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PCM II Exam 1 > Scoliosis > Flashcards

Scoliosis Flashcards

1
Q

What is the definition of Scoliosis?

A

Abnormal curve, primarily in coronal plane

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2
Q

How do you name an abnormal curve present in Scoliosis?

A

Named for the side of the CONVEXITY

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3
Q

What are the different classifications of Scoliosos?

A
  • Idiopathic
  • Congenital
  • Acquired
  • Neuromuscular (Muscle Imbalance)
  • Syndromic
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4
Q

Describe the different stages of Idiopathic Scoliosis.

A
  1. Infantile: Age 0-3 years
    - MALES > females
    - CONVEX to LEFT (Usually Thoracolumbar)
    - 85% resolve spontaneously
  2. Juvenile: Age 4-9 years
    - Most progress steadily
    - Refer to Ortho is Cobb Angle > 20 Degrees
  3. Adolescent: 10 years or greater
    - MOST COMMON presentation
    - FEMALES progress to surgery more than males (8:1)
    - Deformity will increase with growth spurts
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5
Q

What is the most common presentation of Adolescent Idiopathic Scoliosis?

A

Right Thoracic and Left Lumbar (Double Major)

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6
Q

Describe the mechanism behind Congenital Scoliosis.

A

Failure of Formation

  • Wedge Vertebrae (Partial Unilateral)
  • Hemivertebrae (Complete Unilateral)

Failure of Segmentation

  • Unilateral unsegmented bar
  • Bilateral
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7
Q

What are some related abnormalities related to Congenital Scoliosis?

A
  1. Urinary Tract (20%): Similar Embryonic Origin
  2. Cardiac (10-15%)
  3. Spinal Dysraphism (up to 20%): Failure of spine to close properly along midline
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8
Q

Approximately how many patients will need surgery for congenital scoliosis?

A

50% will progress and need surgery

25% will not progress

25% will progress but not need surgery

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9
Q

What are some issues that present with Neuromuscular Scoliosis?

A
  1. Cerebral Palsey (Upper motor nueron disease)
    - Trauma pre/postnatal
  2. Polio (lower motor neuron disease)
  3. Duchenne’s muscular dystrophy (Chemical imbalance in structure of muscles)
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10
Q

What are some issues that present with Syndromic Scoliosis?

A
  1. Marfan’s Syndrome
  2. Ehlers Danlos
  3. Neurofibromatosis (Look for CADE AU LAIT spots or neurofibromas)
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11
Q

What are some issues that are associated with acquired Scoliosis?

A
  • Structural Short Leg Syndrome
  • Psoas Syndrome
  • Poor Posture
  • Healed leg fracture
  • Post hip prosthesis Surgery
  • Splinting from PAIN
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12
Q

What is the typical appearance of Scoliosis?

A
  • Body tries to keep eyes LEVEL
  • Shoulder height difference
  • Posterior Scapula
  • Crease at waist
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13
Q

What is the Adams Forward Bend Test looking for?

A

Scoliosis (Rotation in the upper thoracics)

Make sure the feet are equal

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14
Q

What is the Cobb Angle that will define Scoliosis?

A

10 degrees or greater

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15
Q

How do you measure the Cobb Angle?

A

Look at most CEPHALAD Vertebra and CAUDAL vertebra that have the most curvature

Look at the SUPERIOR surface of the most Cephalad Vertebra that goes INTO the curve

Look at the INFERIOR surface of the most Caudad Vertebra that goes INTO the curve

DRAW RIGHT angles on both of these lines and where they cross is going to be the COBB ANGLE!

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16
Q

How can you use a scoliometer to determine if a patient has scoliosis or not?

A

If you have GREATER than 7 DEGREES then that will correlate to a COBB ANGLE of 20 or more

  • If someone has a LARGE BMI, the scoliometer is not going to be accurate and it will UNDERESTIMATE the degree of the curvature
17
Q

What are some indications for Ortho Referral?

A
  • Cobb Angle > 20 degrees
  • Progression of Cobb Angle > 5 degrees
  • Some refer for baseline evaluation if Cobb Angle is GREATER than 10 degrees
18
Q

Describe the treatment that can be performed on patients with Idiopathic Scoliosis.

A

0 - 10 Degrees, Asymptomatic, Skeletally IMMATURE

  • OMT
  • Observation with follow-up every 4-6 months
  • If curve progresses > 5 degrees (refer to Ortho)

10 - 20 Degrees, Asymptomatic, Skeletally IMMATURE

  • OMT
  • After initial ortho evaluation, Primary Care Physician can follow up with x-rays every 6 months until mature skeletally

> 20 Degrees, Skeletally Immature

  • Ortho Referral
  • OMT

0 - 30 Degrees, Skeletally MATURE

  • OMT
  • Follow Clinically
19
Q

What is the goal of patients that have already reached skeletal maturity?

A

Don’t progress the curve to 50 degrees!

20
Q

Differentiate between the Milwaekee, Boston, and Charleston Nighttime Brace.

A

Milwaekee Brace

  • 23 hrs/Day
  • 20-40 Degree curves
  • Used in GROWING Patient

Boston Brace

  • Works on lordosis and rotation as well
  • APEX of curve must be BELOW T10
  • TLSO = Thoracic, Lumbar, Sacral orthotic

Charleston Nighttime Brace

  • Only worn at night
  • Sidebends Pts INTO the curve
  • Allows patients to participate activities without a brace on
21
Q

What is the goal in using OMT with Scoliosis?

A

Restore MOBILITY to the musculoskeletal system where possible

  • All modalities may be used
22
Q

What is the goal of Surgery for patients with Scoliosis?

A
  • Prevent Pulmonary Compromise (> 50 degrees)
  • Prevent Cardiac Compromise (> 75 degrees)
  • Goal is to FUSE the spine and prevent further Progression of disease!

PCM II Exam 1 (9 decks)

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