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Orthotics2 > 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 Structural2. Transient Structural3. Structural Scoliosis
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3
Q

Non-Structural

A

Flexible reversible (minor) curvature with minimal rotationCurve will spontaneously correct with side bending towards the convexity of curve or when patient is supineExamples: Compensatory curves caused by LLDHabitual 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 correctedExample 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 rotationDoes not correct with side bending or removal of gravity3 types1. 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 yearsRareAffects M=FLeft thoracic most commonSome resolve spontaneouslyRib vertebral angle less than 20 degrees is predictive of resolutionTreated with serial cast or brace

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11
Q

Junvenile IS

A

<10 yearsMild precursor to AISAssociated 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 minimal80% femaleOften seems like it occurred overnightUsually brace between 20-45 degreesBeyond 45 degrees, bracing ineffective, surgery is indicated

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13
Q

Common Idiopathic Curvatures

A

Curve patterns fall in to 4 distinct patterns1. Thoracic2. Thoracolumbar3. Lumbar Curve4. Double Major Curve

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14
Q

Thoracic Curvature

A

Major structural curveUsually to the right, with minor compensatory curves occurring above and below Apex above T10

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15
Q

Thoracolumbar

A

Longer structural curveEither 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 leftThoracic compensatory curve remains flexible Apex L2 or lower

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17
Q

Double Major Curve

A

Major Lumbar Curve, usually leftMajor thoracic curve usually rightUsually 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 separateRibs 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 sideThe pedicles and lamina become shorter and thinner on the concave sideThe spinal canal narrows toward the concave sideVertebral 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 correctSecondary changes will turn minor non structural compensatory curve into a structural oneTendency 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 remainingCurves 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 18Girls 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 wearingMinimum 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 strengthImprove effectiveness of the brace

26
Q

Indications for Milwaukee

A

T7 apex or higheractive correction

27
Q

Indications for Charleston

A

Night braceBest for single curvesAntigravityBending 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 USAHighly aggressive

31
Q

Providence

A

Night Brace

32
Q

Treatment Theories (2)

A
  1. Solid Pelvic Base2. Outrigger or extensions form base for pressure application
33
Q

Solid Pelvic Base

A

a) Prefabricated pelvic moduleb) 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 possibleb) relief of areas or voids created opposite the corrective forcec) trimlines established according to x rayd) lumbar corrective pressure applied by pad over the musculature directly lateral to transverse processese) length of lumbar pad from distal base of curve to apex or “null point” of lumbar curvef) thoracic corrective pressure applied to ribs, transferring force to vertebraeg) length of thoracic pad from distal base of curve to rib attaching to vertebra at the apex of null point of the thoracic curveh) physiotherapy- stretching and strengthening exercises

35
Q

Weening off period

A

Usually 6 month weening periodOnce 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 AngleInferior angle of ScapulaPSISASISWaist rollPubic boneXyphoid ProcessUmbilicusGreater 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 CurvatureDirection of CurvatureRange of curveMagnitude of the angle (Cobb angle)Apex of the curveRotation (pedicles)Presence of pelvic obliquityRiser signHead compensation

39
Q

Risser Classification

A

Classification of Illiac Epiphysis to evaluate skeletal maturityOssification progresses from direction of ASIS to PSISBased on % of excursionRisser sign indicates change of curve progression

40
Q

Rotation - Nash Moe Technique

A

Measures pedicle rotation by dividing vertebral body into segmentsSegment into which the pedicle is located quantifies the rotationUses 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 imageDecreased Pulmonary Function- 20-30 degrees, lung capacity is decreased to 75-80% of normalPain 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 scoliosisONLY BRACE UNTIL SKELETAL MATURITY~14 in girls~ 17 in boys

43
Q

Indications and Goals for Bracing

A

Infantile - usually self correctingJuvenile and Adolescent - 20 decision to brace is made- 25 to 40-45 degrees- skeletal immaturity- Risser 0, 1, 2GoalsStop ProgressionPrevention of Surgery Delay of Surgery- earlier you fuse vertebrae, more likely you will lose height

44
Q

Patient History

A

AgeHeight and WeightPresence of family historyMenarche- indicator of skeletal maturityProgression in the curvature

45
Q

Visual Assessment - Back

A

Head- shifted to left or rightShoulders - levelScapula - height, wingingRibs - one side more posterior than otherWaist roll- one side more prevalentOne arm hangs closerPelvic obliquityKnees, legs, ankles, foot position

46
Q

Visual Assessment - Front

A

Check shouldersBreast AsymmetryASIS position - one lower than the other, more anteriorLateral pelvic tilt

47
Q

Sagittal

A

KyphosisLordosisPelvic Tilt

48
Q

Adam’s Forward Bend Test

A

Forward bend with hands clapped togetherNo knee bendSighting down the spineDO NOT say “touch your toes”, maybe a presence of asymmetrical hamstring tightnessThoracic region: Rib hump- on the convex sideLumbar region: Prominence of paraspinal muscles

49
Q

X-Ray Evaluation (9 points)

A
  1. Type of Curvature2. Direction fo Curvature3. Range4. Apex5. Degree6. Rotation7. Bony Age (Risser or wrist)8. (De)Compensation9. Pelvic Obliquity
50
Q

X-Ray Orientation (4)

A

Viewed from POSTERIOR to ANTERIOR4 IdentifiersLocation of the heart - situated on the leftStomach bubble on the leftLiver located on the rightMarker on the X ray

51
Q

Brace selection based on

A

Location of apex of the curvatureType of curvaturePatient Compliance

52
Q

SpineCor

A

Uses dynamic forces to cause body to work in conjunctionSimulate continual physiotherapyCorrection movement to become neuromuscularly indicatedWorn 20 h a dayMild to moderate curvatures

Orthotics2 (9 decks)

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