title: Hip joint pain in spastic dislocation: aetiological aspects.
abstract: OBJECTIVE
  Children with severe forms of cerebral palsy (CP) are at high risk of hip joint displacement. Various studies have found that the pain from affected joints occurs in 40 to 84% of studied individuals. The purpose of this study was to establish a correlation between the density of nociceptors localized in selected areas of the spastic dislocated hip joint and clinical evidence of hip joint pain in children with CP.
  
  
  METHODS
  Nineteen samples of articular capsule and 19 samples of teres ligaments, collected during open hip joint reduction from 19 non-ambulatory children with spastic CP (Gross Motor Function Classification System level V; mean age 9y 6mo; 10 males, nine females), were studied. Pain was assessed using the numeric rating scale completed by caregivers. The density of nociceptive fibres was compared between the children with painful and children with painless hip joints, using S-100 and substance P monoclonal antibodies.
  
  
  RESULTS
  The presence of S-100 protein and substance P were significantly increased (p=0.024 and p=0.02 respectively) in the children with painful hip joints. There were significantly positive correlations between the intensity of pain and the density of nerve fibres with S-100 protein (teres ligament, p=0.001; joint capsule, p=0.032) as well as substance P (teres ligament, p=0.001).
  
  
  CONCLUSIONS
  Direct and indirect inflammatory factors, present in dislocated hip joints with cartilage damage in children with spastic CP, lead to hip joint sensitization.
authors.affiliation: Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, Lodz, Poland. adian@gazeta.pl
authors.forename: Adrian
authors.initials: A
authors.lastname: Masłoń
authors.forename: Marek
authors.initials: M
authors.lastname: Jóźwiak
authors.forename: Maciej
authors.initials: M
authors.lastname: Pawlak
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Modrzewski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Grzegorzewski
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D006617:Hip Dislocation / Q000150:complications* / Q000209:etiology; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008022:Ligaments / Q000503:physiopathology; D008297:Male; D009412:Nerve Fibers / Q000378:metabolism; D010146:Pain / Q000209:etiology* / Q000473:pathology; D010147:Pain Measurement; D009418:S100 Proteins / Q000378:metabolism; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013373:Substance P / Q000378:metabolism
chemical_list: D009418:S100 Proteins; D013373:Substance P