Scoliosis and Short Leg Syndrome

Question 1

Scoliosis definition

Answer 1

lateral deviation of the spine

Fryette I: sidebending will automatically induce rotation
-“rotoscoliosis”

Question 2

Dextroscoliosis

Answer 2

Curve sidebent to the left (restricted translation to left)

Convexity to right (scoliosis to right)
-curvature points to the side of naming

Question 3

Levoscoliosis

Answer 3

curve side bent to right (restricted translation right)

Convexity to left (scoliosis to left)
-curvature points to side of naming

Question 4

Structural curve

Answer 4

fixed and inflexible

does not correct with sidebending in opposite direction

Assoc w/ vertebral wedging, shortened ligaments and muscles on concave side of curve

Question 5

Functional curve

Answer 5

Flexible curve, partially or completely corrected w/ sidebending to opposite side

uncorrected can progress to structural curve

Question 6

Double major curve

Answer 6

Most common scoliotic curve

degenerative changes at junction of two curves (where they change directions)

second curve develops to keep eyes level - compensatory

Question 7

Problems associated with thoracic and lumbar curves

Answer 7

Thoracic curve: heart and lung problems

Lumbar curve: arthritic changes in low back (least common)

Question 8

Severity of scoliosis

Answer 8

Mild 5-15 degrees cobb angle
Moderate 20-45 degrees
Severe over 50 degrees

Resp function compromised at over 50 degrees, CV function compromised after 75 degrees

Question 9

Cobb angle

Answer 9

angle at intersection of two parallel lines drawn from topmost and bottommost vertebrae in the scoliotic curve

Question 10

Causes of scoliosis

Answer 10

Idiopathic - 80%

Congenital - malformation of vertebrae - most often progressive

Neuromuscular - muscular weakness or spasticity - polio, cerebral palsy, Duchenne’s MD, meningomyelocele

Acquired: tumor, infection, osteomalacia, sciatic irritability, psoas syndrome, short leg syndrome

Question 11

Treatment of scoliosis

Answer 11

Mild: PT, Konstancin exercises, OMT - improve flexibility, strengthen trunk and abdominal musculature.

Moderate: mild tx + bracing w/ spinal orthotic

Severe: surgical if resp compromise or if progresses quickly

Question 12

Short Leg Syndrome definition

Answer 12

anatomical (e.g. hip replacement) or functional leg length discrepancy

Sacral base unleveling
Vertebral sidebending and rotation
Innominate rotation

Question 13

S/S of short leg syndrome

Answer 13

Sacral base unleveling - lower on side of short leg

Anterior innominate rotation on short side (to lengthen)

Posterior innominate rotation on long side (to shorten)

Lumbar spine sidebends away (induces rotation toward) side of short leg

Ferguson’s angle (LS) increases 2-3 degrees

iliolumbar ligament first, then SI ligaments become stressed on side of short leg

Question 14

Treatment of short leg syndrome

Answer 14

OMT of spine and LE

Standing postural xrays - determine heights of femoral head

greater than 5mm difference consider heel lift

Question 15

Heel lift guidelines

Answer 15

Final lift height .5 to .75 of measured leg length discrepancy unless recent, sudden loss (e.g. hip fracture or prosthesis), then lift full amount

“fragile” elderly, arthritic, osteoporotic, acute pain - begin with 1/16” lift and increase 1/16” every two weeks

“flexible” begin with 1/8” and increase 1/8” every two weeks

Max 1/4” inside shoe, up to 1/4” outside of shoe without adding height to toe as well to keep pelvis from rotating to opposite side