scolio and thorax Flashcards
an older term that refers to an abnormal bending of the spine but gives no reference to the coupled rotation that also occurs
scoliosis
describes the curve of the spine by detailing how each vertebra is rotated and side flexed in relation to vertebra below
rotoscoliosis
spine curves (convex) to the left; commonly affects lumbar region
levocoliosis
spine curves (convex) to the right; commonly affects thoracic region; more common
dextroscoliosis
it refers to the vertebra that is located at the farthest point out laterally from the midline of the body (convex side)
apex of curve
vertebra w the greatest distance from the midline with most rotation
apical vertebra
apex of curve in cervical scoliosis
c1-c6
apex of curve in cervicothoracic
c7-t1
apex of curve in thoracic scoliosis
t2-t11
apex of curve in thoracolumbar scoliosis
t12-l1
apex of curve in lumbar scoliosis
l2-l4
apex of curve in lumbosacral scoliosis
l5 or lower
discuss cobb angle and how to measure scoliosis
cobb angle - standard measurement used to quanitfy scoliosis
measured on PA (post-ant) or AP (ant-post)
- draw a line above the vertebra w greatest lateral tilt and another line at the bottom vertebra w greatest lateral tilt
- extend the lines to the margin of the image
- draw perpendicular lines on the two lines u drew
- cobb angle is where the 2 perpendicular lines intersect
- measure the angle
type of curve considered as structural and has a larger cobb angle
primary curve
type of curve considered as compensatory curve; lesser in magnitude, more flexible and less rotated; allows head to be centered over the pelvis; may or may not be structure curves, depending on flexibility
secondary curve
discuss structural scoliosis (based on rigidity)
- also called non-functional
- definite morphologic abnormality
- therapeutic effort is concerned
- has a fixed lateral curvature w rotation
on radiographs
- spinous process rotated to concavity
- lack of normal flexibility on side bending or traction radiograph
discuss non structural scoliosis (based on rigidity)
- also called as functional scoliosis
- results from temporary postural influence
- no rotational or asymmetric change in the individual structures of the spine
- curve is not fixed
- if problem is corrected, scoliosis resolves
- corrects or overcorrects on spine side bending radiograph or traction films
discuss structural scoliosis based on etiology
- idiopathic
- congenital
- neuromuscular (neuropathic, myopathic)
- neurofibromatosis with scoliosis
- scoliosis with disease of vertebrae (tumor, infection, metabolic, arthritis)
discuss non structural scoliosis based on etiology
- postural
- leg length inequality
- nerve root irritation
- contracture about the hip
this type of structural scoliosis has an unknown cause and is the most common type
idiopathic scoliosis
idiopathic scoliosis - infantile
under 3 years of age
idiopathic scoliosis - juvenile
3-10 years of age
idiopathic scoliosis - adolescent
above 10 years old to skeletal maturity
discuss infantile idiopathic scoliosis
- detected during1-3 years old
- common in boys
- curves develop within the first 6 months
- 85% of curves regress spontaneously (usual if curve appeared before 12 months)
- left thoracic curve most common
treatment of infantile idiopathic scoliosis
- observe
- serial cast
- surgery (if curve progresses); posterior growing rod until 10-11 yrs old; posterior spinal fusion after skeletal maturity
discuss juvenile scoliosis
- 3-10 yrs of age
- of equal sex predilection
- right thoracic curve most common
- curves do not resolve spontaneously
treatment of juvenile scoliosis
- less than 20 deg, observe. follow up after 6-8 mos
- braces: 20-25 deg with > 5 deg progression or > 25 deg curve
- surgery: rapid progression or failure of braces; w/o fusion before puberty followed by fusion at puberty
discuss adolescent idiopathic scoliosis
- 10-16 years old (skeletal maturity)
- common in females
- increases incidence in children who are daughters of mothers with scoliosis (familial)
- most common type (80%)
- right thoracic curve most common
risk of progression in adolescent idiopathic scoliosis
- age < 12 yrs old
- female gender
- maturity- father from skeletal; maturity (risser 0-1) higher risk
- larger curve at detection, higher risk
-larger curve at detection, higher risk
discuss congenital scoliosis
- failure of vertebral formation (hemivertebrae)
- failure of segmentation (partial or complete bar)
- abnormal spinal canal or cord (myelodysplasia)
this is used to grade skeletal maturity based on the level of ossification and fusion of iliac crest apophyses
risser classification
stage 0 of risser
no ossification center at the level of iliac crest apophysis
stage 1 of risser
apophysis under 25% of iliac crest
stage 2 of risser
apophysis over 25-50% of the iliac crest
stage 3 of risser
apophysis over 50-75% of iliac crest
stage 4 of risser
apophysis over > 75% of the iliac crest
stage 5 of risser
complete ossification and fusion of iliac crest apophysis
physical examination of scoliosis
- shoulder not leveled
- tilt of trunk
- decompensation is measured by plumb bomb from c7 where it falls w respect to gluteal line
- flexibility test
clinical presentation of scoliosis (structural or functional)
- produce a fixed deformity
- rib hump occuring on convex side
- persistent scoliosis during forward bending (adam’s sign)
- adaptive shortening of intrinsic trunk muscles on the concave side; lengthening of intrinsic muscles on convex side
characteristics present on convex side of scoliosis
-ribs pushed posteriorly forming post rib hump
- vertebral body rotate towards convex side
- ribs are farther apart
- lamina thicker
- vertebral canal wider
- iv discs spaced wider
characteristics present on concave side of scoliosis
- ribs pushed anteriorly
- spinous process rotates concavity
- ribs are closer
- lamina is thinner
- vertebral canal is narrower
- iv disc spaced narrower
duration of hours required in wearing a brace
-16-23 hours/day until skeletal maturity or surgical intervention deemed necessary (actual wear min of 12 hrs required to slow progression)
type of brace used of curves with apex above T7
milwaukee brace
type of brace used of curves w apex T7 or below
TLSO
boston style brace (underarm)
charleston bending brace
bracing success is defined if
<5 deg curve progression
bracing failure is defined if
- 6 deg or more curve progression at skeletal maturity
- absolute progression to >45 deg either before or at skeletal maturity in favor of surgery
skeletal maturity is defined as
- risser 4
- < 1cm change in heigh over 2 visits 6 mos apart
- 2 years postmenarcal
this recommends one level above and two levels below the end vertebrae if these levels fall within the stable zone
harrington technique
this recommends fusion to the neutral vertebrae
moe technique
this recommends including all major curves and minor curves that are not flexible or are kyphotic
lenke technique
known as hallow back; anteroposterior curvature of the spine in which the concavity is directed posteriorly; cervical and lumbar lordosis exhibits this
lordosis
sternum projects forward and down like a keel of a boat; increases AP diameter of thorax; impairs the effectiveness of cough and restricts volume of ventilation
pigeon breast (pectus carinatum)
cause of pigeon breast
premature development of emphysema or cor pulmonale
management of pigeon breast
mild deformities can be less noticeable w exercises that increase strength of pectorals
surgery if severe deformity
treatment of funnel chest
- mild- exercises to improve posture and build up shoulder girdle and pectoral muscle
- swimming
- surgery for severe cases
sternum is pushed posteriorly be overgrowth of ribs; ap diameter of thorax is decreased; heart displaced to left side; shortening of central tendon, seen in marfan’s syndrome
funnel chest (pectus excavatum)
tenderness of costochondral junction of ribs or chondrosternal joint of anterior chest (2nd to 5th)
costochondritis
cause of costochondritis
localized inflammation; may precede upper respiratory infection and excessive coughing, local trauma, arthritis (ra, as)
symptoms of costochondritis
chest pain - sharp, associated w deep breathing or coughing
tenderness on the area
no observed swelling
treatment of costochondritis
non surgical:
- activity modification
- nsaids
-corticosteroid injection
-local anesthesia patch
- pt
-good prognosis and responds to conservative management
painful inflammation of the costochondral cartilages of upper front of chest (usually 2nd-3rd)
tietze’s syndrome
causes of tietze’s syndrome
heredity (genetic predisposition); viruses; trauma
tietze’s syndrome vs costochondritis
tietze’s syndrome
- rare, more common in females
- < 40 yrs old
- no of sites affected: one in 70% of cases; usually unilateral
- 2nd-3rd costochondral junction
- (+) local swelling
- no associations w other conditions
costochondritis
- more common
- > 40 yrs old
- no of sites affected: more than once (90% of cases)
- 2nd-5th costochondral junction
- no swelling
- associated w seronegative arthropathies, anginal pain
