Chapter 5 Scoliosis and Short Leg Syndrome Flashcards
Epidemiology of scoliosis?
5% of school-aged children develop it before 15
Percentage of children with actual sxs related to their scoliosis?
10%
Female: Male ratio for scoliosis?
4:1
Dextroscoliosis?
Curve that is SB left = scoliosis to the right
Levoscoliosis?
Curve that is SB right = scoliosis to the left
2 types of scoliosis curves?
1) Structural curve
2) Functional curve
Which curve is fixed and inflexible?
Structural
Which curve will NOT correct with sidebending in opposite direction?
Structural
Which is assoc with vertebral wedging and shortened ligaments/musccles on concave side?
Structural
T/F An uncorrected functional curve may progress to a structural curve?
True
When should kids be screened?
10-15 years
What is the angle measures the degree of scoliosis?
Cobb angle
What is Cobb angle?
Draw horizontal line from vertebral bodies of extreme ends of curve; then draw perpendicular lines from these horizontal lines
At what angle is respiratory function compromised?
> 50
At what angle is cardiac function compromised?
> 75
What are the causes of scoliosis?
Idiopathic, congenital, neuromuscular, acquired
Which type is most often progressive?
Congenital
What are Konstancin exercises?
A series of specific exercises that has been proven to improve the pt with scoliotic postural decompensation
When is bracing indicated?
Moderate scoliosis
When i surgery indicated?
Severe scoliosis–if there is resp compromise or if it progresses despite conservative management
3 things that cause short leg?
1) Sacral base unleveling
2) Vertebral SB and rotation
3) Innominate rotation
Most common cause of anatomical short leg?
Hip replacement
First ligament to be stressed in short leg?
Iliolumbar ligaments, then the SI ligaments
Sacral base unleveling compensation?
Sacral base will be lower on short leg side
Innominate compensation?
Anterior rotation on short leg side; posterior rotation on long leg side
Lumbar spine compensation?
SB away, rotate toward short leg side
Lumbosacral (Ferguson’s) angle compensation?
Increased 2-3 degrees
How to quantify differences in heights of femoral head for short leg syndrome?
Standing x-ray
When to consider heel lift?
Femoral head difference >5mm
When should the full lift be administered?
Sudden onset of discrepancy (e.g. fracture, surgery)
What should the final lift height be?
1/2 - 3/4 of measured leg length discrpancy
What should the “fragile” pt begin with?
1/16” (1.5mm) and increase 1/16” every 2 weeks
What should the “flexible” pt begin with?
1/8” (3.2mm) and increase 1/8” every 2 weeks
What is the max height that can be applied to INSIDE the shoe?
1/4”
What if >1/4” is needed?
Apply to OUTSIDE of shoe
What is maximum heel lift possible?
1/2”
How do you prevent pelvis from rotating to opposite side when >1/2” lift is needed?
Apply an ipsilateral anterior sole lift extending from heel to toe
Most common cause of scoliosis?
Idiopathic
