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Neuromuscular conditions Poliomyelitis Dr. Mohammed M. Zamzam Associate Professor & Consultant Pediatric Orthopedic Surgeon Poliomyelitis Infectious disease characterized by Asymmetric flaccid motor paralysis Pathology Entro Virus (Picornavirus) Polio (3) no cross immunization Transmitted by oronasal route By water and milk Distribution Lower limb Trunk + LL LL + UL Bilateral UL Trunk + UL + LL Deformities: 92 % 4% 1.33 % 0.67 % 2% – Spine (scoliosis, Kyphosis) – Limbs (equinous, pes cavus, flail knee & UL) Causes of deformity in Polio Unbalanced muscle paralysis: – Unopposed muscle pull from the non-paralyzed muscles Gravity pull effect Posture: – e.g. Sitting with knee flexed Deformities Vary according to degree of muscle imbalance, or if patient was diagnosed early and attempts were made to prevent deformities Lower limbs are the commonest. If associated with trunk deformity, they are really disabled Muscle power grading Grade 0 total paralysis (no contraction palpated) Grade 1 evidence of slight contractility but no joint movement Grade 2 complete range of motion with gravity eliminated Grade 3 complete range of motion against gravity Grade 4 complete range of motion against some resistance Grade 5 complete range of motion against maximal resistance Diagnosis Is not difficult Asymmetric, flaccid lower motor neuron paralysis No sensory loss, or loss of proprioception There is full control of the bladder & bowel There should be a history of febrile illness Management Management starts with diagnosis & accurate muscle charting (assessing power & deformities) Discussion of expectations Assessment Family resources support Deformity correction Mainly lower limb Aim for walking with or without orthosis by getting straight limb with plantigrade foot Methods – – – Reconstructive surgery Physiotherapy Orthosis Orthosis Reconstructive surgery Correction of deformities Improving the function (transfer of a tendon or muscle, removal of deforming force) Stabilizing paralyzed joints (arthrodesis) Paralytic scoliosis Usually long C shaped curve Trunk collapse occurs when there is weak erector spinae muscles. Long spine fusion is the treatment Orthosis maturity might be used to delay fusion till
