Scoliosis and Short Leg

Question 1

Define Scoliosis

Answer 1

a lateral curvature of the vertebral column

Question 2

describe classifications of scoliosis

Answer 2

Structural: does not correct with side-bending (irreversible)Functional: partially or completely straightened by sidebending opposite to the presenting curve (reversible)

Question 3

list osteopathic considerations in scoliosis

Answer 3

• body compensatory curves form to keep body balanced and eyes balanced- rotation accompanies lateral curve (rotates INTO convexity)- ribs on convex side separate and move posterior (ribs on concave side more anterior and closer together)- Disc narrows on concave side

Question 4

explain the use of Cobb angle measurements in scoliosis treatment

Answer 4

10 degrees- follow every 4-6 monthsCurve progresses >5 degrees - treatCurves > 30 degrees = treatCurves

Question 5

discuss the benefits of using OMT on patients with scoliosis

Answer 5

• Increase muscle balance on both sides of curve- Optimize function of existing structures- Remove any somatic dysfunction- Stretch lumbosacral tissues- Reduce the lumbosacral angle and strengthen psoas and abdominal muscles

Question 6

explain biomechanics of short leg syndrome

Answer 6

Sacral Base Unleveling (Most clinically relevant element)- Innominates rotate to compensate- pelvic rotation and side shift will occur

Question 7

explain compensatory changes associated with short leg syndrome

Answer 7

Early compensation: Side bending, cephalad horizontal planes are typically depressed on side opposite the pelvic horizontal planeLate compensation: (Inequality > 10mm or 0.4 inches) S-shaped curve develops. Greater trochanteric planes depressed on the SAME side.

Question 8

explain guiding principles for progressive compensation in short leg syndrome

Answer 8

• Postural changes- Lower back pain (Most common/bothersome complaint)- Pelvis will side shift and rotate AWAY from side of sacral base declination- Innominate rotates anteriorly on side of short leg/ posteriorly on side of long side [opposite rotation] to compensateLumbosacral angle increases 2-3 degrees- Vetertebrae of most caudal scoliotic curve suually sidebend away from and rotate toward the side of sacral base declination

Question 9

explain diagnostic difficulties in short leg syndrome

Answer 9

Clinical diagnosis based on structural findings alone is difficult and innacurate

Question 10

list diagnostic clues in short leg syndrome

Answer 10

• Recurrent somatic dysfunction of the pelvis, spine, cranium, or myofascial structures- soft tissue involvement- tight abductors on one side and tight adductors on the controalateral side- Iliolumbar ligament on the side of convexity becomes stressed- Visceral somatic reflexes between T1 and L2

Question 11

explain the role of OMT in the patient with short leg syndrome

Answer 11

Corrects any somatic dysfunction once the spine is mobile as possible standard standing postural xrays

Question 12

explain and apply guidelines for lift therapy in short leg syndrome

Answer 12

Lift Therapy: The longer something has been around/compensated, the more slowly you add the lift. For fragile patient, begin w/ 1/16” heel lift (up to +1/16” per two weeks)Flexible patient: begin with 1/8” heel lift (up to +1/8” per two weeks)Sudden loss of leg length: lift FULL amount that was lost (ex. fracture)

Question 13

list principles of lift therapy in short leg syndrome

Answer 13

…

Question 14

A scoliosis of 5 to 15 degrees is called what?

Answer 14

mild scoliosis

Question 15

A scoliosis of 20 to 45 degrees is called what?

Answer 15

moderate scoliosis

Question 16

A scoliosis of > 50 degrees is called what?

Answer 16

severe scoliosis

Question 17

At what degree of scoliosis is there compromising of the respiratory/pulmonary function?

Answer 17

> 50 degrees

Question 18

At what degree of scoliosis is there compromising of the cardiovascular function?

Answer 18

> 75 degrees

Question 19

What is the classical pattern for iliolumbar ligament syndrome?

Answer 19

pain from the ligament, down the side of the tigth, into the mediolateral inguinal region