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30 Cards in this Set
- Front
- Back
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What is scoliosis?
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An abnormal lateral curvature of the spine in the coronal plane
Accompanied by rotation of the vertebrae and ribs in a horizontal (transverse) plane |
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What mechanics does scoliosis follow?
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A scoliotic curve follows Type 1 Fryette’s mechanics (NSxRy
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How is scoliosis named?
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Named for the side of convexity
Sidebent Left (rotated right) = convexity right |
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What produces convexity?
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Vertebral rotation is essentially what produces the convexity
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What is the most common form of scoliosis?
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Double major
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Describe double major?
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Most common
Type 1 curves in both the lumbar and thoracic spines |
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What is single scoliosis?
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Single Scoliosis
A single curve in either the lumbar or thoracic spines Thoracic scoliosis (2nd most common) Lumbar Scoliosis (3rd most common) Usually associated with arthritic change |
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What is Junctional Thoracolumbar or Cervicothoracic Scoliosis?
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Very uncommon
Found at the junctions of the associated regions |
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What is structural scoliosis?
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spinal curve that is relatively fixed and inflexible
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What is functional scoliosis?
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A spinal curve that is flexible. Its usually a correctable condition that is caused by postural or biomechanical factors
Can progress to structural if not treated and diagnosed while still flexible. |
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How is scoliosis diagnoised?
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Adams forward bending test
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Why does scoliosis usally present in adolescnents?
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Fast bone growth that is asymptric
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What percentage of scoliosis is idiopathic?
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80%
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What are the acquired causes of scoliosos?
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Osteomalacia
Osteoporosis Psoas syndrome Healed leg fracture Following a hip prosthesis Short leg |
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What is the problem with short leg?
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Short leg leads to unlevel sacral base. The spine compensates to keep the eyes level (via a Type 1 curve)
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What are the tenants to short leg syndrome
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Leads to a Functional Scoliosis
Remember: functional scoliosis can lead to structural if not addressed early enough Not necessarily an anatomical short leg Genu valgus/varus; Foot pronation (eversion) An unlevel sacral base is the key The unlevel sacral base it what causes the spine to change its curves Vertebral sidebending and rotation Innominate rotation |
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How is Adams Forward Bending Test performed?
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Stand Behind Patient
Ask patient to bend forward at the waist Identify a rib hump Patient sidebends towards side of rib hump Rib hump disappears = functional scoliosis Rib hump persists = structural scoliosis |
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When are xrays indicated for diagnosisng scoliosis?
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When are X-rays appropriate?
Static postural exam abnormality Adams test confirms structural scoliosis OMT not entirely successful Congenital abnormality suspected (i.e., butterfly vertebrae) Monitor progress of postural treatment regimen |
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What is cobb angle?
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Line across top of superior vertebra
Line across bottom of inferior vertebra Perpendicular lines off both lines Angle of intersection is Cobb Angle |
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How is the cobb angle used to evaluated scoliosis?
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Mild: 5 – 15°
Moderate: 20 – 45° Severe: > 50° Impaired respiratory function: >50° Impaired cardiovascular function: > 75° Important to identify curves likely to progress > 5° increase in 5 months –- significant progression |
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What xray is used to analyise cobb angle?
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AP
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Do you want to get xrays before or after OMT?
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Treat with OMT beforehand and try to get Xrays soon thereafter
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Lumbosacral Angle (LSA)/Ferguson’s Angle:
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Look in erect lumbosacral
Angle between line from sacral base to line parallel to the ground sould be between 25-35 any variation is bad >35 usally increases shear strain. |
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Fergusons angle?
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Normally between 25°-- 35°
Increased angle causes greater shear stress on lumbosacral joint and supporting structures (i.e., ligaments) Increased angle increases lumbar lordosis A major contributor to back pain Factors that increase angle: obesity, pregnancy, weak abdominal muscles |
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Treatment for mild, moderate, and severe
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Mild—goal is to increase flexibility and strengthen core musculature
OMT Heel Lifts Home stretches Moderate—same as mild, but consider bracing Severe—surgery if visceral compromise or rapidly progressive curve despite conservative management |
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Heel lift therapy steps
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Start with 1/8” lift
Increase 1/8” every two weeks Max of ¼” inside shoe; if > ¼”, apply outside of shoe Final heel lift 1/2 –3/4 leg length discrepancy Unless recent cause (fracture, amputation), then replace entire length |
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Heel lift protocol for fragile or elderly patients
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Start with 1/16” heel lift
Increase 1/16” every two weeks |
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OMT for scoliosis?
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Treat type II
If no type II treat type I |
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