7- Scoliosis/Short Leg Syndrome (Sandhouse) Flashcards
Define Scoliosis
a lateral curvature of the vertebral column
describe classifications of scoliosis
Structural: does not correct with side-bending (irreversible)
Functional: partially or completely straightened by sidebending opposite to the presenting curve (reversible)
list osteopathic considerations in scoliosis
- body compensatory curves form to keep body balanced and eyes balanced
- rotation accompanies lateral curve (rotates INTO convexity)
- ribs on convex side separate and move posterior (ribs on concave side more anterior and closer together)
- Disc narrows on concave side
explain the use of Cobb angle measurements in scoliosis treatment
10 degrees- follow every 4-6 months
Curve progresses >5 degrees - treat
Curves > 30 degrees = treat
Curves < 20 degrees in mature adult will not usually progress.
discuss the benefits of using OMT on patients with scoliosis
- Increase muscle balance on both sides of curve
- Optimize function of existing structures
- Remove any somatic dysfunction
- Stretch lumbosacral tissues
- Reduce the lumbosacral angle and strengthen psoas and abdominal muscles
explain biomechanics of short leg
syndrome
Sacral Base Unleveling (Most clinically relevant element)
- Innominates rotate to compensate
- pelvic rotation and side shift will occur
explain compensatory changes associated with short leg syndrome
Early compensation: Side bending, cephalad horizontal planes are typically depressed on side opposite the pelvic horizontal plane
Late compensation: (Inequality > 10mm or 0.4 inches) S-shaped curve develops. Greater trochanteric planes depressed on the SAME side.
explain guiding principles for progressive compensation in short leg syndrome
- Postural changes
- Lower back pain (Most common/bothersome complaint)
- Pelvis will side shift and rotate AWAY from side of sacral base declination
- Innominate rotates anteriorly on side of short leg/ posteriorly on side of long side [opposite rotation] to compensate
Lumbosacral angle increases 2-3 degrees - Vetertebrae of most caudal scoliotic curve suually sidebend away from and rotate toward the side of sacral base declination
explain diagnostic difficulties in short leg syndrome
Clinical diagnosis based on structural findings alone is difficult and innacurate
list diagnostic clues in short leg syndrome
- Recurrent somatic dysfunction of the pelvis, spine, cranium, or myofascial structures
- soft tissue involvement
- tight abductors on one side and tight adductors on the controalateral side
- Iliolumbar ligament on the side of convexity becomes stressed
- Visceral somatic reflexes between T1 and L2
explain the role of OMT in the patient with short leg syndrome
Corrects any somatic dysfunction once the spine is mobile as possible standard standing postural xrays
explain and apply guidelines for lift therapy in short leg syndrome
Lift Therapy: The longer something has been around/compensated, the more slowly you add the lift.
For fragile patient, begin w/ 1/16” heel lift (up to +1/16” per two weeks)
Flexible patient: begin with 1/8” heel lift (up to +1/8” per two weeks)
Sudden loss of leg length: lift FULL amount that was lost (ex. fracture)
list principles of lift therapy in short leg syndrome
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A scoliosis of 5 to 15 degrees is called what?
mild scoliosis
A scoliosis of 20 to 45 degrees is called what?
moderate scoliosis
