Strategies of hip management in neuromuscular disorders: Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease and Arthrogryposis Multiplex Congenita.
Joint contractures, subluxation and dislocation are common problem in children with neuromuscular disorders. Medical, surgical and rehabilitative approaches can be used to maintain patient function and comfort. Contracture release, hip dysplasia correction and procedures to address or prevent hip subluxation or dislocation, are not always necessary since patients can be asymptomatic and surgical treatment will not always be successful in maintaining a reduced hip. In fact, controversy surrounds the management of hip disorder in children with Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease and Arthrogryposis Multiplex Congenita. Patients with neuromuscular disorders also frequently develop a progressive scoliosis with pelvic obliquity which may affect sitting balance and become painful. Most subluxations and dislocations have the tendency to occur on the high side of a tilted pelvis. Spinal stabilisation is sometimes necessary to improve the pelvic tilt and to prevent further increase. The present article provides an overview of the current strategies of hip management in neuromuscular disorders.
Canavese
F
F
Department of Orthopedics, Shriners Hospital for Children, 3101 SW Sam Jackson Park Road, Portland, OR 97239, USA. canavese_federico@yahoo.fr
Sussman
M D
MD
D000293:Adolescent; D001176:Arthrogryposis / Q000150:complications / Q000628:therapy*; D002607:Charcot-Marie-Tooth Disease / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D006616:Hip Contracture / Q000209:etiology / Q000628:therapy*; D006617:Hip Dislocation / Q000209:etiology / Q000628:therapy*; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007223:Infant; D020388:Muscular Dystrophy, Duchenne / Q000150:complications / Q000628:therapy*; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D014897:Spinal Muscular Atrophies of Childhood / Q000150:complications / Q000628:therapy*