Abstract
Hip adductor spasticity is a contributing factor to hip dislocation in patients with cerebral palsy (CP). We hypothesized that botulinum toxin injected into the hip adductor muscles would reduce spasticity and help prevent hip dislocation. Twenty patients with bilateral spastic CP aged 2 to 10 years with gross motor function classification system level IV or V were included. Botulinum toxin was injected into the hip adductor muscles at baseline and at 6-month follow-up. Muscle tone was measured with an eight-channel surface electromyography (EMG) recorder. A hip X-ray was performed, and Reimer’s hip migration index (MI) was measured. The Wilcoxon signed-rank test was used to compare the surface EMG values of the hip muscles at baseline and follow-up. The mean root mean square surface EMG value of the hip adductor muscles was significantly reduced at 1, 2, 3, and 7 months after the first injection, up to approximately 53% of the baseline. The 1-year progression of the hip MI was −0.04%. Repeated sessions of botulinum toxin injections at the hip adductor muscles significantly reduced muscle tone and hip displacement. A botulinum toxin injection may be used as an adjunctive treatment in the prevention of hip dislocation.
Highlights
In non-ambulatory patients with cerebral palsy (CP), the lack of physiologic mechanical stress on the hip joint leads to coxa valga, femoral anteversion, and acetabular dysplasia [1,2], which increase the risk of hip dislocation
Three and seventeen patients were classified with gross motor function classification system (GMFCS) levels IV and Intervention (n = 20)
In conclusion, a botulinum toxin injection is effective in reducing hip adductor muscle tone and spasticity
Summary
Factors associated with hip dislocation in patients with spastic cerebral palsy (CP). Can be divided into three categories, namely, developmental, protective, and mechanical. Developmental factors include weight bearing and ambulation [1]. In non-ambulatory patients with CP, the lack of physiologic mechanical stress on the hip joint leads to coxa valga, femoral anteversion, and acetabular dysplasia [1,2], which increase the risk of hip dislocation. Mechanical factors are hip adductor muscle spasticity and an imbalance in hip muscle tone. Increased adduction forces on the hip joint are thought to create torque on the femoral head, shifting it laterally out of the acetabulum [3,4,5,6]
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