DEVELOPMENTAL HIP DYSPLASIA (DDH)(Keywords: DEVELOPMENTAL HIP DYSPLASIA, hip dysplasia Ortholani Galeazzi, Barlow manoeuver, hip arthritis, hip stiffness, groin pain, transverse position in utero, Femero Acetabular Impingement syndrome) DEVELOPMENTAL HIP DYSPLASIA begins with a hypermobile hip in the child and young adult and, untreated, then gradually becomes stiff and arthritic as the patient ages.
What is HIP DYSPLASIA?The hip socket, or acetabulum, like all bones must develop, both in utero, and after birth. A child lying in the transverse or breech position is about twenty times more likely to suffer from a congenital dislocatable, or subluxatable hip.In these positions the head of the femur, the ball, does not lie deeply in the socket which is essential to develop a normal deep socket. The result in the newborn child is that the cup is too shallow, and the ball tends to subluxate or dislocate giving a deep sounding 'thunk', not a 'click'. The hip in the child, teen and young adult is HYPERmobile. Too much movement. In the adult, the ball of the hip is partially 'unroofed' - it juts out of the socket, giving reduced femoral head-acetabular contact. The full weight of the body is thus distributed over a much smaller area of the hip and the result is progressive degenerative arthritic change. Unless action is taken timeously, the hip gradually changes from HYPERmobile TO HYPOmobile. Generally speaking patients are unaware there is a problem as it causes no pain in the early stages, and they are unaware that their hip is TOO MOBILE, or NOT MOBILE enough, unless the hip dysplasia is unilateral. They may then be aware of a disconcerting clicking sound, and that they can dislocate their hip.
Paediatric examinationThe paediatrician of course is specifically looking for Developmental Hip dysplasia, because treated immediately it's usually no big deal. S/he will use some of these Hip dysplasia Ortolani Galeazzi Barlow tests... DEVELOPMENTAL HIP DYSPLASIA ORTOLANI GALEAZZI BARLOW...However marginal cases sometimes slip through undetected until perhaps the concerned mother hears the disconcerting clunk, or sees aysmmetical skin folds around the hip, whilst she's changing the diaper. Also, with increasing numbers of babies being treated by chiropractors for Infantile Colic, s/he too should be abreast of these tests. The standard procedure is a Pavlik Harness, developed by a Czech orthopaedic surgeon. This braces forces the head of the femur firmly into the socket by flexing and abducting the hips. In African culture and certain other primates, the baby is carried on its mother's back in this very position, so it's no coincidence that DDH is uncommon in rural African communities.
Sometimes too, an astute mother may notice that her child walks with distinct increase in the lumbar lordosis, and a waddling gait. These are primary signs of DDH, together with the abnormal folds of skin around the hip(s). EXAMINATION OF THE TEENAGER AND YOUNG ADULTThe range of motion of the hip in the young person is normally highly mobile and unrestricted. Thus we do rush to make a diagnosis of probable DDH! However, in the case of the child or young adult who has a 'collapsing hip', or pain in the groin and anterior thigh, there is a high suspicion of DDH as well as other hip conditions such as Perthes disease. Every case should be treated seriously, and followed until the condition has resolved. Left undiagnosed and untreated the likelihood of early disability and hip arthritis is high.Interestingly, as in this Developmental Hip Dysplasia Casefile the presenting complaint in the chiropractic clinic may be upper lumbar pain, mediated through either the Psoas muscle or the Superior cluneal nerves, or the Femoral nerve. With a coexisting DDH it's difficult to decide: is this a DDH or a Maignes Syndrome? In her case, I decided it was both.
DEVELOPMENTAL HIP DYSPLASIA CaseFile ...
MATURE ADULTMr P, a 52-year old man presented recently with right hip and groin pain, beginning about three years previously. Despite various medical treatments, it was clear that the condition was worsening. Putting on shoes and socks was becoming difficult. Walking was painful.Interestingly, he knew the answer to one important question, mostly never known. He remembers his mother telling him that during her pregnancy that he lay in the Transverse position. Both the transverse position, and the breech presentation are known to be associated with a much higher incidence of Developmental Hip Dysplasia. Conversely, in the normal vertex position the baby lies with the legs in the "taylor's posture, with the hips flexed and abducted, and the head of the femur sitting snuggly in the socket.
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