Hip disorders

Developmental hip dislocation, commonly called congenital hip dislocation, refers to a partially or completely displaced femoral head in relation to the acetabulum. It is estimated that it occurs six times more often in females than in males, it may be bilateral or unilateral, incurring most often in the left hip.

Generally, the acetabulum is shallower on the af­fected side than on the nonaffected side, and the fem­oral head is displaced upward and backward in rela­tion to the ilium. Ligaments and muscles become deranged, resulting in a shortening of the rectus femoris, hamstring, and adductor thigh muscles and af­fecting the small intrinsic muscles of the hip. Pro­longed malpositioning of the femoral head produces a chronic weakness of the gluteus medius and mini­mus muscles. A primary factor in stabilizing one hip in the upright posture is the iliopsoas muscle. In de­velopmental hip dislocation, the iliopsoas muscle serves to displace the femoral head upward- this will eventually cause the lumbar vertebrae to become lordotic and scoliotic.

Detection of the hip dislocation may not occur until the child begins to bear weight or walk. The child walks with a decided limp in unilateral cases and with a waddle in bilateral cases. No discomfort or pain is normally experienced by the child, but fatigue tolerance to physical activity is very low. Pain and discomfort become more appar­ent as the individual becomes older and as postural deformities become more structural.

Medical Treatment. Medical treatment of the developmental hip disloca­tion depends on the age of the child and the extent of displacement. Young babies with a mild involve­ment may have the condition remedied through gradual adduction of the femur by a pillow splint, whereas more complicated cases may require trac­tion, casting, or operation to restore proper hip con­tinuity. The thigh is slowly returned to a normal po­sition.

Therapeutic Treatment. Active exercise is suggested along with passive stretching to contracted tissue. Primary concern is paid to reconditioning the movement of hip exten­sion and abduction. When adequate muscle strength has been gained in the hip region, a program of ambulation is conducted, with particular attention paid to walking without a lateral pelvic tilt.

A child in the adapted physical education or ther­apeutic recreation program with a history of devel­opmental hip dislocation will, in most instances, re­quire specific postural training, conditioning of the hip region, continual gait training, and general body mechanics training. Swimming is an excellent activity for general conditioning of the hip, and it is highly recommended

Activities should not be engaged in to the point of discomfort or fatigue.

Дата добавления: 2015-11-16