. Author manuscript; available in PMC: 2016 Apr 5.

Published in final edited form as: Biol Blood Marrow Transplant. 2015 Mar 31;21(7):1167–1187. doi: 10.1016/j.bbmt.2015.03.024

Table 12.

Ancillary Therapy and Supportive Care Recommendations for Fasciitis, Contractures, Steroid Myopathy, and Avascular Necrosis

Type of Intervention	Rating
Fasciitis/Contractures
Refer to PT for quantitative ROM measurements, to provide the patient with stretching exercises and to monitor progress.	AIII
Evaluation of ROM at each clinic visit.	AIII
Daily stretching exercises at home	AIII
PT stretching 2–3 times a wk (severe impairment)	AIII
Surgical release	DIII
Steroid myopathy and deconditioning
Strengthening: isometric, isotonic, isokinetic exercise	AII
Decreased stamina: aerobic exercise should be progressive with increase in duration and resistance to achieve elevated heart rate	AIII
Avascular necrosis
Nonoperative management in more advanced cases (bracing, crutches, intra-articular steroids, oral medications)	DIIb
Surgical management, including joint replacement	BIIb

PEDIATRIC CONSIDERATIONS In children, a major goal is to avoid early replacement with artificial joints that have a finite lifespan. Therefore, therapy for moderate to severe AVN in children involves appropriate chronic analgesia and a variety of temporizing surgical interventions including core decompression, partial or total hip resurfacing at centers specializing in these approaches.