Scoliosis Screening and Diagnosis

Scoliosis Screening

• Females screened twice at ages 10 and 12
• Males screened once at age 13 or 14
• Screenings usually done in school but should not be the only screening
• Health professional should also screen at primary care appointments

Scoliosis History Questions

• Family history of scoliosis or musculoskeletal disorders
• Menstrual onset (less growth after onset, less concern for worsening scoliosis)
• Development of secondary sexual characteristics and recent growth patterns
• Presence of pain and neurologic changes (atypical for AIS)
• Assess for asymmetry of the child’s contour of the back

Diagnosing Scoliosis

• The Adam's Bend Forward test assesses symmetry using a scoliometer
• Have the child bend at the waist with arms extended and palms together
• Examine from behind and the side
• Flexibility evaluation by stabilizing the spine and twisting side to side

Scoliosis Progression

• Double lumbar and thoracic curves progress more than single curves
• Larger curves progress more than smaller curves
• Determinants of progression: gender, future growth potential, curve magnitude
• Females = higher progression than males
• Progression increases during adolescent growth spurts, especially at peak height velocity (time when adolescents grow fastest)
• Peak height velocity occurs in females at Tanner Stages 2-3 and in males at Tanner Stages 3-5

Evaluating Growth Potential

• Tanner Stage Assessment: determines progression based on the stage. More progression is expected if the stage hasn't been reached.
• Risser Scale: evaluates skeletal maturity through x-ray of the iliac crest (higher number = less growth potential). Ex: Risser scale of 1 indicates high growth potential, causing concern.
• Sanders Bone Age Test: uses hand x-rays to determine growth potential by evaluating epiphyseal plates. Ex: Fused plates indicate little growth potential.
• Cobb Angle: determines the magnitude of the curve by measuring the superior and inferior vertebrae of the curve (top and bottom of the curve)

Scoliosis Treatment

• Bracing:
  • Indicated for curves greater than 20 degrees
  • Goal: prevent curve progression
  • Continued until bone growth is complete
  • Types include Schroth (coupled with bracing)
• Schroth Method:
  • Coupled with bracing
  • Goal: decrease the curve
  • Must be performed daily
  • Exercises focus on spine elongation
• Surgery:
  • Indicated for Cobb angles greater than 45 degrees or for those unsuccessful with bracing
  • Objectives: arrest progression, achieve maximum correction, improve appearance, keep short/long term complications to a minimum
  • Surgical procedure: vertebrae fused with bone grafts
  • Post-op recovery in ICU
  • Complications include: bleeding, infection, nerve damage, pseudoarthrosis (failed fusion), disk degeneration, and lower back pain

Clubfoot

• Causes:
  • Intrauterine positioning
  • Neuromuscular or muscle abnormality
  • Genetic predisposition
  • Arrested fetal development of skeletal and soft tissue
  • Amniotic banding
• Categories:
  • Positional: intrauterine crowding, responds to simple stretching and casting
  • Syndromic (tetralogic): associated with other congenital abnormalities, severe form, doesn't respond well to treatment (ex: spina bifida)
  • Congenital (idiopathic/true clubfoot): most common form, etiology unknown
• Symptoms:
  • Small foot
  • Shortened Achilles tendon
  • Underdeveloped calf muscle
  • Empty heel bed
  • Transverse plantar crease
  • Normal leg lengths
• Diagnosis:
  • May be detected prenatally
  • Usually diagnosed at birth
  • X-rays determine degree and severity of deformity
  • MRI may be used to view soft tissue impairment
• Treatment:
  • Early evaluation and treatment are crucial for successful correction and reduced complications
  • Begin treatment before bone calcification

Bone Remodeling Stages

• Resorption: Old bone is broken down by osteoclasts
• Reversal: Osteoclasts stop breaking down bone
• Formation: New bone is formed by osteoblasts
• Mineralization: New bone deposits minerals
• Consolidation and Remodeling: New bone strengthens and converts to normal bone, able to bear weight

Compartment Syndrome

• Increase in pressure within a closed space that compresses vessels and nerves, reducing blood flow and sensation
• Caused by swelling from trauma or immobilizing device
• Symptoms:
  • Severe pain unrelieved by analgesics
  • Pain greater than expected for fracture
  • Pallor, paresthesia, weak or lack of pulse, skin cold to the touch
  • Pain with extending fingers or toes
  • Most common in lower extremities or lower arms
• Requires immediate ER intervention

Osteomyelitis

• Infection of a bone
• Occurs in the metaphyseal region of long bones (most commonly distal femur)
• Most frequent in kids aged 5-14 years old
• Categories:
  • Exogenous: direct inoculation from outside bone (ex: surgical reset)
  • Hematogenous (acute and subacute): spread from pre-existing infection
    • Acute: abrupt onset, most intense in the first few days
    • Subacute: occurs after 2 weeks, present for longer than acute
• Organisms:
  • Staphloccus aureus (most common over 5 years old)
  • Haemophilus influenzae, strep, pneumonia
  • Salmonella, Staph aureus (Sickle Cell Disease)
  • Community acquired MRSA
  • E coli, B strep (neonates)
  • Pseudomonas (puncture wounds over 6 years)
  • Nisseria gonorrhea (sexually active adolescents)
• Diagnosis:
  • Symptoms: infant (fever, irritability, poor feeding), older child (pain, warmth, tenderness, fever, lethargy, decreased ROM)
  • Lab data: leukocytosis, elevated ESR, blood cultures, bone cultures, CT scan and MRI (x-rays often cannot visualize it)

Therapeutic Management of Osteomyelitis

• Long term IV antibiotics (7-14 days)
• If symptoms improve, switch to oral antibiotics (up to 6 weeks)
• Monitor for side effects

This quiz covers essential information about scoliosis screening protocols, including age-specific assessments for males and females. It also discusses the evaluation of family history, physical assessments, and diagnosing methods like the Adam's Bend Forward test. Additionally, it delves into the characteristics of scoliosis progression and their implications.