scoliosis Flashcards
QL Origin insertion action and nerve
O-illiolumbar ligament and posterior illiac crest
I-12th rib (inferior border) and TVP L1-4
Action= lateral flexion bilateral extension and stabilizes 12th rib during insipration/depresses it upon forced expiration elevates coxal bone
Nerve Lumbar plexus L1-L4
Lattisumus Dorsi Origin insertion nerve action
Referral:
pain will be felt in the anterior part of the shoulder and the lower back.
O-SPT7-S5 via thoracolumbar fascia
posterior illiac crest; ribs 10-12 and inferior scapular border
I-floor of the bicipital groove of the humerus
Nerve is thoracodorsal nerve C(6)-8
Action:Adducts, extends and medially rotates the humerus
ASSISTS FORCED INSPIRATION
intercostals Origin; insertion nerves and action
External O-rib above (inf border)
I-rib below (sup border)
N-intercostal nerves (t1-12)
A-Elevates rib during INSPIRATION
Internal O-rib below (sup border)
I-Rib above (inf border)
N-intercostal nerves(T1-12)
A-decreases thoracic cavity volume during FORCED EXPIRATION (draws adjacent ribs together)
Innermost O/I= adjacent ribs in lateral curve of rib cage
***assists in both external and internal intercostals MORE forced expiration (internal)
What special test do you perform for scoliosis
Hemipelvis
Functional/structural test
What’s rom for thoracic spine
Flex 20-45
Ext25-45
Lat flex 20-40
Rotation 35-50
Rom of lumbar spine
Flex 40-60
Ext 20-40
Lat flex 15-20
Rotation 3-18
Thoracic spine review
What organs are located in the right upper quadrant?
Liver Gallbladder Duodenum Pancreas Right kidney
What organs are located in the left upper quadrant
Kidney left Spleen Stomach Pancreas Splenic flexure
Right lower quadrant holds what organs
Cecum
Appendix
Right ovary and tube
Left lower quadrant holds the
Left ovary and tube
Sigmoid colon
Functional scoliosis may be due to
Poor posture or postural changes NOT positional
Are able to be corrected
Scoliosis curves are named for the side that the _____ occurs on.
Convexity
The _____ is the distance on the spine that the curve occurs
Span
The apex is the vertebrae that is _________.
Farthest away form midline
What is the major curve in a S scoliosis
The curve that is the largest with the greatest angulation
The minor curve in an S scoliosis is also referred to as the
Compensatory curve
What is the transitional vertebra in terms of scoliosis
The one that marks the end of one curve and beginning of the next
List the degrees in terms of severity
Mild
Moderate
Severe
0-20 degrees
20-50
Greater than 50
What refelex is likely responsible for secondary curves
Righting reflex
The fact that the entire body head to toe can be involved in a scoliosis is a example of what principal?
Wolffs principal
Over time bones remodel themselves along the line of force being applied to them ( applied also to connective tissues, muscles and viscera)
Causes of scoliosis
Idiopathic Iatrogenic Congenital Functional Neuromuscular
Idiopathic scoliosis explain the differences in who is more apt to get it and when
Infantile idiopathic more common in boys (up to 3yrs old)
Juvenile scoliosis occurs equally boys to girls 4-9
Adolescent more common girls age 10-16
Which muscles may cause idiopathic scoliosis when spindle cells have abnormal response
Paraspinals
The _____ in the inner ear if asymmetrical May influence spinal posture
Labyrinth
Fun fact:
Study found increase in labyrinth sensitivity on convex side and right eye dominance may be associated with left sided curves
;) the more you know
List some things you should check for in a functional scoliosis
Unilateral pes planus
Short tibia,/small Hemipelvis (places sacrum on oblique angle in standing )
Fractured tibia and femur (can cause pelvis to be oblique and spine must compensate)
Short humerus (must lean to affected side) Torsion of the occiput on sphenoid (cranial sacral!!!!)
How the clients stands/sits (all weight to one side?)
Tps in what muscle may cause appearance of short leg?
Quadratus lumborum
Unilateral _____ shortening and ITB contracture can produce ____ pelvic tilt while unilaterally shortened _____ and ____ muscles lead to thoracic curving and lateral pelvic tilt
Tensor fascia lata
Lateral
Abdominal obliques
Latissumus dorsi
List several neuromuscular causes of scoliosis
Cerebral palsy
Freidreichs ataxia
Muscular dystrophy
Spinal cord lesions
Paralysis following polio can result in _____ scoliosis
Long C curve
On side of impairment
List some congenital causes that contribute to scoliosis
- Hemivertebrae( incomplete formation of 1/2 vertebra)
- Vertebral wedging ( slows growth and occurs on concave side)
-Vertebral bridging ( failure of segmentation bony
bars occur btwn vertebra
-malformed or absent ribs
Scoliosis is often associated with what two major spine deformities
Hyper lordosis
Hyper kyphosis
Vertebral bodies rotate toward the _____, tvps are ____ on convex side causing ________.
Ribs are flattened and more closer together on the ______ side and tvps are ______.
Convexity ; posterior ; rib humping
Concave; anterior
From an anterior view ribs appear more prominent on the _____ side and muscles appear bulkier on what side?
Concave
Convex
What muscles are shorter on the concave side
Multifidus
Erector spinae
Intercostals
Which muscles acting unilaterally will increase the severity of the curve
Abdominals Iliopsoas Lats Intercostals Erector spinae
The shoulder on the convex side will be _____ due to actions of ______ and _____.
Elevated
Upper trapezius
Levant or scapulae
What muscles and in what sequence together will maintain a pelvic obliquity
One side :
Tight quadratus lumborum
Iliopsoas
Adductors
Other side:
Tight tfl and gluten medius
Origin and insertion gluten medius
Originates : between ant and posterior gluteal lines and gluteal aponeurosis
Inserts: post lat surface greater trochanter
Superior gluteal nerve
Abduction primary assist medial rotation
Multifidus Origin/ insertion
Sacrum mammillary process L5-T12
Tvps all t spine
Articular processes of all c spine
Inserts on SPs L5-C2 (2-4 vertebrae above origin
Extension lateral flexion
CONTRALATERAL ROTATION
Levator scapulae origin insertion
Posterior tubercles C1-C4
Vertebra, border of scapula superior to spine
Dorsal scap nerve C5
Cervical nerve C3/4
Elevates and rotates scapula inferiorly (glenoid fossa)
Extension and lateral flexion if scapula fixed
Internal obliques origin insertion
Origin:
Thoracolumbar fascia
Anterior 2/3 illiac crest
Lateral 2/3 inguinal ligament (external obliques)
Insertion:
Ribs 10-12
(Abdominal aponeurosis ) to Linea alba xiphoid process pubic symphysis
Flexion
Ipsilateral flex and rotation *****
Supports compresses abd viscera and assist forced expiration micturition parturition defecation Vomitting
External oblique origin insertion
Ribs 5-12
Abdominal aponeurosis to xiphoid process
Linea alba pubic crest, tubercle
Anterior 1/2 illiac crest
CONTRALATERAL rotation **
Lateral flexion
Flexion
Supports compresses viscera and assists expiration (forced) micturition parturition defecation Vomitting
Illiopsoas origin insertion
Vertebral bodies discs and tvps T12 to L4
Lesser trochanter of femur
Lumbar plexus L1-4
Primary flexion of hip
If legs fixed flexes trunk
TFL origin insertion nerve
Anterior illiac crest (ASIS)
Iliotibial band
Superior gluteal nerve L4-S1
Upper traps origin
Superior nuchal line medial 1/3
EOP
Ligamentum nuchae up to c7 then SPs c7 to t12
Inserts on spine of scapula acromion process lateral 1/3 clavicle
Accessory nerve (cnXI) Cervical nerve c3/4
What is the action of upper traps
Elevate and rotate scapula superiorly
Extend head and neck
Rotate head and neck contralateral
Laterally flex to same side
Latissumus dorsi origin and insertion and
SPs t7 to s5
Via thoracolumbar fascia
Posterior illiac crest and inferior angle of scapula
Floor of bicipital groove of humerus
Extends adducts and medically rotates humerus
Assist forces INSPIRATION
What muscles do we test often in scoliosis and what is often found
Abdominals weak
Any muscles in concave side (tight so usually weak) glute med test on high side
List 5 CIs to treating scoliosis
Jt mobs to fused or vertebra immobilized by rods
Rib springing or jt play to hypermobile jts or ribs or history of subluxation
Randomly treating fascia
Heat over metal rods
Longitudinal or stretching work to muscles of convex side
What secondary conditions may develop in scoliosis
Intercostal neuralgia
Thoracic outlet syndrome
May be result of pes planus
When recording a scoliosis the therapist lists what 5 important things
Span if curve Apex if curve(s) Transitional vertebra Functional or structural S or C curve
Person with leg length discrepancy will weigh bear on the ____ leg while they will ___ the hip and knee of the _____ leg or position it to the _____ or side.
Short
Longer
Front
If client has both knees fully extended and locked the pelvis is now _______ and _____ on the shorter leg side
It is said a client weight bears more on the ____ side than the _____.
Laterally tilted
Lower
Convex
Concave
With pelvic torsion:
___________ raises the innominate bones and sacrum on the same side while ________ lowers it on the same side
With leg length differences people often ______ on the long leg side and _____ on the short to even them out
Anterior rotation
Posterior rotation
Posteriorly rotate
Anteriorly rotate
Left thoracic pattern and cafe au lait spots or faux beard is most common with _______ scoliosis
Non idiopathic
What is the most common pattern for idiopathic scoliosis
Where is the apex
Right thoracic curve t5-t11 and a compensatory lumbar curve from t12 to l4
Apex t8
Scoliosis resulting from neurological conditions generally appear as
What will you see
Lumbar or thoracolumbar curve extending to the pelvis
Pelvic obliquity
Prominent hip and adduction of femur
Lateral view of C curve scoliosis you will see an increased _____ on the short leg side; Anteriorly the _____ is lower on the short limb side ribs on the ____ side will be prominent and if a small hemipevis is involved face bones on the ___ side may be found
Anterior tilt (5 to 10 degree women 0-5 degree men is normal)
ASIS
Concave
Same
In a right thoracic left lumbar S curve scoliosis fill in the blank :
May be a ____ compensatory cervical curve
_____ AC joint is higher
____ scapula higher and possibly winged
___rib humping is present
Asymmetrical skin folds with more on the ____ side
Illiac crests higher on the ____
Lateral pelvic tilt PSISs are _____ on the ____ side while in a torsion they will be ____ on the ________side.
Unilateral pes planus on the ____ is possible
Left Right Right Right Concave Right Lower Dropped Higher Anteriorly rotated shorter side Left or concave
From a superior view describe what you’d see in a unilateral torsion and what you’d see in a opposing torsion
Unilateral AC and ASIS anterior on one side
Opposing AC on one side and ASIS on other are anterior
Homecare for scoliosis
Heel sitting exercises :
Sits with knees bent heels under glutes bends forward abdomen rests on ant thighs and arms stretched above head
Laterally walks hands to side of Convexity when fill stretch reached inhales and exhales and goes deeper into Convexity repeated several times
Strengthening for weak convex muscles:
Lie on concave side lift shoulder off ground hold 5-10 seconds and release repeat several times upper arm slides down lateral thigh
