HIP DYSPLASIA ORTOLANI GALEAZZIWhat is DEVELOPMENTAL HIP DYSPLASIA ? (DDH)(Keywords: HIP DYSPLASIA ORTOLANI GALEAZZI, Developmental Hip Dysplasia, chiropractic, DDH, hip arthritis) The normal development of the acetabulum in the young child is utterly dependent on the apposition of a normal round femoral head. Should the spherical hip dislocate, or subluxate, the three epiphyseal growth plates in the acetabulum will not grow normally.
The result? A shallow, misshapen socket from which the head of the femur will tend to dislocate or subluxate. Developmental Hip Dysplasia which untreated and improperly managed inevitably progresses to hip arthritis.
The three ossifications centres are totally dependent on the presence of the ball in the socket. No ball, then no healthy socket will develop, hence the term Developmental Hip Dysplasia.
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HIP DYSPLASIA ORTOLANI GALEAZZI
OTHER FINDINGSLooking for foot flare and a short leg accompanied by an obviously skew pelvis, and associated scoliosis, is part of the normal chiropractic examination of every patient, so it's no surprise that chiropractors may be tbe first to discover less severe cases with negative Hip Dysplasia Ortolani Galeazzi Barlow signs, but certainly with "lateralisation of the head of the femur" as it's called in Holland.Asymmetry of the gluteal folds is another perhaps less obvious sign. In the both the child and adult pain in the groin and anterior thigh may be the presenting complaint.
"Any limp in a child should be considered abnormal. The diagnosis can be quite variable, but an underlying etiology must always be pursued." Dr JJ McCarthy, Consulting Orthopaedic Surgeon. What concerns me is that cases slip through under the radar, probably mild cases, but there are plenty of them. Barely a week goes by when I don't encounter a new case, and hip pathology is not the reason most patients consult a chiropractor. These mild cases which at birth had no obvious dislocation or subluxation, or were missed, but on X-ray as children or adults clearly have Developmental Hip Dysplasia. Those are the people where chiropractic has a vital role to play.
Cornwall Hip Foundation.
We speculate, but firmly believe that much of this hip arthritis can be prevented by early detection and correct chiropractic management. It's not rocket science. A sixty second examination of the hip gives the shrewd clinician a pretty sure indication of whether the patient may have DDH. The range of motion is grossly increased in the young patient, gradually becoming stiff, and ultimately stiff and arthritic. Detected early...
The heartbreak of HIP DYSPLASIA ORTOLANI GALEAZZI ...Children and young adults with mild cases of Developmental Hip Dysplasia, because of the greatly increased range of motion of the hip, may excel at ballet, modern dancing, gymnastics and other sports. Persuading them and their parents that they must choose other activities less traumatic for the hip creates the typical clinician dilemma.Opinion of other professionals is obviously mandatory, but sometimes is not worth a dime...
My daughter has just been diagnosed with hip dysplasia at 28 and my sister was at the age of 21. I am 45 now but first had knee problems at the age of 25. My knee occassionally just gave way!! Not much pain really. Then about 4-5 years ago when I started going to the gym regularly and cycling a lot my left hip would 'dislocate' it didnt hurt much but felt really awkward and sometimes took days or weeks to go back in. I didn't go to the GP untill 18 months ago when the pain got bad and I couldn't walk properly. I also noticed I had the same walk as my sister! As a child I excelled in athletics and was very flexible (I always amused people with my unusual sitting position of kneeling with my legs out to the side!) I can't do this anymore and cannot walk far. I also now have more pain in the right hip and the x-ray shows the right hip to be worse? Could this be where I have compensated for the left hip pain? Might I just have osteo arthritis or do you think it sounds like dysplasia? And does it matter for my outlook anyway? Please help me..I don't want to go back to my gp as they have little sympathy." An ounce of advice, a very specific set of exercises done daily for life, and a minimum of chiropractic care thirty years ago would have saved this lady a lot of the current drama. But the past lies fixed in concrete, one can only profitably look to the future, rather than bemoaning what should or should not have been done.
CHIROPRACTICBoth the ball and acetabulum are living tissue, capable of regeneration and remoulding. Much research now proves that hyaline cartilage can and does regenerate given the right environment.Doing nothing, the most common scenario, until the patient has pain in the groin and difficulty walking leads to the inevitable deterioration with time and the likelihood of an early total hip replacement, or other dire procedures such as Peri-Acetabular Osteotomy. The young adult with a greatly increased range of motion of the hip, particularly if associated with pain in the groin, should be regarded with a high degree of suspicion. X-ray of the pelvis to assess the shape and size of the acetabulum is mandatory. An ounce of prevention ... FROM THE CHIROPRACTIC COALFACEA 24-year old woman presented six months ago, complaining of chronic thoraco-lumbar pain. There was no mention of hip or groin pain.Routine examination of the hip revealed greatly increased range of motion of the right hip and, on palpation extreme tenderness of the hip capsule and Pectineus and Adductor magnus muscles. The insertion of the Psoas major in the upper femur was red hot. X-ray examination of the spine revealed no abnormalities but, in the radiograph of the right hip, the typical shallow acetabulum and partially unroofed head of femur typical of DDH were to be seen. She was not a breech birth, and had no history (I asked her mother to accompany her for the Report of Findings) of hip problems as an infant or in childhood. Certainly there was never mention of HIP DYSPLASIA ORTOLANI GALEAZZI. My first thoughts before seeing the X-rays were of a Maignes Syndrome, referring pain to the groin. Ultimately I have decided that it's vice versa: The hip is referring pain to the back, mediated via the Psoas major and the Cluneal nerves.
MAIGNES SYNDROME ... She is now consulting me once a month for maintenance care. Yesterday she had minimal pain or tenderness in the groin, but the low thoracic spine remains unstable. It's largely painfree for a few weeks, and then with bending and lifting (she cares for small children in a creche) the thoraco-lumbar pain recurs. She is doing the rehab exercises faithfully, and together with a colleague we are developing a new specific exercise for the muscles of the hip. It's complex to describe, and hopefully will be loaded onto Utube in the future. Perhaps most encouraging is the change in her demeanour. Six months ago she was hesitant and doubting and altogether miserable, having been told there was nothing wrong with her. Now she breezes into my consulting room like a breath of fresh air, confident and even a bit saucy! Update: Recently she had a setback. Suddenly for no obvious reason the pain in her groin and upper lumbar spine increased again. I treated her three times, the pain reduced significantly, but her mother insisted she see her GP. He finally took it seriously, referred her to an orthopod who proclaimed she had DDH. Hello, we diagnosed that a year ago, Doc! She's doing fine again, but clearly the hip is unstable, and an unusual movement and set the pain up again. That's hip dysplasia.
MIXED FAIS DDHVery occasionally a hip can show signs of both Femero Acetabular Impingement and Developmental Hip Dysplasia. From an examination point of view it can be very misleading, but the signs and symptoms are much the same: Groin pain, limping patient and usually the reduced range of motion takes precedent. MIXED FAIS DDH ...
Another perspective of DDH. How the position in utero contributes to this problematic syndrome... and what contribution does chiropractic have?
DEVELOPMENTAL HIP DYSPLASIA ...
Mr F had no idea he had a problem until he was 53. By 58 he was quite disabled. If only someone had examined his hip twenty years earlier... it would have save him a heap of misery, and his insurance a packet of euros.
HIP DYSPLASIA CaseFile ... KELLGRAN LAWRENCE grading scaleIt's useful to be able to grade hip arthritis. Kellgran and Lawrence have come up with a simple and handy classification system. KELLGRAN LAWRENCE grading scale for hip arthritis ...
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