SLOB

What we KNOW: 1. High muscle tone (especially 'dystonic') WILL stress and strain these baby hips, and older ones as well. It is that fierce. 2. Cross leg posture focuses the abnormal pressure on the weakest part of the socket, the soft edge rather than the firm center. 3. This dysplasia is not a static anatomic deformation – it is a process. However bad it looks now, it will look even worse next week. PDH x-rays are like a photo of windshield wipers, only capturing the moment. Mild dysplasia = ongoing damage. 4. Remove the high muscle generated pressure AND [must be “and”] abnormal crossed posture --- and the hips will be fine if damage has not yet created an inherently unstable joint as [a marble put into an empty shoe box]. 5. The palsy related muscle tendon contractures are often of greater strength than the socket walls. Muscle “STRETCHING” is only an assumption when doing stretching exercises. They should be called: “Hopefully stretching muscle while not instead driving the femur through the socket wall.” With the leg not aBducted, passive knee extension pistons the femur and presses the socket wall out. The femur is a huge lever and the hip socket walls are soft. “Stretching” vs “Demo” ? At what age should we intervene to not lose the hips? Well, with CDH/DDH a few days old was certainly not too soon. It is the same with PDH in order to PREVENT dysplasia !!!! 'Early detection' [x-ray] is NOT early. You need to have substantial cartilage damage before anything – even trace change in BONE can be seen on an x-ray. There is no ultrasound available for PDH. In PDH the cause isn't going away, it is increasing. You do not need x-ray to see the cause . We can see what damages