Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Orthotic Study > Scoliosis > Flashcards

Scoliosis Flashcards

1
Q

Scoliosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 Classifications of Scoliosis based on Etiology

A
  1. Non Structural
  2. Transient Structural
  3. Structural Scoliosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Idiopathic structural scoliosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Congenital structural scoliosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Classes of Idiopathic Scoliosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Thoracic Curvature

A

Major structural curve

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

Apex above T10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Thoracolumbar

A

Longer structural curve

Either left or right with minor compensatory curves above or below

Apex between T10-L2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lumbar Curve

A

Major structural curve, usually to the left

Thoracic compensatory curve remains flexible

Apex L2 or lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Double Major Curve

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Physiotherapy
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
Indications for Milwaukee
T7 apex or higher active correction
27
Indications for Charleston
Night brace Best for single curves Antigravity Bending brace
28
Boston
T8 or lower
29
Custom Molded
T8 or lower
30
Cheneau
Primarily done in Europe, starting in USA Highly aggressive
31
Providence
Night Brace
32
Treatment Theories (2)
1. Solid Pelvic Base | 2. Outrigger or extensions form base for pressure application
33
Solid Pelvic Base
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
Outrigger or extensions form base for pressure application
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
Weening off period
Usually 6 month weening period Once curve has been shown not to be progressing and patient has riser sign of 5
36
Surface Anatomy, Important Landmarks
``` Spine of Scapula/Superior Angle Inferior angle of Scapula PSIS ASIS Waist roll Pubic bone Xyphoid Process Umbilicus Greater Trochanter ```
37
Orientate X ray
Heart (left side) Stomach Bubble (left side) X- ray marker
38
Examinate X ray
``` 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
Risser Classification
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
Rotation - Nash Moe Technique
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
Why Treat Scoliosis
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
Orthotic Management
is only non operative method to alter natural history of progressive scoliosis ONLY BRACE UNTIL SKELETAL MATURITY ~14 in girls ~ 17 in boys
43
Indications and Goals for Bracing
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
Patient History
Age Height and Weight Presence of family history Menarche- indicator of skeletal maturity Progression in the curvature
45
Visual Assessment - Back
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
Visual Assessment - Front
Check shoulders Breast Asymmetry ASIS position - one lower than the other, more anterior Lateral pelvic tilt
47
Sagittal
Kyphosis Lordosis Pelvic Tilt
48
Adam's Forward Bend Test
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
X-Ray Evaluation (9 points)
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
X-Ray Orientation (4)
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
Brace selection based on
Location of apex of the curvature Type of curvature Patient Compliance
52
SpineCor
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions