Kyphosis

Question 1

Kyphosis can be a common source of what kind of pain?

Answer 1

musculoskeletal pain

Question 2

Define kyphosis.

Answer 2

abnormally increased convexity in the curvature of the thoracic spine; hunchback

Question 3

List two types of kyphosis

Answer 3

Arcuate (Kyphosis arcuata); Angulate (Kyphosis angulate, Gibbus deformity)

Question 4

What is the normal Cobb angle for the kyphotic curve?

Answer 4

25-45 degrees

Question 5

How is the kyphotic Cobb angle curved measured?

Answer 5

Parallel lines to T1 and T12, 90 degree line, measure angle

Question 6

How can an increased kyphotic curve affect the respiratory system?

Answer 6

decreased chest wall mobility, impaired ventilation of lungs, decreased clearance of mucus (pulmonary infection), and increased load on diaphragm

Question 7

How can an increased kyphotic curve affect the circulatory and lymph system?

Answer 7

decreased venous return to the heart and decreased lymphatic return to the venous system

Question 8

What is the minimum number of flexed thoracic segments needed to increase the thoracic kyphosis?

Answer 8

one

Question 9

What can cause increased antero-posterior diameter increase or”barrel chest” ?

Answer 9

inhaled ribs, asthma, emphysema, anterior failure of segmentation (congenital) , weak paraspinal musculature, postural collapse, increased lumbar lordosis, kyphoscoliosis

Question 10

List some causes of weak paraspinal musculature

Answer 10

deconditioning, radiation, neurologic disease (polio), neurofibromatosis, muscular dystrophy, myopathies

Question 11

List individuals who are prone to postural collapse.

Answer 11

office workers, students, surgeons, cyclists

Question 12

In osteoporosis, trabecular microfractures lead to this…

Answer 12

vertebral wedging which leads to increased kyphosis

Question 13

Osteochondrosis of the vertebral endplate growth plates

Answer 13

Sheurmann Disease

Question 14

When does Scheuermann Disease develop

Answer 14

during adolescence ; 10-16 increased kyphosis

Question 15

Can Scheuermann disease be straightened?

Answer 15

Not with muscular effort

Question 16

Patient comes in with fatigue, increased kyphosis, back pain. During testing straight leg raising is limited by hypertonic hamstrings.

Answer 16

Scheuermann Disease

Question 17

Treatment options include mild? moderate? severe?

Answer 17

OMT & excercise; bracing; surgery

Question 18

What radiographic findings might be present in Scheurmann disease?

Answer 18

increased thoracic kyphosis; vertebral wedging, undulating endplate, Schmorl node formation; MUST affect THREE adjacent segments

Question 19

Positive Adam’s test may indicate what disease?

Answer 19

Scheuermann Disease

Question 20

Patient comes in bent forward to reduce pressure on painful joints. What may be the cause?

Answer 20

Facet joint arthritis

Question 21

Upon radiographic imaging, disc narrowing is seen with shorter vertical height anteriorly. What is the cause and effect?

Answer 21

Degenerative disc disease; increased kyphosis

Question 22

Genetic predisposition and an immune trigger could cause this.

Answer 22

Ankylosing Spondylitis

Question 23

What is ankylosing spondylitis?

Answer 23

ligaments, disc and facet joints turn to bone

Question 24

What is Paget’s disease, Osteitis deformans?

Answer 24

trabecular microfracturing with vertebral wedging

Question 25

An elderly man with history of smoking comes in complaining of bone ache, headaches and vertigo. What could be a possible cause?

Answer 25

Osteitis deformans

Question 26

Why is cardiac failure seen in many cases of osteitis deformans?

Answer 26

Adnormal bone is highly vascular and creates shunts. Heart cannot keep up.

Question 27

What does this image show?

Answer 27

Osteitis deformans

Question 28

How can osteitis deformans be treated?

Answer 28

•Disease may be suppressed with bisphosphonate class of medications

Question 29

What disease has characteristic candle wax osteophytes?

Answer 29

DISH Diffuse Idiopathic Skeletal Hyperostosis

Question 30

Answer 30

DISH

Question 31

What are the signs of ochronosis?

Answer 31

spontaneous fractures, calcification of cartilage, osteoporosis

Urine lefrt to stand will turn from yellow to blue-gray, brown or black

Question 32

What is the etiology of ochronosis?

Answer 32

Congenital defect in tyrosine and phenylalanine metabolism which causes alkaptonuria

Question 33

What can cause angulate kyphosis?

Answer 33

vertebral compresion fracture, congenital failure of formation of vertebral body, osteoporosis, Pott disease, osteogenesis imperfecta “brittle bone disease”, metastic cancer

Question 34

List the types of treatment for kyphosis.

Answer 34

OMT, exercise, postural reeducation, mattress & pillow, bracing, traction, pain mgmt, surgery

Question 35

Answer 35

Pott Disease

Question 36

What is the purpose of postural reeducation?

Answer 36

works to retrain proprioceptive input and interpretation

Question 37

What type of mattress and pillow should be used?

Answer 37

firm mattress, low pillow

Question 38

Which medications should be used in the pain management of kyphosis? Which are of no benefit?

Answer 38

Acetaminophen, NSAIDS

Muscle relaxants are of no benefit in lordosis/kyphosis

Question 39

What types of surgery are available and what is the maximum age of effectiveness?

Answer 39

fusion surgery, osteotomy and instrumentation, balloon kyphoplasty (new fractures only)

Age 25