Background & Aims
Hip disorders frequently affect individuals with cerebral palsy (CP), encompassing a broad range of issues such as hip subluxation, dislocation, degeneration, and pain. Despite the normal state of the hip at birth, the interplay between muscle imbalance and bony deformities contributes to the development of these disorders in CP patients. In addressing the associated pain, hip joint neurolysis emerges as a palliative interventional procedure, focusing on the selective destruction of sensory nerves responsible for the pain sensation in the hip joint.
In this case study, we present the successful application of hip joint neurolysis for pain management in a 23-year-old severely spastic, bed-ridden girl with cerebral palsy, who experienced hip joint dislocation leading to intractable pain..
Methods
A 23-year-old patient diagnosed with cerebral palsy sought assistance at the pain clinic due to bilateral hip joint dislocation. The patient’s mother reported her daughter experiencing severe left hip joint pain for the past six weeks, despite the use of multiple pain medications that proved ineffective. Although corrective sub-trochanteric osteotomy with extensive soft tissue release was initially planned, the mother expressed concerns regarding anesthesia risks and potential postoperative intensive care unit (ICU) stay. Consequently, she declined consent for the surgical procedure and requested exploration of non-surgical alternatives. In response to this, the patient was referred to a pain physician to explore potential interventions for pain relief as an alternative to surgical correction.
Results
We performed a diagnostic block targeting the anterior articular sensory nerve branches, which play a significant role in pain sensation, using local anesthetics and steroids. There was an immediate reduction in pain of more than 80% upon movement of the hip. According to her mother, the patient remained pain-free for two weeks but then experienced a gradual return of partial to full pain. Subsequently, a neurolytic agent containing 90% alcohol was administered around the specific nerve area, specifically the articular branches of the sensory nerve of the hip joint as identified in the diagnostic block. This neurolysis provided relief from her symptoms for a period of 5 months, as reported during her last follow-up.
Conclusions
In conclusion, hip joint neurolysis emerges as a viable option for addressing severe movement-related pain associated with hip joint disorders in cerebral palsy (CP) patients. This intervention becomes particularly valuable when conventional oral and injectable analgesics prove ineffective, and surgical correction poses a high risk in terms of anesthesia.
References
Flynn JM, Miller F. Management of hip disorders in patients with cerebral palsy. J Am Acad Orthop Surg. 2002 May-Jun;10(3):198-209. doi: 10.5435/00124635-200205000-00006. PMID: 12041941.
Presenting Author
Gouhar Afshan
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Acute Pain and Nociceptive Pain