Hip joint pain in spastic dislocation: aetiological aspects.

AIM: Children with severe forms of cerebral palsy (CP) are at high risk of hip joint displacement. Various studies have found that the pain from affected joints occurs in 40 to 84% of studied individuals. The purpose of this study was to establish a correlation between the density of nociceptors localized in selected areas of the spastic dislocated hip joint and clinical evidence of hip joint pain in children with CP.

METHOD: Nineteen samples of articular capsule and 19 samples of teres ligaments, collected during open hip joint reduction from 19 non-ambulatory children with spastic CP (Gross Motor Function Classification System level V; mean age 9y 6mo; 10 males, nine females), were studied. Pain was assessed using the numeric rating scale completed by caregivers. The density of nociceptive fibres was compared between the children with painful and children with painless hip joints, using S-100 and substance P monoclonal antibodies.

RESULTS

The presence of S-100 protein and substance P were significantly increased (p=0.024 and p=0.02 respectively) in the children with painful hip joints. There were significantly positive correlations between the intensity of pain and the density of nerve fibres with S-100 protein (teres ligament, p=0.001; joint capsule, p=0.032) as well as substance P (teres ligament, p=0.001).

INTERPRETATION: Direct and indirect inflammatory factors, present in dislocated hip joints with cartilage damage in children with spastic CP, lead to hip joint sensitization.