Poliomyelitis
Poliomyelitis is an acute viral infectious disease affecting the Anterior Horn Cells of the spinal cord, leading to Lower Motor Neuron (LMN) flaccid paralysis. While largely eradicated, post-polio sequelae are still common in orthopedic practice.
1. Pathology & Stages
- Acute Stage: Fever, muscle tenderness, paralysis. Rx: Rest, splinting (prevent contracture).
- Convalescent Stage: Recovery of muscle power (sprouting of axons). Lasts up to 2 years. Rx: Strengthening, stretching.
- Residual Stage: Permanent paralysis and fixed deformities. Rx: Surgery, Orthotics.
2. Clinical Features
- Paralysis: Flaccid, asymmetrical, patchy. Sensation is intact.
- Common Deformities:
- Hip: Flexion, Abduction, External Rotation (due to TFL contracture).
- Knee: Flexion, Valgus, External Rotation.
- Ankle: Equinus (tight Achilles).
- Hand-to-Knee Gait: Patient pushes thigh backward with hand to lock the knee due to Quadriceps paralysis.
3. Management Principles
Post-Polio Syndrome:
New onset weakness and fatigue decades after the original infection. Due to "burnout" of the enlarged motor units.
Treatment: Energy conservation, non-fatiguing exercise.
New onset weakness and fatigue decades after the original infection. Due to "burnout" of the enlarged motor units.
Treatment: Energy conservation, non-fatiguing exercise.
- Orthotics: KAFO (Callipers) for quad weakness. AFO for foot drop.
- Surgery: Tendon transfers (only if passive ROM is full) or Arthrodesis (Fusion) for stability.
25 Practice MCQs
Q1. The primary site of pathology in Poliomyelitis is:
Answer: A). Leads to LMN paralysis.
Q2. Sensation in Polio is typically:
Answer: A). Pure motor neuropathy.
Q3. "Hand-to-Knee" gait is seen in paralysis of:
Answer: A). Hand pushes the femur back to lock the knee in extension.
Q4. Iliotibial Band (ITB) contracture causes:
Answer: A). Classic polio hip deformity.
Q5. Recovery in the Convalescent stage continues for up to:
Answer: A). Axonal sprouting takes time.
Q6. Ober's Test is used to detect:
Answer: A). Leg stays abducted when dropped.
Q7. Paralytic dislocation of the hip is most common in:
Answer: A). Gluteal weakness + Adductor strength.
Q8. A "Calcaneal Gait" (heel walking) is due to paralysis of:
Answer: A). Lack of push-off.
Q9. Tendon transfer rules require the donor muscle to have:
Answer: A). Muscle loses one grade of power after transfer.
Q10. Gluteus Maximus lurch involves:
Answer: A). To maintain hip extension passively.
Q11. Yount's fasciotomy releases:
Answer: A). For hip flexion abduction contracture.
Q12. Triple Arthrodesis fuses:
Answer: A). Stabilizes the flail foot.
Q13. Knee recurvatum in polio is often beneficial because:
Answer: A). Allows locking in extension.
Q14. Post-Polio Syndrome symptoms include:
Answer: A). Metabolic exhaustion of surviving motor neurons.
Q15. Which muscle is most commonly paralyzed in the lower limb?
Answer: A). Followed by Quadriceps.
Q16. Short limb gait is treated conservatively with:
Answer: A). Compensates for leg length discrepancy.
Q17. Arthrodesis is preferred over tendon transfer when:
Answer: A). Provides stability at the cost of motion.
Q18. "Tripod Sign" involves:
Answer: A). Meningeal sign in acute phase.
Q19. Sharrard's procedure transfers:
Answer: A). Corrects gluteus medius lurch.
Q20. The spinal cord level for Quadriceps is:
Answer: A). Knee extension.
Q21. Muscle atrophy in polio is:
Answer: A). LMN lesion characteristic.
Q22. KAFO stands for:
Answer: A). Stabilizes knee and ankle.
Q23. Soft tissue release must be done:
Answer: A). Deformity must be passively correctable first.
Q24. Blue skin in polio limbs is due to:
Answer: A). Autonomic involvement.
Q25. Is polio progressive?
Answer: A). The virus clears, but damage remains.
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