Knee pain in a young woman who was born with spastic cerebral palsy

Patient

Q: I was born with spastic diplegic cerebral palsy. I am used to joint pain, but over the last week or so, my right knee has been hurting more than usual, and there is some bruising and swelling. Should I be concerned?

Doctor

A:    Anterior knee pain arising from the patellofemoral joint may be a significant problem in the cerebral palsy (CP) population. The pain in the knee that you described might be a complication of your Spastic cerebral palsy. Cerebral Diplegia is a type of Cerebral Palsy which is a disorder affecting the development of movement and posture that is believed to arise from non-progressive disturbances in the developing fetal or infant brain. In addition to the motor disorders that characterize cerebral palsy, which limit a patient's activities, individuals with cerebral palsy often display epilepsy, secondary musculoskeletal problems (joint problems), and disturbances of sensation, perception, cognition, communication, and behavior. Cerebral palsy has traditionally been classified on the basis of the type of motor disorder that occurs, with variable numbers and descriptions of types The revised classification now in use defines 3 main categories of motor disorder, as follows: Spastic (70-80%), Dyskinetic (10-15%) and Ataxic (less than 5%). The Spastic Cerebral palsy is classified according to involvement of the extremities: Diplegia ( 30-40%) the lower extremities are affected more than the upper extremities and in some cases are solely involved.). Conservative treatment methods such as anti-inflammatory drugs, local ice packs, stretching exercises, and braces should be the first step in treatment. If the conservative treatment is not effective, surgical treatment alternatives must be discussed. Knee pain resolves in all patients after surgical treatment of the underlying pathology. Gait analysis can be performed for patients with patellofemoral subluxations to evaluate the rotational malalignment of the tibia and femur. In conclusion, anterior knee pain arising from the patellofemoral joint in patients with CP should be evaluated and treated to prevent future functional deterioration.

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