CAUSES OF PAIN IN THE MUSCLES OF THE LOWER EXTREMITIES IN CHILDREN WITH CEREBRAL PALSY

Authors

  • Oleksandr Danilov Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-4605-7032
  • Oleksandr Shulga Shupyk National University of Health Care of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-9962-2816
  • Oleksandr Kucheruk KNP KOR «Kyiv Regional Children's Hospital No. 2». Ukraine, Ukraine
  • Kateryna Bandrina Dobrobut Clinic, Kyiv. Ukraine, Ukraine

DOI:

https://doi.org/10.15674/0030-59872024341-48

Keywords:

Children, cerebral palsy, subfascial pressure, pain syndrome

Abstract

A high level of muscle spasticity in children with cerebral palsy is one of the causes of degenerative and dystrophic changes in tissues. Against the background of high spasticity, there is a violation of blood flow in the vessels of the lower extremities, which leads to changes in subfascial pressure and the formation of primary pain syndromes. The analysis of the literature shows the need to study the issues related to the mechanism of formation of changes in the muscles and determine the primary causes of pain. Objective. Тo study the mechanism of changes in the muscles of the lower extremities, as well as the primary causes of pain syndrome. Methods. The analysed indicators were obtained during the treatment of 40 patients with cerebral palsy, who were divided into 3 groups depending on the muscle tone disorder. Clinical and instrumental methods were used to examine patients. The data obtained were statistically processed with the determination of M ± m, the coefficient of reliability according to Student’s criteria. Results. According to the results of the study, high spasticity leads to impaired blood flow and increased subfascial pressure in the musculofascial sheaths. There is an inverse correlation between the increase in subfascial pressure, the diameter of the vessel lumen and blood flow velocity. This is one of the causes of degenerative and denervation changes in muscles and fascia. It was proved that the occurrence of primary pain in the lower extremities is caused by various etiological causes: tissue ischemia; increased subfascial pressure; narrowing of pathologically significant anatomical areas in which nerves lie; degenerative and dystrophic changes in the joints. Conclusions. The study found that the cause of changes in the muscles and fascia is a violation of blood flow, a change in subfascial pressure in the musculofascial cases of the lower extremities. The occurrence of pain in the lower extremities in children with cerebral palsy is multifactorial in nature and consists of myofascial, articular, and tunnel syndromes.

Author Biographies

Oleksandr Danilov, Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine, Kyiv

MD, Prof. in Traumatology and Orthopaedics

Oleksandr Shulga, Shupyk National University of Health Care of Ukraine, Kyiv

MD, PhD in Traumatology and Orthopaedics

Oleksandr Kucheruk, KNP KOR «Kyiv Regional Children's Hospital No. 2». Ukraine

MD

Kateryna Bandrina, Dobrobut Clinic, Kyiv. Ukraine

MD

References

  1. Bezsmertnyi, Y., Shevchuk, V., Jiang, Y., Bezsmertna, H., & Bezsmertnyi, O. (2021). Impact of post- amputation pain syndrome on the results of bone stump formation. Morphologia, 15(3), 50–56. https://doi:10.26641/1997-9665.2021.3.50-56
  2. Bordoni, B., & Varacallo, M. (2021) Bony pelvis and lower limb, thigh quadriceps muscle. StatPearls. Anatomy
  3. Cheverda, A. I., Huk, Y. M., Zyma, A. M., Kincha-Polishchuk, T. M., Syvak, M. F., & Zotia, A. V. (2019). Diagnosis and treatment of contractures of the hip and knee joints in patients with the consequences of open forms of spinal Dysraphism. Visnyk ortopedii travmatologii protezuvannia, 103(4), 61–72. https://doi:10.37647/0132-2486-2019-103-4-61-72
  4. Simons, D. G., Travell, J. G., & Simons, L. S. (1999). Travell & Simons’ Myofascial pain and dysfunction: Upper half of body. Lippincott Williams & Wilkins.
  5. Danilov O., Balitskaya Y., & Motsya M. (2013) Mechanism of formation and clinical course of flexion contractures of knee joints in children with cerebral palsy. Surgery of paediatric age,4, p.8–15.
  6. Danylov, O., & Shulha, O. (2023). Optimisation of methods of diagnosis and correction of heel foot in children with cerebral palsy. Paediatric surgery Ukraine, 4(81), 49–58. https://doi:10.15574/ps.2023.81.49
  7. McDowell, B. C., Duffy, C., & Lundy, C. (2017). Pain report and musculoskeletal impairment in young people with severe forms of cerebral palsy: A population-based series. Research in developmental disabilities, 60, 277–284. https://doi:10.1016/j. ridd.2016.10.006
  8. Fishchenko, V., & Obeidat, K. J. (2022). Lower limb muscles functioning in the condition of flexion contracture of the knee joint. Trauma, 23(2), 17–24. https://doi:10.22141/1608-1706.2.23.2022.886
  9. Graham, H. K., Rosenbaum, P., Paneth, N., Dan, B., Lin, J., Damiano, D. L., … Lieber, R. L. (2016). Erratum: Cerebral palsy. Nature reviews disease primers, 2(1). https://doi:10.1038/nrdp.2016.5
  10. Hauer, J., Houtrow, A. J., Feudtner, C., Klein, S., Klick, J., & Murphy, N. A. (2017). Pain assessment and treatment in children with significant impairment of the central nervous system. Pediatrics, 139(6). https://doi:10.1542/peds.2017-1002
  11. de Bruijn, J. A., Wijns, K. C., van Kuijk, S. M., Hoogeveen, A. R., Teijink, J. A., & Scheltinga, M. R. (2021). Chronic exertional compartment syndrome in the differential diagnosis of peripheral artery disease in older patients with exercise-induced lower limb pain. Journal of vascular surgery, 73(6), 2114–2121. https://doi:10.1016/j.jvs.2020.11.027
  12. Klochkova, O. A., Kurenkov, A. L., & Kenis, V. M. (2018). Development of contractures in spastic forms of cerebral palsy: Pathogenesis and prevention. Pediatric traumatology, orthopaedics and reconstructive surgery, 6(1), 58–66. https://doi:10.17816/ptors6158-66
  13. Komshina, K. (2020). Pain syndrome and comorbidity in adult patients with cerebral palsy. Saratov journal of medical scientific research, 16 (1).
  14. Komshina, K, & Antipenko, E (2020). Evaluation of the features of pain syndrome in adult patients with infantile cerebral palsy. MA, 1(62), 7.
  15. Lontkovsky, Y. (2016). Treatment of adults and children with organic localised spasticity of the lower extremity muscles. International neurological journal, 6, 51–57. https://doi:10.22141/2224-0713.6.842016.83.
  16. Lontkovskyi, Y., Pichkur, L., Vaslovych, V., & Shmeleva G. (2016). Morphological changes of the adductor muscles of the thigh in local spasticity in patients with cerebral palsy. Ukrainian neurosurgical journal, 2, 28–32
  17. Mathewson, M, & Lieber R. (2015). Pathophysiology of muscle contractures in cerebral palsy. Physical medicine and rehabilitation clinics of North America, 26(1), 57–67. https://doi: 10.1016/j.pmr.2014.09.005
  18. Martyniuk, V., & Nazar, O. (2016). Unified clinical protocol «Cerebral palsy and other organic brain lesions in children, accompanied by movement disorders». Part I. Sovremennaya pediatriya, 75(3), 100–105. https://doi:10.15574/sp.2016.75.100
  19. Nenko A., Vlasenko S. (2009). Diagnstics and treatment neuroorthopedic syndromes at patients by snfantile cerebal palsy. Algorithms choice and tactic of therapy. Evpatoria: Managements for doctors., 1–152
  20. Poirot, I., Laudy, V., Rabilloud, M., Roche, S., Ginhoux, T., Kassaï, B., & Vuillerot, C. (2017). Prevalence of pain in 240 non-ambulatory children with severe cerebral palsy. Annals of physical and rehabilitation medicine, 60(6), 371–375. https://doi:10.1016/j.rehab. 2017.03.011
  21. Tondiy, O., Zavalna, O., & Korenev, S. (2016). Tunnel mononeuropathies: Etiology, pathogenesis, clinical manifestations, diaghosis, treatment. Shidnoevropejskij zurnal vnutrisnoi ta simejnoi medicini, 2016(1), 68–74. https://doi:10.15407/internalmed2016.01.068
  22. Semkovych, Y., & Dmytriiev, D. (2022). Visual analogue scale as a tool for assessing quality of life (PEDSQL™) and emotional stress in children after anterior abdominal wall surgery. Pain, anaesthesia & intensive care, 2(99), 41–48. https://doi:10.25284/2519-2078.2(99).2022.265838.
  23. Strafun, S., Tkach, A., Strafun, A., & Saliy, A. (2014). Risk of local hypertensive ischaemic syndrome in trauma. Trauma, 15(3), 5–10. https://doi:10.22141/1608-1706.3.15.2014.81418.
  24. Willard, F. H., Vleeming, A., Schuenke, M. D., Danneels, L., & Schleip, R. (2012). The thoracolumbar fascia: Anatomy, function and clinical considerations. Journal of anatomy, 221(6), 507–536. https://doi:10.1111/j.1469-7580.2012.01511.x
  25. Zharikova, A., Krivoshey, O., & Tsukanova, S. (2020). Tunnel neuropathies of the pelvic girdle and lower extremities. Gomel: GU «RNPC RMEH», 1–50.
  26. Zozulya, I., & Bredikhin, A. (2011). Myofascial pain syndrome: Diagnosis, treatment. Ukrainion medical magazine, 3(83)

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How to Cite

Danilov, O. ., Shulga, O. ., Kucheruk, O. ., & Bandrina, K. . (2024). CAUSES OF PAIN IN THE MUSCLES OF THE LOWER EXTREMITIES IN CHILDREN WITH CEREBRAL PALSY. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (3), 41–48. https://doi.org/10.15674/0030-59872024341-48

Issue

No. 3 (2024)

Section

ORIGINAL ARTICLES

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Copyright (c) 2024 Олександр Данілов, Олександр Шульга, Олександр Кучерук, Катерина Бандіна

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