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Orthotic Study > Scoliosis > Flashcards

Scoliosis Flashcards

1
Q

Scoliosis

A

Refers to deformity of the spine involving the lateral curvature and vertebral rotation

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2
Q

3 Classifications of Scoliosis based on Etiology

A
  1. Non Structural
  2. Transient Structural
  3. Structural Scoliosis
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3
Q

Non-Structural

A

Flexible reversible (minor) curvature with minimal rotation

Curve will spontaneously correct with side bending towards the convexity of curve or when patient is supine

Examples:
Compensatory curves caused by LLD
Habitual poor posture or those curves above or below major curves

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4
Q

Transient Structural Scoliosis

A

Reversible type of curvature which appears structural but will spontaneously correct when the underlying cause has been corrected

Example curves caused by pain or muscle spasm from sciatica, inflammation, or trauma

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5
Q

Structural Scoliosis

A

Irreversible (major) curvature with marked rotation

Does not correct with side bending or removal of gravity

3 types

  1. Idiopathic
  2. Congenital
  3. Neuromuscular
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6
Q

Idiopathic structural scoliosis

A

Unknown specific cause with probable genetic origins. Accounts for approximately 80% of all braced scoliosis.

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7
Q

Congenital structural scoliosis

A

Skeletal deformities such as hemi vertebra or failed segmentation (not braced)

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8
Q

Neuromuscular structural scoliosis

A

Neuropathic forms such as cerebral palsy or polio, myopathic forms such as DMD (usually accommodated, braced to allow for improved sitting position in chair)

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9
Q

Classes of Idiopathic Scoliosis

A

Infantile (10 years, chance of occurrence 2 years post menarche is minimal)

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10
Q

Infantile IS

A 
<2 years
Rare
Affects M=F
Left thoracic most common
Some resolve spontaneously
Rib vertebral angle less than 20 degrees is predictive of resolution
Treated with serial cast or brace
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11
Q

Junvenile IS

A

<10 years
Mild precursor to AIS
Associated with Arnold Chiari Malformation (15% of cases)
Brace if curvature is greater than 20 degrees

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12
Q

Adolescent IS

A

> 10 years, chance of occurrence 2 years post menarche is minimal
80% female
Often seems like it occurred overnight
Usually brace between 20-45 degrees
Beyond 45 degrees, bracing ineffective, surgery is indicated

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13
Q

Common Idiopathic Curvatures

A

Curve patterns fall in to 4 distinct patterns

  1. Thoracic
  2. Thoracolumbar
  3. Lumbar Curve
  4. Double Major Curve
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14
Q

Thoracic Curvature

A

Major structural curve

Usually to the right, with minor compensatory curves occurring above and below

Apex above T10

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15
Q

Thoracolumbar

A

Longer structural curve

Either left or right with minor compensatory curves above or below

Apex between T10-L2

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16
Q

Lumbar Curve

A

Major structural curve, usually to the left

Thoracic compensatory curve remains flexible

Apex L2 or lower

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17
Q

Double Major Curve

A

Major Lumbar Curve, usually left
Major thoracic curve usually right
Usually well compensated and balanced

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18
Q

Initial Manifestations of Scoliosis

A

Ribs on convex side of the curavture are pushed posterior and begin to separate

Ribs on concave side of the curve are pushed anterior and are compressed together

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19
Q

Secondary Changes

A

Disc Spaces become narrower and wedging of the vertebra toward the concave side

The pedicles and lamina become shorter and thinner on the concave side

The spinal canal narrows toward the concave side

Vertebral body distortion toward convex side

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20
Q

Once secondary pathologic changes set in

A

Curve and rotation will become more rigid and harder to correct

Secondary changes will turn minor non structural compensatory curve into a structural one

Tendency for increase in lumbar lordosis, thoracic kyphosis associated with scoliotic deformities

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21
Q

Most favourable indications for orthotic treatment includes

A

Curves in children with at least 1, preferably 2 years of growth remaining

Curves between 25-40 degrees with apex of T8 or lower with 50% flexiblity

22
Q

Goal of the orthosis

A

To prevent or slow the progression of the curve until skeletal maturity is reached

23
Q

Skeletal Maturity Males/Females

A

Males finish around the age of 18

Girls finish growing around the age of 16, 2 years post menarche

24
Q

Schedule of wear

A

General research has shown that most effective orthotic treatment is with compliance of 23 hours a day of brace wearing

Minimum 18 hours, it is best to stress longer rather than shorter number of hours as patient compliance can be an issue

25
Q

Physiotherapy

A

Plays active role in scoliosis treatment, increase flexibility of hip flexors, hamstrings, and para spinal muscles and maintain core strength

Improve effectiveness of the brace

26
Q

Indications for Milwaukee

A

T7 apex or higher

active correction

27
Q

Indications for Charleston

A

Night brace

Best for single curves

Antigravity

Bending brace

28
Q

Boston

A

T8 or lower

29
Q

Custom Molded

A

T8 or lower

30
Q

Cheneau

A

Primarily done in Europe, starting in USA

Highly aggressive

31
Q

Providence

A

Night Brace

32
Q

Treatment Theories (2)

A
  1. Solid Pelvic Base

2. Outrigger or extensions form base for pressure application

33
Q

Solid Pelvic Base

A

a) Prefabricated pelvic module
b) Symmetrical
c) Partial reduction of lordosis (usually 15 degrees is what is included)
Theory behind the reduction of lordosis is to unlock the facet joints to allow for greater back flexibility

34
Q

Outrigger or extensions form base for pressure application

A

a) use of force couples where ever possible
b) relief of areas or voids created opposite the corrective force
c) trimlines established according to x ray
d) lumbar corrective pressure applied by pad over the musculature directly lateral to transverse processes
e) length of lumbar pad from distal base of curve to apex or “null point” of lumbar curve
f) thoracic corrective pressure applied to ribs, transferring force to vertebrae
g) length of thoracic pad from distal base of curve to rib attaching to vertebra at the apex of null point of the thoracic curve
h) physiotherapy- stretching and strengthening exercises

35
Q

Weening off period

A

Usually 6 month weening period

Once curve has been shown not to be progressing and patient has riser sign of 5

36
Q

Surface Anatomy, Important Landmarks

A 
Spine of Scapula/Superior Angle
Inferior angle of Scapula
PSIS
ASIS
Waist roll
Pubic bone
Xyphoid Process
Umbilicus
Greater Trochanter
37
Q

Orientate X ray

A

Heart (left side)
Stomach Bubble (left side)
X- ray marker

38
Q

Examinate X ray

A 
Type of Curvature
Direction of Curvature
Range of curve
Magnitude of the angle (Cobb angle)
Apex of the curve
Rotation (pedicles)
Presence of pelvic obliquity
Riser sign
Head compensation
39
Q

Risser Classification

A

Classification of Illiac Epiphysis to evaluate skeletal maturity

Ossification progresses from direction of ASIS to PSIS

Based on % of excursion

Risser sign indicates change of curve progression

40
Q

Rotation - Nash Moe Technique

A

Measures pedicle rotation by dividing vertebral body into segments

Segment into which the pedicle is located quantifies the rotation

Uses symmetry of pedicels as point of reference, migration of pedicles toward the concavity of the curve determines degree of rotation

41
Q

Why Treat Scoliosis

A

Cosmesis

  • mild 20-30 degree do not experience pain
  • body image

Decreased Pulmonary Function
- 20-30 degrees, lung capacity is decreased to 75-80% of normal

Pain as an adult

  • mild curvatures do not experience more back pain than normal population
  • however >40 degrees may experience pain
  • also tend to be a progressive curve, 1 degree/year increase
42
Q

Orthotic Management

A

is only non operative method to alter natural history of progressive scoliosis

ONLY BRACE UNTIL SKELETAL MATURITY
~14 in girls
~ 17 in boys

43
Q

Indications and Goals for Bracing

A

Infantile - usually self correcting

Juvenile and Adolescent

  • 20 decision to brace is made
  • 25 to 40-45 degrees
  • skeletal immaturity
  • Risser 0, 1, 2

Goals

Stop Progression

Prevention of Surgery

Delay of Surgery- earlier you fuse vertebrae, more likely you will lose height

44
Q

Patient History

A

Age

Height and Weight

Presence of family history

Menarche- indicator of skeletal maturity

Progression in the curvature

45
Q

Visual Assessment - Back

A

Head- shifted to left or right

Shoulders - level

Scapula - height, winging

Ribs - one side more posterior than other

Waist roll- one side more prevalent

One arm hangs closer

Pelvic obliquity

Knees, legs, ankles, foot position

46
Q

Visual Assessment - Front

A

Check shoulders

Breast Asymmetry

ASIS position - one lower than the other, more anterior

Lateral pelvic tilt

47
Q

Sagittal

A

Kyphosis

Lordosis

Pelvic Tilt

48
Q

Adam’s Forward Bend Test

A

Forward bend with hands clapped together

No knee bend

Sighting down the spine

DO NOT say “touch your toes”, maybe a presence of asymmetrical hamstring tightness

Thoracic region: Rib hump
- on the convex side

Lumbar region: Prominence of paraspinal muscles

49
Q

X-Ray Evaluation (9 points)

A
  1. Type of Curvature
  2. Direction fo Curvature
  3. Range
  4. Apex
  5. Degree
  6. Rotation
  7. Bony Age (Risser or wrist)
  8. (De)Compensation
  9. Pelvic Obliquity
50
Q

X-Ray Orientation (4)

A

Viewed from POSTERIOR to ANTERIOR

4 Identifiers

Location of the heart - situated on the left

Stomach bubble on the left

Liver located on the right

Marker on the X ray

51
Q

Brace selection based on

A

Location of apex of the curvature

Type of curvature

Patient Compliance

52
Q

SpineCor

A

Uses dynamic forces to cause body to work in conjunction

Simulate continual physiotherapy

Correction movement to become neuromuscularly indicated

Worn 20 h a day

Mild to moderate curvatures

Orthotic Study (45 decks)

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