- pattern of hip deformity in cerebral palsy depends on type and extent of neurologic impairment;
- non progressive neuromuscular disorder w/ onset before 2 yr resulting from injury to the immature brain;
- etiology includes: perinatal infections (TORCH), prematurity (most common), anoxic injuries, head injuries, and meningitis;
- commonly immobility leads to joint contractures that, if uncorrected, can progress to cartilage deformity and joint dysplasia;
- associated disorders:
- convulsive seizures occur in about 25% of patients, most often in those with hemiplegia;
- strabismus and other visula field defects may be seen.
- children with athetosis due to kernicterus commonly display nerve deafness and paralysis of upward gaze;
- children with spastic hemiplegia or paraplegia frequently have normal intelligence and a good prognosis for social independence;
- spastic quadriplegia and mixed forms often are associated w/ disabling mental retardation;
- diff dx:
- w/ a "progressive CP" consider another diagnosis such as the San Filippo's syndrome (see mucopolysaccharidoses);
- surgery is best reserved for children over 3 yr with spastic CP, good intelligence, and voluntary muscle control;
- muscle imbalance yields later to bony changes, so goal is to perform soft tissue procedures early and, if necessary, bony procedures later;
- sites of involvement:
- hip joint in CP:
- flexion deformity of the knee:
- foot and ankle in CP:
- hand in cerebral palsy
- patient locomotor profile is based on primative reflexes;
- presence of 2 or more primitive reflexes usually means the child will be a non ambulator;
- common tests are the Morrow and Parachute Reflexes, which normally dissapear at 4-5 months;
- parachute reflex:
- hold the child prone and then lower the child rapidly toward the floor;
- parachute reaction is normal or positive if the child reaches toward the floor
- Relationship between the parachute reactions and standing and walking in normal infants.
- The parachute reactions in normal and late walkers.
Current Concepts Review. Management of the Hip in Cerebral Palsy.
Review Article: Current Concepts: Surgical Management of Spastic Diplegia in Cerebral Palsy.
Cerebral Palsy: An Overview from the Orthopaedic Care Textbook
Surgical Management of Cerebral Palsy in the Upper Extremity from the Orthopaedic Care Textbook