Poliomyelitis

By: Dr. Masoud Shayesteh Azar

Associate Professor, Orthopaedic Department,
Mazandaran University

Poliomyelitis
polio= gray matter
Myelitis= inflammation of the spinal cord

Poliomyelitis
First described by Michael Underwood in 1789
First outbreak described in U.S. in 1843
paralytic cases reported in the U. S. in 1952 21,000
Global eradication in near future

Poliomyelitis
Poliomyelitis, literally meaning gray spinal
cord inflammation
It is a viral infection
There are three types of poliovirus and
many strains of each type
It is contagious: usually spread from person
.to person
Only harmful to humans

The Poliovirus
Virus localized in the anterior horn cells of the
spinal cord and certain brain steam motor
.nuclei

Poliovirus
Enterovirus (RNA)
Three serotypes: 1, 2, 3
Minimal heterotypic immunity
between serotypes
Rapidly inactivated by heat,
formaldehyde, chlorine, ultraviolet
light

Poliomyelitis Pathogenesis
Entry into mouth
Replication in pharynx, GI tract,
local lymphatics
Hematologic spread to lymphatics and central
nervous system
Viral spread along nerve fibers
Destruction of motor neurons

Poliomyelitis Pathogenesis
The ant. Horn motor cells may be damaged
by viral multiplication or toxic byproducts of
the virus or indirectly by ischemia, edema,
. and hemorrhage in the glial tissues
Destruction of the spinal cord occurs focally
and within 3 days wallerian degeneration is
.evident

poliomyelitis
Most affects children under the age of 5
.years in developing tropical countries
Incubation period ranges from 6 to 20 days

?What are the symptoms

.Acute stage: generally lasts 7 to 10 days
Many include fever, pharyngitis, headache,
anorexia, nausea, and vomiting. Illness may
progress to aseptic meningitis and
menigoencephalitis in 1% to 4% of patients.
These patients develop a higher fever &
sever headache with stiffness of the neck
. and back

?What are the symptoms

Paralytic disease occurs 0.1% to 1% of
those who become infected with the polio
.virus
Paralysis of the respiratory muscles or from
cardiac arrest if the neurons in the medulla
.oblongata are destroyed

Clinical course
Symptoms range :from mild malaise to
generalized encephalomyelitis with
.widespread paralysis
Hyperesthesia or paresthesia in the
.extremities and muscular pain is common
. Muscles are tender even to gentle palpation

Poliomyelitis
According to Sharrard, weakness is clinically
detectable only when more than 60% of the
nerve cells supplying the muscle have been
.destroyed
Paralysis occurs twice as often in the lower
.extremity as in upper extremity

Poliomyelitis
The most commonly affected muscles are the
Quadriceps, glutei, tibialis anterior, medial
.hamstrings, and hip flexors
. Deltoid, triceps, and pectoralis major

Poliomyelitis
Patients have some or full recovery from
paralysis, most clinical recovery occurs
during the 1 month and almost complete
.within 6 months
Limited recovery may occur for about 2
.years

Poliomyelitis
In cases with paralysis superficial reflexes
usually are absent first, and deep tendon
reflexes disappear when the muscle group
. is paralyzed
DDX.: Guillain-Barre syndrome, and other
forms of encephalomyelitis

Treatment in the acute stage

Bed rest, analgesics, hot packs, and
anatomical positioning of the limbs
gentle passive ROM exercises of all joints

Treatment in the acute stage

close monitoring of respiratory and
cardiovascular functioning is essential during
the acute stage of poliomyelitis along with
fever control and pain relievers for muscle
.spasms
Mechanical ventilation, respiratory therapy may
be needed depending of the severity of
.patients

Convalescent stage
From 2 days after the temperature return to
normal and continues for 2 years
Muscle power improves
Physical therapy is recommended for full
.recovery
Passive stretching exercises and wedging
casts can be used for mild to moderate
.contractures

Convalescent stage
Surgical release of tight fascia and muscle
aponeuroses and lengthening of tendons
may be necessary for contractures
.persisting longer than 6 months
Orthoses should be used until no further
.recovery is anticipated

Chronic stage
:months after the active illness 24
The goals of treatment include correcting any
significant muscle imbalance and
preventing or correcting soft tissue or bony
. deformities

Chronic stage
Static joint instability can be controlled by
.Orthoses
Dynamic joint instability result in a fixed
deformity that cannot be controlled by
.Orthoses

Chronic stage
Soft tissue surgery, such as tendon transfers,
should be done in young children before
the development of any fixed bony
. changes
Bony procedures for correcting a deformity
can be delayed until skeletal growth is near
. completion

Global eradication in near future

Prevention
Prevention
Prevention
Immunization of the young continues

Wild Poliovirus 1988

National Immunization Program

Centers for Disease Control and Prevention

Wild Poliovirus 2004

National Immunization Program

Centers for Disease Control and Prevention
National Immunization Program
Centers for Disease Control and
Prevention

National Immunization Program

Centers for Disease Control and Prevention

Study
We study 246 patient with polio in Sari
Male:156 cases (63/4%)
female: 90 cases (36/6%)
age :22 to 63 years old main age 46/3
One lower limb: 164 cases (66/6%)
Both lower limb: 62 cases (25/2 %)
Both lower limb together with upper limb 10
cases (4/1% )

:Result
From 246 patients ;108 used brace
56 patients needs brace but not used
187 operation has down for these patients
97 patients more than one operation has down
82 patients have mild symptoms and dont need
To any operation or brace.

:Result
:From 187 operation
cases; ankle triple arthrodesis 53
cases; tendon transfer EHL to dorsum 81
foot
cases; other kind of tendon transfers 10
cases; ATL 11
cases; lower limb lengthening 8

:Result
cases; Ephypisodesis 2
case; ankle fusion 1
cases; toe deformity correction 23
cases; soft tissue release for knee and hip 53
flexion contracture
cases; osteotomy around knee 37

:Result
Very important point
No any new case in last 10 years
.reported