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INJECTION PALSY: A TRUE 25-YEARS (1968-1993) ENDEMIC RATE OF A USUALLY MISDIAGNOSED PARALYTIC CONDITION IN A LAGOS UNIVERSITY TEACHING HOSPITAL. John E^1,2; ¹University of Kansas Medical Center, Kansas City, KS, USA. ²Department of Physiotherapy, College of Medicine, University of Lagos (At the time of Study)

PURPOSE: The purpose of the present study was to retrospectively assess the true endemic rate of injection palsy treated by Nigerian Physiotherapists at the Lagos University Teaching Hospital (LUTH) over a 25-year period using a clinical differential diagnosis method (CDDM). RELEVANCE: Laboratory test results are the final definitive diagnosis for poliomyelitis and is largely unavailable in most developing countries such as Nigeria. The CDDM deviced in this study is a simple clinical tool that maybe used in lieu of definitive laboratory test results by physiotherapists in developing countries to differentially diagnose between injection palsy and poliomyelitis paralysis in pediatric populations. DESCRIPTION: The Expanded (now National) Program on Immunization by the World Health Organization and the Federal Government of Nigeria has considerably reduced the prevalence and incidence of poliomyelitis in Nigeria. This has brought to fore another endemic paralytic condition known as injection palsy which mimics poliomyelitis symptoms and clinical manifestations and might have been misdiagnosed as poliomyelitis for decades in the Nigerian pediatric population. Injection palsy refers to isolated paralysis of lower limb muscle groups supplied by the sciatic nerve traumatized by injection needles and/or injection induced abscess during administration of injection to the glutei region in pediatric populations. EVALUATION: The CDDM has eight major differential diagnosis items outlined below (Poliomyelitis = P, Injection Palsy = IP): (1) P=Onset of paralysis 8-17 days post provocative injection (average 10 days);IP=Onset of paralysis 0-48 hours after injection. (2) P=No sensory loss, only motor paralysis; IP=Both sensory and motor impairments exists in distribution of sciatic nerve. (3) P=Pattern of motor paralysis arbitrary and does not follow any order of anatomical distribution; IP=Pattern of motor paralysis follows anatomical distribution of only the sciatic nerve. (4) P=No trophic disturbances; IP=Trophic disturbances present. (5) P=Strength Duration Curve (SDC) of affected muscles show complete denervations; IP=SDC usually show partial innervations. (6) P=Age ranged usually 0-4 years at onset of motor paralysis; IP=Age ranged from 0–16 years at onset of motor paralysis. (7) P=Paralysis is permanent or has a prolong recovery period upon rehabilitation (month/years); IP=Paralysis is temporary, and recovery in relative short period (few weeks to few months) except in very severe cases. (8) P=No reports of injection abscess; IP=Reports of injection abscess after administration of injection. Each item for P has a score of 1; each item for IP has a score of 3, giving a total possible score of 24. Scores between 1-8 and 9-24 on the CDDM are differentially diagnosed respectively as poliomyelitis or injection palsy. CONCLUSIONS: Data analysis using the CDDM showed that 166 (8.17%) of the 2031 cases referred for physiotherapy as poliomyelitis at the LUTH over a 25-year period (1968-1993) are actually cases of injection palsy. That is only 1,865 (91.83%) cases were differentially diagnosed as poliomyelitis. Injection palsy therefore has a true 25-years endemic rate of 8.17%. IMPLICATIONS: Injection palsy clinical manifestations mimics poliomyelitis and the CDDM used in this study may help physiotherapists in developing countries differentially diagnose between poliomyelitis and injection palsy. Physiotherapy treatment and rehabilitation goals in either conditions should therefore be different. KEYWORDS: Poliomyelitis, Motor Paralysis, Injection Palsy, Differential Diagnosis. FUNDING ACKNOWLEDGEMENTS: None. CONTACT: Emmanuel B. John, PT, PhD, ebjohn@ebjohn.net