short leg CI and DSA Flashcards
When does a C shaped scoliosis occur?
Early compensation pattern
What compensation happens in a C shaped scoliosis
- Shoulder is higher on the short limb side
- Pelvis side shifts and rotates toward the long limb
- Anterior innominate rotates on the short limb side to functionally lengthen it, posterior innominate rotation on long limb side
- Long leg is internally rotated and foot is pronated
When does a S chaped scoliosis occur?
Chronic postural compensation for a short limb
What compensation happens in a S shaped scoliosis?
A secondary compensatory curve develops more superiorly that sidebends the opposite way to counter balance - shoulder on short leg side is depressed
Rest is the same as C scoliosis:
- Pelvis side shifts and rotates toward the long limb
- Anterior innominate rotates on the short limb side to functionally lengthen it, posterior innominate rotation on long limb side
- Long leg is internally rotated and foot is pronated
What will a pelvic side shift test?
Shows which leg is short by stabilizing the shoulders and allow the pelvis to shift-
Pelvis will shift to the side with the long leg because it is more stable
A 47 y/o M presents with upper thoracic pain and short left leg. What compensatory SD would you expect to find on structural exam?
A- left posterior innominate B- lumbar group curve neutral sidebent left and rotated R C- L anterior innominate D- Pelvic sideshift L E- L lower extremity internal rotation
C- Left anterior innominate
Will expect- posterior innominate on the long leg side, sidebent away from the short leg, pelvic shift toward long leg, long leg will be internally rotated
When right sidebending is introduced to a group curve displaying type 1, neutral mechanics, the vertebrae will rotate:
A- superiorly B- toward the concavity C- interiorly D- toward the convexity E- posteriorly
D- toward the convexity
Will expect- Side bend into concave, rotate to convexity
A pt has a short L leg due to a recent femur fracture. On PE, you will find
A- r paravertebral mm elevation due to group curve convex L
B- Lumbar group curve neutral, SB R RL
C- L paravertebral elevation due to group curve convex R
D- Lumbar group curve extended, SR RR
E- L5 flexed, rotated L SB L
B
What are the typical curves of the spine?
Cervical- lordosis
Thoracic- kyphosis
Lumbar- lordosis
70 y/o F with a hx of osteoporosis and osteoarthritis is noted to have a L short leg and ¾ inch of sacral base unleveling on the L. The most appropriate heel lift to initially prescribe is?
1/16
patient is fragile- raise 1/16 inch
A scoliotic curve is most likely to progess in which patient? A- neonate B- child C- adolescent D- adult E- senior citizen
C- adolescent
Going through a period of rapid growth. If they are progressing with the curve, you need to do something about it.
Which thoracic curve measurement can seriously compromise cardiovascular function? A- 5 degrees B- 20 C- 40 D- 50 E- 75
E-75
Which of the following is most likely found in a pt with a L short leg?
A- Tenderness over the right sacroiliac ligaments
B- Shortening of the L paraspinal tissues
C- Tenderness over the L iliolumbar ligament
D- L posterior innominate
E- R groin pain
C- tenderness over the L iliolumbar ligament
Which of the following will be most likely associated with a thoracic scoliotic curve sidebent L and rotated right?
A- L paravertebral mm elevation
B- Elevated (superior) L AC joint
C- Depressed (inferior) L inferior angle of scapula
D- Shortened R thoracic paraspinal tissues
sidebending
E- R index finger more inferior (lower) than L
C- depressed L inferior angle of scapula
A pt has a short R leg. Which of the following compensatory changes would you expect to find?
A: R posterior innominate B: Lumbar group curve neutral SB R R L C: L anterior innominate D: Pelvic sideshift L E: Right lower extremity internal rotation
D- pelvic sideshift L
Spine surgery and Harrington rod placement is the most appropriate treatment for progressive scoliotic curves that are already beyond?
45 degrees
When treating a pt with scoliosis, the primary goal of OMM is to:
A- straighten the curve
B- optimize motion and fxn of the existing structures
C- increased sidebending toward the concavity
D- stretch the mustlces on the side of the convexity
E- improve rotation toward the convexity
B- optimize motion and fxn of the existing structures
Where does the weight bearing line run through?
Runs midway between the feet, through the pubic symphysis, along the midline of the vertebral column, and bisects the center of the suprasternal notch and glabella.
What is the optimal postural alignment in the sagittal plane?
Through the lateral maleolus, midknee, femoral head, anterior third of the sacral base, middle of the body of the L3 vertebrae, humeral head, and external auditory meatus.
What is somatization of the psyche
Posture can be a somatic depiction of one’s inner emotions
EX- depression can cause a pt to hang from their soft tissues without the apparent energy to stand tall
What is a functional or secondary curve
Motion such as sidebending can reduce a lateral curve- it is reversible
What is a structural or primary curve?
The curve is unable to be reduced with side bending- is nonreversible
When are curves considered pathological?
Coronal sidebending of more than 5 degrees –> scoliosis
What happens to tissues on the convex side of sidebending?
They lengthen
What happens to tissues on the concave side of sidebending?
They shorten
How are group curves named?
Named for the convex side
Ex: left sidebending is named a R scoliosis
Where does the L3 center of gravity fall and how does it effect the sacrum and innominates?
Falls anterior to the middle transverse sacral axis and behind the femoral axis.
Encourages the sacral base to rotate anteriorly and innominates posteriorly
How much does the lumbosacral angle increase in short leg scoliosis?
2-3 degrees
Significance of iliolumbar ligament and how does pain present?
The iliolumbar ligament on the side of the convexity of the lumbopelvic curve is often the first structure to react to added stress
- Point of maximal tenderness to palpation is at L4/L5 transverse processes
How does pain of the sacroiliac ligament present?
Will refer pain down the lateral side of the leg
How much do you lift in a fragile patient?
1/16 lift and lift no faster than 1/16 of an inch every 2 weeks
How much do you lift in a flexible spine?
Begin with 1/8 lift and lift at a rate no fater than 1/16 inch per week or 1/8 every 2 weeks
How much do you lift in a sudden loss of leg length?
If the patient had a level sacral base before a fracture or surgery, lift the full amount that was lost
What is the true height of the lift?
It is measured from the bottom of the lift to a pint where the calcaneal bone strikes the lift
How much lift can be used inside a shoe before the shoe no longer fits well?
1/4 inch
How much lift can be placed between the heel of the patient’s foot and the floor before foot mechanics are significantly disturbed?
1/2 inch
Adding a lift will make bone ____?
Grow faster
Mild severity scoliosis classification
A curve of 5-15 degrees
Moderate scoliosis curves measure?
20-45 degrees
Severe scoliosis has a curve of more than?
50 degrees
What does a curve of more than 50 degrees compromise?
Respiratory function
What does a curve of more than 75 degrees compromise?
Cardiovascular function
Acquired scoliosis may result from which conditions? (6)
- Osteomalacia
- Response to inflammation or irradiation
- Sciatic irritability
- Psoas syndrome
- Healed leg fracture
- Following a hip prosthesis
When is a brace used?
In a growing patient with 20-40 degree curves. It works to control the scoliotic (lateral) curves until the spine matures, which is generally around age 21
