Screening for Congenital Dislocation of the Hip, Scoliosis, and Other Abnormalities Affecting the Musculoskeletal System

Abstract

The three main conditions affecting the musculoskeletal system currently being screened for are spina bifida cystica, congenital dislocation of the hip, and scoliosis. The techniques of screening are different for each: amniotic fluid analysis for spina bifida cystica, a manual physical examination for congenital dislocation of the hip, and a visual examination for scoliosis. Properly time amniotic fluid analysis for alpha-fetoprotein is both a sensitive and specific test for neural tube defects. However, because of the low incidence of spina bifida cystica, this examination is justified only in high-risk pregnancies. Maternal serum screening has not achieved widespread acceptance because of its lack of sensitivity and the low and apparently falling incidence of the deformity. The neonatal manual examination for congenital dislocation of the hip is now well established and widely practiced. Almost all agree that the incidence of persistent congenital dislocation of the hip has been lowered as a result. However, the examination lacks both sensitivity and specificity because of intrinsic difficulties with the examination and the occurrence of late onset subluxation and dislocation. It is becoming apparent that congenital dislocation of the hip is a dynamic problem in the peri- and early neonatal period. Repeated careful evaluation of the hips during infancy is necessary to make the diagnosis as early as possible. To further enhance early detection, it may be necessary to consider obtaining an anteroposterior pelvis radiograph at age 4 to 6 months in babies at high risk. The visual evaluation for scoliosis is a very sensitive test but lacks specificity. Efforts are now being made to quantify visual screening techniques and thus decrease the numbers of false-positive examinations.