Developmental hip dysplasia casefile

Developmental hip dysplasia casefile usually have groin and upper leg pain as the commonest complaint; but that's not always the case.

Miss S is a 21-year old young woman. Six years ago she began to get pain in the upper lumbar spine. She's not quite sure when the pain in the front of the upper thigh and groin began, but she thinks it was after her back. The last year or two walking became a misery, and 'op stap' (what young people do in the evenings and over the weekend, walk gezellig in the town with their friends, sometimes perhaps a pub-crawl!) became impossible.

She consulted me for the first time five months ago.



On examination

On examination her pelvis was level, but there was an obvious severe right sacroiliac joint fixation. SIJ tests were negative though. Forward flexion, and extension were tight in the low back, and rotation to the left caused quite severe pain in the upper lumbar spine; these findings are much in common with conditions other than a developmental hip dysplasia casefile.


The reflexes were normal, and there was no loss of muscle power, but there were definite sensory changes in the front of her thigh on pinwheel examination. Hyperesthesia is an increased prickle when testing the skin.

A test for femoral nerve by stretching it was positive. Range of motion of the right hip (and the left to a lesser extent) was greatly increased. Internal and external rotation was especially hypermobile giving rise to a suspicion of developmental hip dysplasia.

The insertion of the iliopsoas muscle in the groin was exquisitely painful. In the infant, your chiropractor will be doing the tests of Ortholani, Galeazzi and Barlow.


X-rays

A mild case of Developmental Hip Dysplasia was immediately evident in the right hip, and to a lesser extent the left hip. A very shallow socket, with a sloping roof, explaining why the hip range of motion was greatly increased. In the upper lumbar spine there was no obviously abnormalities of the bones themselves, or the joints, but the abrupt change from a lumbar lordosis at the thoraco-lumbar junction told a story of spinal dysfunction.


Upper leg pain

Upper leg pain is a common complaint as the ball subluxates in and out of the socket. Notice how a large part of the ball of the femur is unroofed - it protrudes nearly one third beyond the boundary of the acetabulum; that's typical of every developmental hip dysplasia casefile.


Developmental hip dysplasia casefile

Developmental hip dysplasia casefiles are interesting in that sometimes the presenting complaint is high lumbar pain, and to a much lesser extent hip and groin discomfort. It was only on further questioning about what aggravated her condition, what was limiting and if there was radiation to the leg that she spoke about the stabs in the groin.


Perhaps that was due to her extreme shyness. She declared later that another doctor had been rather 'personal' about the pain in the groin. In fact she was extremely diffident, and it took some weeks for the whole story to come out. It's for this reason that I encourage patients with groin conditions to bring a partner or parent with them. More traditionally we speak of two conditions, Meralgia Paresthetica and Maignes Syndrome that radiate from the upper lumbar spine to the upper leg and groin.

Sexual advances chiropractor do occur very occasionally, but in this instance it was a medical doctor.



However, in this instance, it appears that the pain was radiating FROM the hip TO the upper lumbar spine. This would probably be mediated along the iliopsoas muscle that travels from the upper lumbars to the groin, or via the Femoral nerve ...


Daily exercises

When faced with any incurable condition, one is forced to return to the basics of good health. A disciplined exercises programme is usually one of those basics.

This is an exercise that I have been working on for some years to perfect, to strengthen the muscles of the hip. It's quite complex, so I've divided it into three parts. Perfect part 1 before moving on to part 2, to part 3. It takes about two minutes on your bed before arising every morning.


Chiropractic help

Chiropractic help progress for chronic conditions is usually slow but Miss S has responded better than expected. The treatment of her back turned out to be more or less routine, but the treatment of her groin pain was excruciating for the first half dozen treatments; that's not uncommon in the management of each developmental hip dysplasia casefile.

She didn't get bruises in the inner thigh, but it does happen. More parsley benefits by the way will help.

She does her exercises faithfully, has accepted that running is not for her, and even a low amble over the weekend can also be very trying.



Hip arthritis

Hip arthritis is a common sequela if a developmental hip dysplasia casefile isn't well managed.

The average person might take about 70 million steps in a lifetime. A bad case of hip dysplasia might walk less than half of that before wearing out and requiring a total hip replacement. A mild case might make the full 70 million steps, but with pain in the latter years.


Best to assume your hip might only manage 40-50 million steps, so jogging and long hikes are not sensible. Walk for fitness, but within moderation. Rather cycle and swim when possible.

She comes faithfully for her consultation every six weeks, mindful of how she has suffered and doesn't want a relapse now. She cycles everywhere, to work, to the theatre, to her violin lessons, and reserves walking for special occasions.

Unfortunately neither I nor anyone will cure her, unless she is ready to attempt radical re-shaping of her pelvis; read lower down.

Like diabetes, high blood pressure and a heap of medical conditions, Miss S has accepted that she has an incurable, but treatable condition.

Her life is good; but not perfect. It isn't for most of us.



USEFUL LINKS



"I just wanted to let you know how interesting I found your Chiropractic Help Hip and Groin pain newsletter on hip dysplasia. Having just been diagnosed, Jan 2009, with Congenital Hip Dysplasia, and having undergone two Periacetabular Osteotomies, it is nice to see that you know of the condition - so few people do - most think it is something that dogs get! I continue to read with interest, all your articles. Thank you. I shall be passing this on to the ladies at the hip women yahoo group."


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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


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