How can muscle/tendon release surgery help children with cerebral palsy?

Children with cerebral palsy may develop a problem called hip subluxation, in which the hip becomes partially dislocated. To alleviate pain, improve function, and prevent full dislocation, physicians may recommend a procedure in which muscles and tendons in the leg are “released,” or lengthened.


What Is Hip Subluxation?

When a hip is subluxed, that means that the head of the femur (thigh bone) is still somewhat in its socket, but no longer in the center as it should be. If left untreated, subluxation can lead the femur to become dislocated, or pop completely out of the socket.

What Causes Hip Subluxation?

Hip subluxation often occurs in young children with spastic cerebral palsy. Spastic cerebral palsy is by far the most common type of cerebral palsy; neurotransmitter levels are affected, leading to hypertonia (extreme tension) in the muscles and tendons that receive signals from damaged portions of the brain. Hypertonic muscles and tendons can pull the femur away from its socket, resulting in hip subluxation.

Hip subluxation can also be caused by issues with the shape of the socket (too vertical or too shallow) or the femur (not angled enough, so that it does not fit properly into the socket).  

What Are the Signs and Symptoms of Hip Subluxation?

Signs and symptoms of a subluxed hip include:

  • Pain on the affected side (in some cases, both hips may be affected)
  • Limited range of motion (difficulty straightening hips, knees, and ankles)
  • Inability to sit comfortably
  • Difficulty standing and walking
  • One leg appears shorter than the other
  • Hips appear to be misaligned

How Can Hip Subluxation Be Treated?

Procedures to treat a subluxed or dislocated hip include (often, more than one of these treatments will be used in conjunction, especially in cases of dislocation):

  • Muscle/tendon lengthenings
  • Femoral osteotomy (cutting, repositioning, and reattaching the femur bone)
  • Pelvic osteotomy (improving the shape of the socket)
  • Botox injections (this can be used to reduce tightness/spasticity in a specific selection of muscles)
  • Phenol injections (this can block neuronal signals that cause spasticity before they reach the muscles)

Here, we will focus on muscle and tendon lengthening, also known as “release” procedures.

How Do Muscle/Tendon Releases Work?muscle release surgery

Usually, though not always, muscle and tendon lengthening procedures are performed before a child is eight years old. Sometimes, a child will have the exact same surgery done on both sides, but in other cases, each side will require a different procedure. Also, in some cases, only one side will be operated on.

Depending on the patient’s individual circumstances, physicians may lengthen any of the following tendons/muscles:

  • The iliacus and psoas, which are also known as the “hip flexor” muscles
  • The tensa fascia lata and the iliotibial band, which help to pull the hip out to the side
  • The adductors and gracillis, which connect the legs to the rest of the body
  • The hamstrings, which are needed to bend at the knees
  • The gastrocnemius and soleus, which attach the ankle to the calf

During the surgery, a small incision will be made in the skin and sheath (covering of a muscle). If the hamstrings are lengthened, the child will be put in knee immobilizers during recovery. If the gastrocnemius/soleus are lengthened, they may wear a cast or removable boot. If only tendons are operated on, they will likely have dissolvable sutures and small dressings.

What Is the Role of Physical Therapy in Recovery?

Physical therapy (PT) after muscle or tendon lengthening surgery is very important. The exact regimen will differ depending on the procedures undertaken and other individual factors, but will need to start off very gently and then become more aggressive once approved by the child’s doctor. Post-operative PT should include strengthening, stretching, and gait training exercises.

Detroit, Michigan Cerebral Palsy AttorneysReiter & Walsh Cerebral Palsy Attorneys

Cerebral palsy is, unfortunately, often caused by medical malpractice that occurs during or near the time of birth. Every year, thousands of children will be diagnosed with cerebral palsy as the result of preventable birth injuries. At Reiter & Walsh ABC Law Centers, our legal team works tirelessly to help these children secure funds for lifelong treatment, therapy, and a secure future.

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Sources:

Children’s Hospital Boston: A Guidebook for Hip Surgery in Children with Cerebral Palsy. file:///C:/Users/rstokes/Downloads/CPLEBookweb2.pdf

BMJ: Hip dislocation in cerebral palsy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420759/