DEVELOPMENTAL HIP DYSPLASIA CaseFile(Keywords: Developmental Hip Dysplasia CaseFile, hip arthritis, upper leg pain) 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 examinationHer 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. 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 - increased prickle when using the pinwheel. A test for the Femoral nerve (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 increased 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, Galieazzi and Barlow.
X-raysA 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.
DISCUSSIONThis is an interesting DEVELOPMENTAL HIP DYSPLASIA CaseFile in that the presenting complaint was high lumbar pain, and to a much lesser extent hip pain. It was only on further questioning about what aggravated the pain, what was limiting and what radiation to the leg(s) there was that she spoke about the pain in the groin.Perhaps that was due to her extreme shyness. (She admitted 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.
"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 hipwomen yahoo group."
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