Short leg scoliosis DSA-- PPT

Question 1

Fryette’s Spinal Mechanics

Answer 1

1. In the neutral range, sidebending and rotation are coupled in opposite directions.
2. In sufficient flexion or extension, sidebending and rotation are coupled in the same direction.
3. Initiating movement of a vertebral segment in any plane of motion will modify the movement of that segment in all other planes of motion.

1 and 2 apply to the thoracic and lumbar spine
3 applies to all vertebrae

Question 2

Type I spinal curves may be produced in the coronal plane

Answer 2

by unilateral muscle contraction. These curves disappear with muscle relaxation.

They become a biomechanical problem when the spine no longer straightens.

Question 3

Spinal Response to an Unlevel Sacral Base

Answer 3

To keep the eyes level, lumbar vertebrae side bend away from the low sacral base, creating a scoliotic curve.
Early compensation is seen as C-shaped curve where typically the horizontal cephalad planes are depressed on the opposite side of the depressed pelvic planes.
Later compensation can create several lateral curves, the S-shaped scoliotic curve. The shoulder and greater trochanteric planes are typically depressed on the same side as the depressed pelvic plane.

Question 4

Group Curves- physiological vs pathological

Answer 4

Physiological :
Kyphotic – forward bending
Lordotic – backward bending

Pathological
Kyphosis

Lordosis
- Both pathological curves in the sagittal plane.

Scoliotic

• Coronal sidebending of more than 5 degrees
• Because sidebending and rotation are linked, a commonly used term is rotoscoliosis.

Question 5

The foot is often pronated on

Answer 5

the long leg side and associated with an internally rotated lower extremity.

Question 6

Scoliotic patterned group curves are named for

Answer 6

for their convex side. For example, a rotoscoliosis left is a postural curve that is convex to the left, meaning it is sidebent to the right by more than 5 degrees in the coronal plane.

Question 7

The term short-leg syndrome is

Answer 7

actually a misnomer. It may not have anything to do with the legs! It is called a syndrome because of the common findings and symptoms associated with it.
An unlevel sacral base is the clinically relevant element here. What would this unlevel base do to the innominates? The lower extremity? The spine?

Question 8

Reversibility

Answer 8

Functional vs. structural
Patient bends forward until maximal rib hump appears on horizon, then swings upper body left and then right. The amount of rib hump remaining indicates a structural scoliotic component.

Functional scoliotic curves go away with side bending, rotation or forward bending.
Structural curves are fixed and do not reduce with side bending, rotation or lift therapy.

Question 9

Severity

Answer 9

Cobb method
5-15 degrees – Mild

20-45 degrees – Moderate

More than 50 degrees – Severe

At what severity do respiratory and cardiovascular compromise occur?

Question 10

Etiology

Answer 10

Idiopathic – most common
Congenital
Acquired

Question 11

Location

Answer 11

Double major scoliosis – most common, often seen with thoracic and lumbar combination
Single thoracic scoliosis
Single lumbar scoliosis
Junctional thoracolumbar scoliosis
Junctional cervicothoracic scoliosis – very uncommon

Question 12

Heel Lift Therapy

Answer 12

fragile pt– 1/16 in lift and lift no faster than 1/16 inch every 2 weeks

spine is flexible and no more than mild-to-moderate strain noted in myofascial system- begin with 1/8 in lift and lift at a rate no faster than 1/16 in per week, or 1/8 every 2 weeks

Recent and sudden loss of leg length on one side following fracture or recent hip prosthesis, and pt had a level sacral base before the fx/ surgery- lift full amount that was lost

Question 13

Heel Lift Therapy in the Pediatric Patient

Answer 13

Compressive force makes bone grow faster.
Lifts may be expected to stimulate faster growth in epiphyseal plates of that lower extremity.
Careful monitoring and follow-up is needed in these patients.

“In the last 15 years I have added lifts to the short side in many cases under the age of fourteen and in every case that I have kept under my observation for some time I have been astonished to find that the legs grew to the same length.”
– Harrison Fryette, DO

Question 14

Treatment Considerations

Answer 14

Before definitive diagnosis, OMT should be directed to all somatic dysfunction.

If after treatment a positive standing flexion test coexists with a negative seated flexion test, think about a leg length discrepancy.

May be helpful to obtain a standard standing postural x-ray series.
- Limited in benefit due to several reasons.

Heal lift therapy which should be combined with OMT.
- How does OMT help when someone is receiving lift therapy?

Braces
- Milwaukee vs. Boston

Surgical fusion

• Usually for progressive 45-50 degree curves
• “The mechanical power of the body is dramatically demonstrated by the propensity of the rods to become stressed and break, requiring another extensive surgery to replace them.”