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BLOG: 31-year-old who developed an acute viral infection as a child
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by Sam Dyer, PA-C, MHS
This case involves a 31-year-old man who developed an acute viral infection as a child while living in West Africa. He said there was no vaccine available to children in his community and after the attack, he was left with significant knee and leg muscle atrophy. He has developed worsening knee joint pain and difficulty with transfers.
He said that even his “good leg” causes some discomfort. He has pain with walking and at rest and NSAIDs are not helping. On exam, the patient is a well-developed well-nourished pleasant man in no apparent distress. He has an antalgic gait to the left. There is marked atrophy of his quads, hamstring and calf muscles. There is a palpable osteophyte along the medial femoral condyle. His range of motion is slightly decreased and his ligaments are stable. See the images. What is it?
Polio and post-polio syndrome
Polio is an acute inflammatory viral disease affecting multiple organ systems. In the musculoskeletal system, the disease affects motor neurons causing paralysis of muscle tissue. The disease is uncommon these days in the United States since the creation of the polio vaccine, but you will still see the occasional patient with post-polio syndrome, which is characterized by progressive muscle weakness occurring years after an acute poliomyelitis attack. Affected extremities have obvious muscle wasting and atrophy. It is very common that these patients develop degenerative joint disease due to the lack of supporting structures.
The treatment is physical therapy and if degenerative changes present, NSAIDs, intra-articular cortisone injections and possible referral for joint arthroplasty. Joint arthroplasty is controversial however due to the poor outcomes associated with instability from the diffuse muscle atrophy and weakness. Many would recommend arthrodesis as the standard.