Femoral Nerve Palsy

Femoral nerve palsy can develop during treatment with the Pavlik Harness. It occurs in about 2-3% of babies that use the harness. It does not mean that the harness was used incorrectly. Femoral nerve palsy sounds bad but it’s like your leg falling asleep when you cross your legs while sitting. It is almost always reversible when the position is changed by removing the harness or adjusting it to decrease the flexed position of the hip.

Femoral Nerve Palsy from pavlik harness treatment[+] Enlarge
This child’s left leg is affected by femoral nerve palsy.

The femoral nerve is a large nerve in front of the hip joint. It can become kinked when the hip is flexed or in the bent up position. There is no pain because it is a muscle nerve only. The muscle on the front of the thigh “falls asleep” and the baby can’t straighten the knee.

If you notice that your child isn’t trying to kick his/her leg out straight, there might be femoral nerve palsy. Your doctor will check for this during regular exams in the Pavlik Harness, but this is most likely to occur during the first week that the child is in the harness.

The causes of femoral nerve palsy aren’t fully understood, but it is more likely to occur in an older infant, in a heavier infant, or when the hip dysplasia is more serious. A recent study published in The Journal of Bone and Joint Surgery found that success with the Pavlik Harness is only 47% when palsy develops and it is more likely to develop in infants with a stiff dislocated hip.

It’s important to know that femoral nerve palsy can occur in the harness so that the harness can be removed or adjusted. However, femoral nerve palsy is a sign of more serious hip problems and is probably not a sign that the harness was used incorrectly.


Reference:
Murnaghan, ML, Browne RH, Sucato DL, Birch J, “Femoral nerve palsy in Pavlik harness treatment for developmental dysplasia of the hip.” J. Bone Joint Surg. 93A:493-9, 2011

 

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