Cerebral Palsy
There must be a multivariate approach when evaluating hip pain in a child with cerebral palsy (CP). Difficulty therefore increases when the child displays with communication deficits or mental retardation. Impairments that increase the prevalence of hip pain are:
- Spastic Quadriparesis
- Significant Tone
- Taking GI medications
Although children and individuals with CP do not have a disease of the musculoskeletal system and will still require the same orthopedic evaluation as a unimpaired child, there are musculoskeletal characteristics that need special attention. First being the assessment of body alignment and posture. This combined with a passive range of motion evaluation will provide the information necessary to establish spasticity impairments and subsequent stresses to the joints of the lower extremity. For diagnosis of hip pain in this population it is more important than ever to assess the Low Back, Pelvis, Knee, and Ankle. It is also important to evaluate the presence of constipation, especially in those who use a wheelchair for their primary mode of mobility as this can refer pain to the hip. A behavior response is another possible aspect of stated hip pain. This is distinguished by a close watch of how the child responds to movement when distracted. Other conditions that a child or adolescent with CP may develop include infection (osteomyelitis or septic arthritis), fracture and insidious heterotrophic ossification. Last an evaluation of the seating position and posture in a wheelchair that may contribute to hip pain or discomfort.
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