Hip pain in 234 non‐ambulatory adolescents and young adults with cerebral palsy: a cross‐sectional multicentre study

Abstract

In orthopaedic clinical practice hip pain is the main complaint of adults with cerebral palsy (CP). The aim of this descriptive study was to specify prevalence of hip pain and to propose methods of care other than surgery. The study was a cross sectional multicentre one based in the Rhône‐Alpes region. Patients over 15 years of age, with CP who were non‐ambulatory were included. Two hundred and thirty‐four patients were questioned. Mean age of the patients was 27 years 10 months, median 26 years 1 month, with 59.3% males and 40.7% females. Patients were questioned about pain with precise information about the circumstances of pain, tolerance, and treatment. Pain was judged to be intolerable if it prevented usual activities. Prevalence of hip pain was 47.2%. Pain was judged to be tolerable in 35.6% of the 234 patients, i.e. in 75.5% of patients with hip pain. There were three types of pain: provoked pain, pain linked to position, and spontaneous pain. Medical treatment was given to only 13.6% of patients with hip pain. The first treatment for hip pain is to avoid circumstances where pain occurs; medical treatment is reserved for when daily life cannot be adapted sufficiently to prevent pain. Medical treatment must be appropriate with doses of adequate strength before proposing surgery.

Self-Reported Health Status and Quality of Life in Youth With Cerebral Palsy and Typically Developing Youth

“…34 Movement disorders associated with CP (ie, spasticity, dystonia, athetosis) are thought to lead to musculoskeletal pain later in life due to relative overuse, lack of active position changes, and/or abnormal forces across joints. 35 Supporting this premise, Hodgkinson et al 35 reported that 47% of sample of 234 nonambulatory adults with CP reported hip pain. In a preliminary sample of 20 children and adolescents with CP, Engel et al 36 recently documented that 70% of the sample experienced recurrent chronic pain of moderate intensity on a daily or weekly basis.…”

Characteristics of Pain in Children and Youth With Cerebral Palsy

“…14,15 Hip surveillance programs consisting of routine hip x-rays help to identify subluxation and allow for a range of interventions, such as stretching, hip abduction bracing, botulinum toxin, and orthopedic surgery, before hip dislocation and chronic pain develop. 16 Evidence from this study suggests that hip subluxation should routinely be assessed and, if present, management strategies should be actively introduced.…”

Ultrasound screening for decentered hips in children with severe cerebral palsy: a preliminary evaluation

“…The changes become noticeable around the age of two and the risk of hip dislocation is highest before seven years of age [1]. Hip migration and/or displacement can cause severe pain, loss of seating balance and comfort, progression of scoliosis (if present), whereas progressive hip contracture makes hygiene difficult [2,3]. However, advanced hip lateralization is preventable and successful screening programs have been developed based on repeated clinical and radiological (X-ray) evaluations, typically in 6-8-month intervals and, where needed, introduction of early preventive treatments [4][5][6].…”