Poliomielite: Sequelas Musculoesqueléticas e Prevenção

Poliovirus (enterovirus) destroys anterior horn motor neurons → flaccid paralysis. Musculoskeletal consequences:

Acute Phase

• Asymmetric flaccid weakness, hypotonia, areflexia.
• Proximal > distal; legs > arms.

Chronic Sequelae

• Muscle atrophy: Denervation → fibrosis, fatty replacement.
• Joint deformities: Unopposed antagonist pull → equinus, knee flexion contracture, hip dislocation, scoliosis.
• Limb length discrepancy: Growth arrest in affected limb.
• Post-polio syndrome (PPS): Decades later — new weakness, fatigue, pain, atrophy in previously affected/affected muscles.

Management

• Acute: Splinting, positioning, avoidance of overuse.
• Rehab: Orthotics (AFO, KAFO), assistive devices, energy conservation.
• Surgery: Tendon transfers, osteotomies, arthrodesis for fixed deformities.
• PPS: Pacing, non-fatiguing strengthening, mobility aids.

Prevention

Vaccination: IPV (inactivated) — 4-dose series (2, 4, 6–18 mo, 4–6 yr). OPV (oral) used in eradication campaigns. Global incidence ↓ 99.9% since 1988.

Endemic only in Afghanistan/Pakistan (2023). Vigilance essential.