Scoliosis

Question 1

Scoliosis

Answer 1

1. Lateral deviation of vert. Column
2. 10 degrees <
3. Occurs 1-3% pop
4. Peak incidence = 12-14 yrs
5. F > M

Question 2

Stats

Answer 2

1. 1 in 20 some degree
2. 1 in 200 clinical symptoms
3. Possible correlation w/ lower body wt. in pre-pubescence
4. Names for direction of convexity
5. Pre-pubescent w/ scoliosis -> further work-up
   A. Syndrome or abnormal vert. Dev.

Question 3

Dextroscoliosis

Answer 3

1. More common
2. Right sided apex
3. Sidebent left
4. Rotations right
5. Concave left
6. Convex right
7. Ribs rotate pst on Rt. Side
8. Space between ribs inc on rt.
9. Common in thoracic spine

Question 4

Levoscoliosis

Answer 4

1. Lt. sided apex
2. Sidebent rt.
3. Rotated lt.
4. Concave rt.
5. Convex lt
6. Common in lumbar spine

Question 5

Reversibility

Answer 5

1. Fxnal 
  A. Non structural 
  B. Most amenable to OMT
  C. No bone abnormalities
  D. Correct posture -> resolves
  E. Vert. Usually sidebent but not rotated
  F. Psoas syndrome
2. Structural
  A. Bone deformity 
    1. Congenital
    2. Acquired
  B. Vert. Wedged or partially dev.
  C. Progressive w/ growth
    1. Degenerative after growth stops

Question 6

Severity

Answer 6

1. Mild (10-20)
2. Moderate
   A. 20-40 immature skeleton
   B. 20-50 adult skeleton
3. Severe (>50)
   A. >50 = resp compromise
   B. >75 = cardio compromise
4. Cobb angle: used to assess severity
   A. PA or lat X-ray
   B. Line from sup aspect most tilted sup vert and inf aspect most tilted inf vert
   C. Angle formed when perpendicular lines cross

Question 7

Location

Answer 7

1. Thoracic and lumbar -> C-shaped
2. Freyette’s principles
3. Body tries to compensate -> double major scoliosis
4. Double major “S”
5. Single thoracic (most common)
6. Single lumbar
7. Jxnal thoracic-lumbar
8. Jxnal cervical-thoracic

Question 8

Etiology

Answer 8

1. Unsure

2. Probably genetic predispositions w/ envir factors

Question 9

Adams test

Answer 9

1. Pt removes shirt
2. Dr. Behind pt
3. Pt. Feet together
4. Pt bends forward
5. Dr. Evaluates for asymmetry

Question 10

Management

Answer 10

1. Mild
   A. Followed every 4-6 mo
   B. Typically just observe
   C. May consider PT or other postural exercises
   D. OMT
2. Moderate
   A. Bracing: only good for immature skeleton
   
   1. Wear up to 23 hrs/day
   2. Most common
      A. TLSO= thoracolumbar sacral orthosis (Boston -turtle shell)
      B. Milwaukee (full torso): for upper thoracic curves

Question 11

Neuromuscular etiology

Answer 11

1. CP
2. Spina bifida
3. Muscular dystrophy

Question 12

Congenital etiology

Answer 12

1. Partial unilateral failure of formation (wedge vert)
2. Unilateral failure of segmentation (congenital bar)
3. Complete unilateral failure to formation (hemivertebrae)
4. Bilateral failure of segmentation (block vert)

Question 13

Muscular imbalance etiology

Answer 13

1. Concave side of curve- hypertonic/spastic muscles
2. Convex side - muscles over stretched
3. Creates pseudo scoliosis

Question 14

Idiopathic etiology

Answer 14

1. ~80% scoliosis
2. Body tries to keep eyes level
3. Body tries to keep balance
   D. Compensatory curves

Question 15

Syndromes etiology

Answer 15

1. Kids w/ CT disorders
  A. Management can differ
2. Common syndromes
  A. Klippel-feil syndrome
  B. Marfan’s syndrome
  C. Prayer wili
  D. Ehlors danlos
  E. Neurofibromatosis
  F. Osteogenesis imperfecta = brittle bone

Question 16

Acquired etiology

Answer 16

1. Traumatic
2. Psoas spasm
3. Healed leg fx
4. After total hip or knee arthroplasty
5. Osteomalacia
6. Short leg -> compensatory

Question 17

Classification

Answer 17

1. Infantile: 0-3 yrs
2. Juvenile: 4-9 yrs
3. Adolescent >10 yrs