SURGICAL: MUSCLE RELEASES
ADDUCTORS, HAM STRINGS AND HEEL CORDS
Children with Cerebral Palsy typically have muscle imbalance. One group of muscles are stronger than the opposing group. This frequently leads to joint deformity and dislocation. Therefore, it is occasionally recommended that the tight group of muscles be lengthened or released.
The goal of a muscle release is to prevent or correct a deformity. In the case of the hips, release of the adductors prevents dislocation. In the case of the knees, release and lengthening of the ham-strings, makes walking easier and more efficient. In the case of the feet ad ankles, lengthening of the heel cords allow easier ambulation.
Lengthening of any of these muscles. Involves cutting them and making them longer. Occasionally, a particular muscle might just be cut and not repaired.
Lengthening of a muscle whether it be adductors, ham-strings or heel cords take approximately one hour. Lengthening multiple groups additively takes longer. The muscle is surgically divided, with a knife or electrocutter. The joint involved is carefully examined to be sure that the range of motion is improved.
Typically, the child will be placed in a cast following release. For hip releases, the cast is usually two long leg casts with a bar between. Releasing the hamstrings requires a long leg cast. Releasing the heel cords, typically require a short leg cast. For hips and knees, the casts are left on for three weeks, for heel cords the casts are left on for six weeks. You should be warned, that in releasing the hips usually the child will have a significant amount of bruising in the groin and around the genitalia.
PHYSICAL THERPAY MANAGEMENT
Once the casts are removed physical therapy may be initiated. First, gentle stretching and range exercises followed by progressive ambulation if appropriate, is recommended.