Transcript Poliomyelitis

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