Hip dislocation in quadriplegic

    
      Re: Hip dislocation in quadriplegic
    


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Posted by CCF Neurosurgery MD on December 15, 1997 at 11:23:16:

In Reply to: Hip dislocation in quadriplegic posted by Jim Dwyer on November 20, 1997 at 19:00:37:

: I am a non-ventilator dependent quadriplegic with a C-2 spinal cord
  fracture.  I am 4 1/2 years post injury with no movement below my neck.
  I was recently diagnosed with a dislocated hip after x-rays and a bone
  scan.  I also had a recent bout of cellulitis (2 months ago) but have been
  advised that my condition is not related to that and I no longer have any
  remaining infection from that illness.  Due to muscle atrophy however it
  is believed that resetting the hip would be futile and the only
  alternatives are to fuse the joint in either a sitting or laying position
  or do nothing and adjust to the condition.  Although the latter is without
  pain due to my level of feeling, the spasms experienced prevent me from
  operating my electric wheelchair (sip 'n puff) and causes autonomic
  dysreflexia when stimulated.
  I'm hesitant to take large doses of medications to control the spasms
  because of my already weak diaphragm and possible urine retention in my
  bladder.  I spent 8 months on a ventilator and still have a trach because
  I don't have a cough reflex. But there must be other options to deal my
  hip dislocation.  Although I can't feel the pain of it my body tells me
  it's having problems through body spasms and blood pressure fluctuations
  and I'm afraid of muscle contractions since proper range of motion can't
  be performed.
  Do you have any suggestion?
_____________________________
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Dear Jim,
Your situation is difficult.  Spasms can be difficult to control without side-effects,
though there may be some medications that you have not tried.  Baclofen comes
to mind, though you may have used it already.  Ask your physician for other
options for medications in spasticity.  Sometimes it takes some fine tuning
of medications to get the desired effects.
The issue with your dislocated hip is also problematic.  The problem with fusing
the hip in a sitting or laying position is that it further limits you to only
position.  This may be too much to ask as a change from sitting to laying
is an element of freedom that a C2 quad may not want to give up.  Orthopedics
is not my specialty, so you may choose to speak to your orthopedic surgeon
about alternatives, or get a second opinion.
The path of least resistance may be to find a medication for spasms and go
from there.  Talk to your physician.
Good luck.