Physical Therapy for Hirayama Disease: Is the Evidence Bending Towards or Away from Flexion?

Arnabjyoti Deva Sarma; Moitrayee Devi

Volume : IX, Issue : II, February - 2019

Physical Therapy for Hirayama Disease: Is the Evidence Bending Towards or Away from Flexion?

Arnabjyoti Deva Sarma, Moitrayee Devi

Abstract :

Hirayama disease (HD) or juvenile muscular atrophy of distal upper extremity is a cervical myelopathy characterized by progressive muscular weakness and atrophy of distal upper limbs, secondary to forward displacement of the posterior cervical dural sac during neck flexion, causing compression of the cervical cord, resulting in atrophic and ischemic changes in the anterior horn.The objective of this study was to perform a scoping review of existing evidence through studies from Pubmed to answer two questions: whether HD has a mechanical pathogenetic component? And if so, what could be the role of Physical therapy in such patients?Evidence demonstrated that excessive flexion range of motion was present in patients with HD, and that flexion was equivocally associated with abnormal spinal cord compression and canal dynamics, cervical spine instability (CSI) as an entity should thus encompass HD at one end of its clinical spectrum. Two major issues arose from this review: one, literature on physical therapy examination and treatment for HD is albeit absent if scarcely available, and two, proven methods of physical therapy for clinical cervical spine instability had not been attempted for HD despite their low risk for complications