Short leg syndrome/Scoliosis

Question 1

scoliosis

Answer 1

coronal curve greater than 5 degrees

Question 2

group postural curves

Answer 2

spinal side bending and rotation opposite ?

Question 3

in the sagittal plane how does gravity encourage the sacral base to move? innominates?

Answer 3

sacral base–> anterior rotation

innominates posterior rotation about the femoral head

increases lordotic and kyphotic curves

Question 4

compensatory changes in the coronal plane

what happens to the lumbar spine

what happens to the pelvis

Answer 4

lumbar spine
-bends away from and rotates toward the lower sacral base

pelvis
-side shifts and rotates around a vertical axis toward the long leg side

innominate may compensate and try to rotate anteriorly on the side of the short leg

Question 5

what happen to the foot on the long leg side

Answer 5

pronated and the lower extremity internally rotates

Question 6

why is short leg syndrome a misnomer

Answer 6

b/c there isn’t actually a short leg there is an unlevel sacral base and the innominates then compensate creating a false picture of a short leg

Question 7

what is the most common spinal response pattern to unlevel sacral base

Answer 7

sidebending of the most caudal curve is away from the side of the low sacral base and usually on the side of the short leg

Question 8

what is a better test to assess short leg syndrome than measuring ASIS or hip to ankle or medial malleoli

Answer 8

radiographic measurements

Question 9

tissues on the concavity of the curve demonstrate what characteristics

Answer 9

shorten- fibrotic

increased electromyographic activity

Question 10

tissues on the convex side of the curve?

Answer 10

lengthen and weaken

Question 11

significance of iliolumbar ligament

Answer 11

often this ligament on the side of the convexity is the first structure to react to added stress in the lumbosacral area

can radiate pain to groin region

can mimic hip pain

Question 12

treatment of short leg syndrome

Answer 12

lift the heel of the leg on the side of the depressed sacral base

don’t treat until OMT has been done first

Question 13

what must you consider in children when using leg lifts

Answer 13

compressive forces makes bone grow faster

Question 14

pt is fragile (arthritic, osteoporotic, elderly)

begin with what length of heel lift

Answer 14

1/16th in life and lift no faster than 1/16 of an inch every 2 weeks

Question 15

pt has flexible spine and no more than mild to moderate strain in the myofascial system

begin with what length of heel lift

Answer 15

1/8 in lift and lift at rate no faster than 1/16 th of an inch per week or 1/8 inch every two weeks

Question 16

if there was a recent and sudden loss of length on one side as might occur following fx or hip prosthesis, what heel lift should you begin with

Answer 16

lift the full amount that was lost

Question 17

how do you name scolisosis

Answer 17

it is more common in girls to have progressive symptoms

name for side of convexity (so if side bent left its a right curve)

Question 18

by what 4 ways can you classify scolisosis

Answer 18

reversibility, severity, cause or location

Question 19

reversibility of scolisosis

Answer 19

functional or not

Question 20

severity of scoliosis

Answer 20

using Cobb method - mild, modest or severe

significant progression is considered to be occurring if an X-ray taken 5 months after the initial shows 5 degree or greater increase in curvature

mild - 5-15 degrees

moderate - 20-45 deg

severe - 50 degree

Question 21

acquired causes of scolisosis

Answer 21

osteomalacia
response to inflammation or irradiation
sciatic irritability 
psoas syndrome 
healed leg fracture
following a hip prosthesis

Question 22

difference b/w balanced and unbalanced curves

Answer 22

balanced - subject to degeneration at crossovers

unbalanced are more likely to decompensate

Question 23

most common type of scolisosis

Answer 23

double major scoliosis

two curves - lumbar and thoracic

Question 24

2nd most common scoliosis

Answer 24

single thoracic scoliosis

Question 25

single lumbar scoliosis

Answer 25

3rd most common

arthritic change

Question 26

treatment of mild scoliosis

Answer 26

OMT
Konstantin exercise
Functional orthotics
Pt and fam education

Question 27

treatment of moderate scoliosis

Answer 27

OMT
bracing
pt and fam education
konstatine exercise 
electricle stimulation - debatable

Question 28

C shaped scoliosis

Answer 28

early compensation pattern

lumbar spine has a type I group curve which is sidebent away from the short leg

shoulder is higher on the short limb side

pelvis side shifts and rotates toward the long limb

anterior innominate rotation on the short limb side to functionally lengthen it

posterior innominate rotation of the long limb side

long leg is internally rotated and the foot is pronated

Question 29

S shaped scoliosis

Answer 29

chronic postural compensation for a short limb

most inferior vertebrae in the group curve remain sidebent away from the short limb

a secondary curve develops more superiorly that sidebends the opposite way to counter balance it (toward the shorter leg)

now the shoulder is lower on the short limb side

Question 30

when right sidebending is introduced to a group curve displaing type I, neutral mechanics , the vertebrae will rotate …

Answer 30

toward the convexity

Question 31

if you sidebend to the right where is your convexity

Answer 31

left

Question 32

at 50 degrees what do you worry about

Answer 32

respiratory function

at 75 worry about heart

Question 33

when to do surgery on scoliosis

Answer 33

progressive 45-50 degrees