the groin area.
• Muscle Atrophy: In chronic cases, muscle atrophy around the hip may be evident due to disuse[4].

Patient Characteristics

Risk Factors

Several factors can increase the likelihood of developing chronic SUFE:

• Obesity: Higher body mass index (BMI) is a significant risk factor, as excess weight can place additional stress on the hip joint.
• Endocrine Disorders: Conditions such as hypothyroidism or growth hormone abnormalities may predispose individuals to this condition.
• Genetic Factors: A family history of SUFE can increase the risk, suggesting a potential genetic predisposition[5].

Associated Conditions

Chronic SUFE can be associated with other musculoskeletal disorders, including:

• Osteoarthritis: Long-term consequences of untreated SUFE may lead to early-onset osteoarthritis of the hip joint.
• Legg-Calvé-Perthes Disease: There may be an overlap in symptoms and presentations with this condition, which also affects the hip joint in children[6].

Conclusion

Chronic slipped upper femoral epiphysis (ICD-10 code M93.02) is a significant condition in pediatric orthopedics, characterized by specific clinical presentations, symptoms, and patient demographics. Early recognition and intervention are essential to prevent complications such as avascular necrosis or osteoarthritis. If you suspect a case of chronic SUFE, a thorough clinical evaluation and imaging studies, such as X-rays, are recommended to confirm the diagnosis and guide treatment options.

Chronic slipped upper femoral epiphysis (CSE) is a condition characterized by the displacement of the femoral head due to slippage at the growth plate. The ICD-10 code M93.02 specifically refers to the stable form of this condition. Here are some alternative names and related terms associated with this diagnosis:

Alternative Names

1. Chronic Slipped Capital Femoral Epiphysis (SCFE): This term is often used interchangeably with chronic slipped upper femoral epiphysis, emphasizing the involvement of the capital femoral epiphysis.
2. Stable Slipped Upper Femoral Epiphysis: This term highlights the stability of the condition, distinguishing it from unstable forms.
3. Chronic SCFE: A shorthand reference that combines the chronic nature of the condition with its common abbreviation.
4. Chronic Slipped Femoral Head: This term focuses on the femoral head's position and its chronic displacement.

Related Terms

1. Slipped Upper Femoral Epiphysis (SUFE): A broader term that encompasses both stable and unstable forms of the condition.
2. Nontraumatic Slipped Upper Femoral Epiphysis: This term specifies that the condition is not caused by trauma, which is relevant for coding and diagnosis.
3. Epiphyseal Displacement: A general term that refers to the displacement of the epiphysis, applicable to various conditions, including SCFE.
4. Growth Plate Slippage: A descriptive term that explains the mechanism of the condition, focusing on the growth plate's role.
5. Hip Slippage: A more general term that may refer to similar conditions affecting the hip joint.

Clinical Context

Chronic slipped upper femoral epiphysis is primarily seen in adolescents and can lead to complications if not diagnosed and managed appropriately. Understanding the various terms associated with this condition can aid healthcare professionals in communication, diagnosis, and treatment planning.

In summary, the ICD-10 code M93.02 is associated with several alternative names and related terms that reflect the nature and characteristics of chronic slipped upper femoral epiphysis, particularly in its stable form. These terms are essential for accurate diagnosis, coding, and treatment discussions in clinical settings.

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.02, is a condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate. This condition can lead to significant complications if not managed appropriately. Here’s an overview of standard treatment approaches for this condition.

Understanding Chronic Slipped Upper Femoral Epiphysis

Chronic SUFE typically occurs in children aged 10 to 16 years and is more common in boys than girls. The condition is often associated with obesity and hormonal changes during puberty. Symptoms may include hip or knee pain, a limp, and limited range of motion in the hip joint. Early diagnosis and intervention are crucial to prevent further complications, such as avascular necrosis or osteoarthritis.

Standard Treatment Approaches

1. Initial Assessment and Diagnosis

Before treatment, a thorough assessment is essential. This includes:

• Clinical Evaluation: A detailed history and physical examination to assess symptoms and functional limitations.
• Imaging Studies: X-rays are the primary diagnostic tool, revealing the degree of slippage. MRI may be used in some cases to evaluate the condition of the femoral head and surrounding tissues.

2. Non-Surgical Management

In cases where the slip is stable and the patient is asymptomatic or has mild symptoms, non-surgical management may be considered:

• Activity Modification: Patients are advised to limit weight-bearing activities to reduce stress on the hip joint.
• Physical Therapy: A tailored physical therapy program can help maintain hip mobility and strengthen surrounding muscles.
• Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to manage pain and inflammation.

3. Surgical Intervention

Surgical treatment is often necessary for symptomatic patients or those with significant slippage. The primary surgical options include:

• In Situ Fixation: This is the most common procedure for stable SUFE. It involves the insertion of one or more screws into the femoral head to stabilize the epiphysis and prevent further slippage. This procedure is typically performed arthroscopically or through a small incision.

• Osteotomy: In cases where there is significant deformity or instability, an osteotomy may be performed. This involves cutting and realigning the femur to improve joint mechanics and stability.

4. Postoperative Care and Rehabilitation

Post-surgery, patients require careful monitoring and rehabilitation:

• Follow-Up Imaging: Regular X-rays are necessary to ensure proper healing and alignment of the femoral head.
• Rehabilitation Program: A structured rehabilitation program focusing on gradual weight-bearing and strengthening exercises is crucial for recovery.

5. Long-Term Management

Long-term follow-up is essential to monitor for potential complications, such as:

• Avascular Necrosis: This is a risk following surgical intervention, where blood supply to the femoral head is compromised.
• Osteoarthritis: Patients may develop hip arthritis later in life, necessitating ongoing assessment and management.

Conclusion

Chronic slipped upper femoral epiphysis (ICD-10 code M93.02) requires a comprehensive approach to treatment, balancing non-surgical and surgical options based on the severity of the condition and the patient's symptoms. Early diagnosis and intervention are critical to prevent complications and ensure optimal outcomes. Regular follow-up and rehabilitation play a vital role in the long-term management of affected individuals. If you suspect SUFE, it is essential to consult a healthcare professional for an accurate diagnosis and tailored treatment plan.

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.02, is a condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate. The diagnosis of this condition involves several criteria, which can be categorized into clinical evaluation, imaging studies, and specific diagnostic criteria.

Clinical Evaluation

1. Patient History:
   - The patient typically presents with a history of hip or knee pain, which may be chronic and insidious in onset.
   - Symptoms may include limping, decreased range of motion, and pain that worsens with activity or weight-bearing.

2. Physical Examination:
   - A thorough physical examination is essential. Key findings may include:

   • Limited internal rotation of the hip.
   • External rotation of the affected leg when the hip is flexed.
   • Possible leg length discrepancy.

Imaging Studies

1. X-rays:
   - Anteroposterior (AP) and lateral views of the hip are crucial for diagnosis.
   - X-rays may reveal:

   • Displacement of the femoral head relative to the femoral neck.
   • Changes in the appearance of the growth plate (physeal widening or irregularity).
   • The degree of slippage can be assessed using the Southwick angle or the slip angle.

2. MRI or CT Scans:
   - In some cases, MRI or CT may be utilized to assess the extent of slippage and to evaluate any associated complications, such as avascular necrosis.

Diagnostic Criteria

1. Stable vs. Unstable:
   - For chronic SUFE to be classified as stable, the patient should not exhibit significant symptoms of instability, such as severe pain or inability to bear weight.
   - Stability is often assessed through clinical examination and imaging findings.

2. Age and Growth Plate Status:
   - Typically occurs in adolescents, often during periods of rapid growth.
   - The diagnosis is more common in individuals aged 10 to 16 years, with a higher prevalence in males.

3. Exclusion of Traumatic Causes:
   - It is essential to rule out traumatic causes of hip pain and slippage, as the ICD-10 code M93.02 specifically refers to nontraumatic cases.

Conclusion

The diagnosis of chronic slipped upper femoral epiphysis (ICD-10 code M93.02) relies on a combination of clinical history, physical examination, and imaging studies. The criteria focus on identifying the characteristic symptoms, confirming the diagnosis through radiographic evidence, and ensuring that the condition is stable and nontraumatic. Proper diagnosis is crucial for effective management and treatment to prevent complications such as avascular necrosis or further slippage.