DOCUMENT

AUTUMN 2025 InTouch | 15 orthopaedic issues. Additionally, steroids can lower the risk of developing scoliosis, or curvature of the spine. Managing the side effects of steroids proactively and anticipatorily is essential. Early interventions should be implemented to prevent potential issues, such as weight gain, mood changes, or bone thinning, and ensure they do not become severe. At this time, no recommendations can be made regarding other supplements or drugs sometimes used in DMD treatment, such as co-enzyme Q10, carnitine, amino acids (like glutamine and arginine), anti-inflammatories/ antioxidants (such as fish oil, vitamin E, green tea extract, pentoxifylline), and various herbal or botanical extracts. Experts have concluded that there is insufficient evidence in the published literature to support their use. Rehabilitation Management: Therapy will be primarily administered by physiotherapists and occupational therapists, though assistance from other professionals, such as rehabilitation specialists, orthotists, wheelchair and seating providers, and orthopaedic surgeons, may also be necessary. Managing muscle extensibility and joint contractures is an essential aspect of rehabilitation care. The primary aim of stretching exercises is to preserve function and ensure comfort. While the physiotherapist will monitor the stretching program, it should become part of the family’s daily routine. In DMD, several factors contribute to the tendency for joints to become tight or “contracted.” These factors include decreased muscle elasticity due to limited use and positioning, or because the muscles around a joint are out of balance (one stronger than another). Maintaining a good range of motion and symmetry across various joints is important. This approach helps preserve optimal function, prevent the development of fixed deformities, and avoid skin pressure issues. Orthopaedic Management: The primary objectives of orthopaedic care are to preserve walking and motor function for as long as possible and to minimize joint contractures. Maintaining the ability to walk or stand can aid in keeping the spine aligned and promote bone health. Some specific orthopaedic considerations include prevention and management of scoliosis, contractures, and fractures. Scoliosis People with DMD who are not treated with corticosteroids have a 90% likelihood of developing progressive scoliosis, a condition characterised by a sideways curvature of the spine that worsens over time. Corticosteroid treatment has been shown to reduce the risk of scoliosis in DMD, or at least delay its onset. Regular assessment of the spine throughout one’s lifespan is important for the proactive management of scoliosis. Contractures As muscles weaken and joints become harder to move, there’s a risk of them getting stuck in one position, known as contracture. Maintaining good posture can help prevent contractures, especially in the back, feet, and ankles. Proper alignment and support of the body are important. For those who use wheelchairs, a seating system that supports spinal and pelvic alignment is essential. In some cases, surgery might be an option to help maintain proper alignment of the feet and legs. Fractures People living with DMD, especially those taking steroids, are at increased risk for fractures in the vertebrae and long bones. Vertebral compression factures occur when the bones of the spine develop small fractures, leading them to collapse or become misshapen, which can cause pain. A DEXA scan is a non-invasive test, similar to an X-ray, that measures bone mineral density. Regular monitoring of bone mineral density through periodic DEXA scans is important for maintaining overall bone health and can help in making management decisions to prevent potential issues before DUCHENNE MUSCULAR DYSTROPHY (DMD) The primary objectives of orthopaedic care are to preserve walking and motor function for as long as possible and to minimize joint contractures. Continued over ...