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At least 379 records · Page 21Linked to original sources
PubMed1988

Idiopathic contracture of the gluteus maximus muscle in children.

Restriction of motion of the hip caused by contracture of the gluteus maximus is not uncommon. Twenty-seven children with this disorder were reviewed between 1975 and 1983. The clinical manifestations are very characteristic. All patients underwent surgical release of the fibrotic contracture tissue of the gluteus maximus with good results. The etiology of the disorder remains unknown. It is likely that the primary cause might be congenital in origin and that some predisposing condition exists. In addition, intramuscular injection might play an important role.

Buttocks↗
PubMed1993

[A radiological study of the hip joint in cerebral palsy].

In cerebral palsy (CP), abnormal posture, contracture of the hip and dislocation occur during a long period of the course. In order to clarify the factors of tendency to dislocation, radiological survey was undertaken for the patients of CP. These data were analyzed from the respects of weight bearing, position of leg and developed deformity at the neck of the femur. One hundred seventy eight hips of 90 patients with an average of 26 years of age and 64 hips of normal individual as a control. Kai's method was used for measuring angles of tilting at neck and anteversion. The incidence of dislocations of the hip joints was more frequent in patients who were incapable of weight bearing than in patients who were capable of weight bearing (p < 0.01). However, there was no difference between spastic type and athetotic type of CP. In patients who were incapable of weight bearing inclination (the neck-shaft angle), anteversion of the femoral neck to the shaft showed larger than in patients who were capable of weight bearing (p < 0.01). Anteversion of patients who were capable of weight bearing of CP was larger than that of the normal control (p < 0.01), but extent of inclination was the same. From these findings the present investigator has concluded that femoral neck becomes valgus with an increased anteversion in longstanding CP patients who are especially unable to stand or walk. Furthermore, such hip joints are found to dislocate easily if adducted.

Adolescent↗
PubMedDate not supplied

[Preliminary treatment of congenital hip dislocation using physical therapy based on neurophysiology].

Adductor tightness is a typical symptom in CDH. In cases of subluxation and complete dislocation even a rigid abduction contracture can occur, preventing reduction and favouring redislocation. The contracture of the hip joint is the result of neurophysiological disorders, which can be treated by an exercise program on a neurophysiological basis. 62 children with 73 severely contracted and 5 hypotonic hip dislocations have been treated by the so-called "Vojta-program" before reduction. In a prospective study over 5 years this kind of treatment has been very successful: the incidence of necrosis of the femoral head could be reduced to 4%, long-lasting traction was not necessary anymore and the rigid hip joints required open reduction only in 2 cases.

Cerebral Palsy↗
PubMedDate not supplied

Normal ranges of hip motion in infants six weeks, three months and six months of age.

Flexion contracture, internal rotation and external rotation of the hip were reported in 40 infants at 6 weeks and 3 months and in an independent sample of 40 infants at 6 months of age. Population means and normal ranges of motion were determined for use in the evaluation of hip problems and their treatment. A mean hip flexion contracture of 19 degrees was present at 6 weeks of age, decreasing to 7 degrees by three months, but still persisting at 6 months suggesting that forceful extension of the hip in infants may be contraindicated. Hip flexion contracture decreased in every child from 6 weeks to three months. In all cases, external rotation was greater than internal rotation. Internal rotation greater than external rotation before the age of 6 months appears contrary to normal development. There was a significant correlation between the changes in hip flexion contracture and internal rotation from 6 weeks to 3 months. An interesting extension of this study would be a longitudinal follow-up of infants beyond 6 months of age to further define these developmental trends.

Aging↗
PubMedDate not supplied

Ankle, knee, and hip moments during standing with and without joint contractures: simulation study for functional electrical stimulation.

Joint contractures have been one of the contraindications for use of functional electrical stimulation for standing in paraplegic patients. A simulation study using a three-segment link mechanical model of the human body was performed to calculate the muscle moments at the ankles, knees, and hips during standing with and without having joint contractures. The knee and hip angles were varied in 5 degrees increments, whereas the ankle angles were varied in 1 degree increments. It was assumed that energy efficient posture was obtained with the least sum of the squared moments of the ankles, knees, and hips joints by the muscles. Ankles at 5 degrees of dorsiflexion, knees at 0 degrees, and hips at 15 degrees of extension resulted in the most energy efficient posture without joint contractures. The muscle moments increased with the increase in angle of contractures. The joint contractures at ankle angles > or = 6 degrees of plantar flexion, knee angles > or = 20 degrees of flexion, and/or hip angles > or = 20 degrees of flexion produce a potentially unstable posture. These findings suggest that some degree of joint contractures can be tolerated in paraplegic patients using functional electrical stimulation for standing.

Algorithms↗
PubMed1985

The hip in arthrogryposis multiplex congenita.

The hip is involved in up to 80% of individuals with a diagnosis of arthrogryposis multiplex congenita. The hip deformity consists of contracture with or without dislocation. Isolated contracture can usually be treated conservatively by manipulation and splinting, only occasionally requiring operative intervention. Dislocation is as frequently bilateral as unilateral. Bilateral hip dislocations are best left unreduced; only accompanying contractures should be treated. The unilateral dislocation should be treated aggressively, because persistent dislocation will give rise to pelvic obliquity and scoliosis. Open reduction is always necessary.

Arthrogryposis↗
PubMed1996

[Hip in arthrogryposis multiplex congenita].

PURPOSE OF THE STUDY: In arthrogryposis Multiplex Congenita (AMC) multiple joint contractures and deformities are present. Hips are often affected. In this follow-up study the outcome after primary treatment and secondary surgical procedures was analyzed with clinical and radiological features. MATERIAL AND METHODS: 52 patients with AMC were treated at Children's Hospital, Helsinki. 34 patients had Hip joint involvement. The most common type of Hip joint involvement was a flexion contracture (40 per cent). Thirty-five per cent of patients had rigid dislocations. Ten hips with rigid dislocations and four hips with flexion contractures was primarily operated on. Two failures of the primary operative procedures were noted. Thirty-one dislocated hips were treated non-operatively. RESULTS: In fourteen cases, reduction could not be achieved. Nineteen delayed surgical procedures were done. Acetabuloplasty was made in 6 hips, femoral osteotomy in 8 hips and total hip replacement in 3 hips. Aseptic necrosis of the femoral head encountered for 4 poor results in two cases of acetabuloplasty and 3 hips had a poor range of motion. In flexion contractures of the hips, 6 corrective osteotomies were done and in four cases the results were good. In all cases of total hip replacement the results were good and no complications were seen. DISCUSSION: The inefficiency to achieve reduction of dislocated hips in AMC-patients by conservative methods was confirmed in this study. Although it has been claimed that the majority of patients with flexion contractures can be managed by conservative treatment there were ten patients in this series who did not respond to this form of treatment. CONCLUSION: The primary form of treatment should be operative. Only in selected cases with bilateral dislocations should it be considered to leave the hips untreated. Double femoral osteotomy in recurrent flexion contractures or resistant flexion contractures and total hip replacement in adult patients with hip dislocations are useful methods.

Adolescent↗
PubMed2001

Motor functions in non-ambulatory children with spastic diplegia and periventricular leukomalacia.

The course of acquisition of various gross motor skills and changes in their patterns with advancing age, in addition to joint contracture, hand function, and mental ability, were investigated in 20 non-ambulatory children with spastic diplegia and periventricular leukomalacia. Among the diplegic children studied, those with lower locomotive ability also had lower hand function, lower mental ability and slower acquisition of gross motor skills. All subjects could roll by 24 months of age. Fourteen patients could creep by 18 months of age, and the remaining six by 30 months. Crawling was observed in only five patients with mild locomotive disability as a final locomotive pattern on the floor. Among ten patients with mild locomotive disability, three could sit by 2 years of age, six by 3 years, and one by 4 years. Among ten patients with severe disability, two, two, four and two children could sit at the ages of 2, 3, 4 and 5 years, respectively. Twelve patients could walk with support at between 2 and 5 years of age. Delay in acquisition of creeping or sitting differed somewhat among subjects with similar final locomotive disability. The majority of subjects with severe locomotive disability developed contracture of the hips and knees. Only two patients with mild disability had contracture of the ankles.

Brain↗
PubMed1978

Sacral agenesis.

Twenty-three patients with sacral agenesis evaluated at Newington Children's Hospital between 1959 and 1977 were classified according to patterns of morphologic deficiency in the bones and articulations. Motor deficit in these patients corresponded, within one level, to vertebral loss; sensory deficit did not correspond. The major orthopaedic problems often associated with sacral agenesis are spinopelvic instability, scoliosis, myelomeningocele, hip dislocation and contracture, knee contracture, and foot deformity. These can be controlled or corrected by proper orthopaedic management.

Abnormalities, Multiple↗
PubMed2006

[Diagnosis and treatment of gluteal muscle contracture associated with unequal leg length caused by pelvis obliquity].

OBJECTIVE: To investigate the pathogenesis, diagnosis, and treatment of the gluteal muscle contracture associated with an unequal leg length caused by the pelvis obliquity (GMC-PO). METHODS: The retrospective analysis was made on the clinical features and the follow-up results in 132 patients who had been admitted from January 1990 to December 2004 for GMC-PO. Among them, 73 were male and 59 were female with a range in age from 5 to 26 years (average, 11 yr). All the patients were characterized by unsymmetrical contracture of the gluteal muscles, including unilateral and bilateral contracture. Of the patients, 89 had a clear limping and 78 had a clearly-unequal leg length. The X-ray examination revealed pelvis obliquity in 97 cases and an increased angle of the femur neck in 11 cases. The arc longitudinal incision was made into the posterolateral area nearby the greater trochanter and then lysis of the gluteal muscles was performed, combined with the skin traction of both legs and exercise training. RESULTS: Of the 132 patients with unequal gluteal muscle contracture before operation, 13 had a relative length difference of 0.5-1.5 cm between the 2 legs, 1 had a difference of 3.0 cm, and the remaining 118 patients had an equal leg length. Excellent and good results were achieved in 118 and 13 patients, respectively after the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateral area nearby the greater trochanter, combined with postoperative skin traction and functional exercises. Only 1 patient had a poor result. The follow-up for 3 months to 14 years showed that the cure rate was as high as 99.2%. CONCLUSION: The gluteal muscle contracture associated with an unequal leg length caused by the pelvis obliquity is a result of the unequal gluteal muscle contracture between the 2 hips and it can be cured with a comprehensive therapeutic method including the surgical release of the gluteal muscle contracture by the are longitudinal incision into the posterolateral area nearby the greater trochanter, and postoperative skin traction as well as the functional exercise.

Adolescent↗
PubMed2003

[Alignment of lower extremity in rheumatoid arthritis patients with a history of both total hip replacement and total knee replacement].

OBJECTIVE: The following is a retrospective study on lower extremity alignment of rheumatoid arthritis (RA) patients with a history of both Total Hip Replacement (THR) and Total Knee Replacement (TKR). METHODS: From 1992 to 2000, our department had 26 rheumatoid arthritis patients who underwent both THR and TKR. We classified these patients into three groups based on radiographic alignment of the lower extremities in the standing position: Knock-knee (valgus deformity of the knees), Bowleg (varus deformity of the knees) and Windswept Deformity (one knee in severe varus alignment with the other in severe valgus alignment). Furthermore, we identified dominant weight bearing points of the hip as classified by the following new criteria: Central Shift, Lateral Shift, and Upward Shift. Mal-alignment was then evaluated based on these two classification systems. RESULTS: Of the 26 patients, 22 patients met our criteria and 4 did not. In mal-alignment, we had 11 cases in the knock-knee group, 5 cases in the bowleg group, and 6 cases in the Windswept deformity. Using the new criteria, central shift had 6 cases; lateral shift had 6 cases; and upward shift had 10 cases. The groups of Lateral shift and Central shift demonstrated deformities of the lower extremities were influenced by moving weight bearing points, pelvis obliquity, and adduction contractures of the hip joint. In upward shift, weight bearing lines did not change. Consequently, destruction of the joint in this group progressed symmetrically. Windswept deformity was asymmetric and had severe destruction on the other side of the knee and forefoot. DISCUSSION: Moving of weight bearing point, pelvis obliquity, and adduction contractures of the hip joint affected the severity of mal-alignment of the lower extremities.

Adult↗
PubMed1998

Development of the hip in diastrophic dysplasia.

We examined 50 patients with diastrophic dysplasia both clinically and radiologically. Two legally aborted fetuses were dissected. The mean age of the patients was 16.2 years (newborn to 38) and the mean follow-up was 11.4 years (3 months to 34 years). The fetal hips and MRI of newborn infants showed congruity and no significant joint deformity. Flexion contracture of the hip became evident later in 93% and was progressive. The radiological appearance of the proximal femoral ossific nuclei was delayed and in 17% of males and 28% of females the ossific nuclei had not appeared by the age of 12 years. Radiological measurements differed considerably from reference values and were related to the rapid and progressive restriction of rotational movement and the increase in flexion contracture. The typical findings were flattening and inferomedial bulking of the femoral head and a double-hump deformation. The changes in the hip led to secondary osteoarthritis before early middle age. We describe the clinical and radiological measurements which define the early degeneration of the joint.

Abortion, Legal↗
PubMed1995

Selective posterior rhizotomy and soft-tissue procedures for the treatment of cerebral diplegia.

The results of selective posterior rhizotomy in fifty patients (group I) and of soft-tissue procedures in fifty patients (group II), all 100 of whom had cerebral diplegia and were seen in a private office, were reviewed retrospectively. No effort was made to randomize the treatment, as the selection criteria for the two procedures are different. We evaluated the range of motion and the ability and quality of walking preoperatively and postoperatively as well as the need for additional operative intervention in the two groups. The average age of the patients in both groups was five years (range, three to twelve years in group I and one to thirteen years in group II). The average duration of follow-up in both groups was four years (range, one to six years in group I and one to seven years in group II). Thirty-two patients (64 percent) in group I and forty-one patients (82 percent) in group II were able to walk independently at the latest follow-up examination. Both groups had an over-all improvement in the ranges of abduction of the hips and dorsiflexion of the ankles, a decrease in the flexion contractures of the hips, and more normal popliteal angles; however, with the numbers available, there were no significant differences in these measurements between the two groups at the 0.05 percent confidence level. Despite the overall improvement in range of motion, thirty-one patients in the rhizotomy group subsequently had soft-tissue releases, and twenty-two patients in the soft-tissue-release group had additional operative intervention.

Adolescent↗
PubMedDate not supplied

Heterotopic ossification after hip surgery in cerebral palsy.

Heterotopic ossification is a post-surgery complication occasionally observed in patients with infantile cerebral palsy. In the majority of the cases such lesions are found at the hip after surgery on the skeleton and the soft tissues. At our Institute in the last five years, this complication has been observed four times, in 39 patients, who underwent mainly soft tissue releases because of flexion and adduction contracture of the hip. In these cases, as in a further patient with myelomeningocele, the periarticular heterotopic ossification appeared in the hip after tenotomy of the ilio-psoas at the lesser tronchater associated to other surgical procedures. Conversely, no cases of ossification have been found after tenotomy of the adductors or the gracilis or selective tenotomy of the psoas at the pelvic brim. The exact causes of this complication are still unclear, but after an analysis of the literature and patient history it can be hypothesised that it may be related to the surgical procedures carried out.

Adolescent↗
PubMed1987

Functional outcomes after hip fracture.

The ability to achieve independent ambulation after hip fracture, orthopedic stabilization, and subsequent rehabilitation was studied in 65 inpatients in a specialized geriatric rehabilitation center. The association of 10 factors with the ability to achieve independent ambulation was measured by Kendall's tau B analysis and a two-tailed t test. The 10 factors were sex, age, surgical technique, side of fracture, site of fracture, presence of previous fracture, presence of lower extremity contractures, strength of hip abductor muscles, number of visits to physical therapy, and number of days from surgery to discharge from physical therapy. Measurements were taken at discharge from physical therapy, at 60 days after surgery, and one year after surgery. Fifty-four (83%) of the 65 patients reached independent ambulation at some time between the date of surgery and one year later. At one year after surgery, only 4 of the 65 patients had died. The variables of age, lower extremity contractures, strength of the affected hip abductor muscles, type of surgical technique, number of visits to physical therapy, and number of days from surgery to discharge were associated with independence in ambulation.

Activities of Daily Living↗
PubMed1984

Femoral neck abnormalities in spina bifida.

Femoral neck abnormalities in spina bifida can be of two types: Type A, consisting of widening of the physis and often associated with varus deformity, and Type B, characterized by marked narrowing of the femoral neck, resulting in a typical mushroom appearance. The Type A deformity is usually associated with an abduction contracture of the hip. This physeal lysis seems to be secondary to microtrauma sustained during persistent exercise done by the parents and therapist to overcome the abduction contracture. No treatment is required, even when varus deformity is present. These patients require an orthosis with a pelvic band for ambulation, and their mobility will not be affected by the deformity.

Child↗