Podcast
Questions and Answers
At what ages are females typically screened for scoliosis?
At what ages are females typically screened for scoliosis?
How many times are males screened for scoliosis during their adolescent years?
How many times are males screened for scoliosis during their adolescent years?
Which of the following is NOT a typical symptom associated with scoliosis?
Which of the following is NOT a typical symptom associated with scoliosis?
What tool is used to assess the symmetry of the spine during the Adam's Bend Forward test?
What tool is used to assess the symmetry of the spine during the Adam's Bend Forward test?
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Which of the following should be evaluated for flexibility during the scoliosis assessment?
Which of the following should be evaluated for flexibility during the scoliosis assessment?
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What percentage of scoliosis curves are typically to the right?
What percentage of scoliosis curves are typically to the right?
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What is scoliosis often referred to as?
What is scoliosis often referred to as?
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Why is it important to address family history during scoliosis screenings?
Why is it important to address family history during scoliosis screenings?
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Which type of curves progress more significantly?
Which type of curves progress more significantly?
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At which Tanner stage do females typically experience their growth spurt?
At which Tanner stage do females typically experience their growth spurt?
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What does a higher Risser Scale number indicate?
What does a higher Risser Scale number indicate?
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Which of the following is evaluated by the Sanders Bone Age Test?
Which of the following is evaluated by the Sanders Bone Age Test?
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What is the purpose of bracing in scoliosis treatment?
What is the purpose of bracing in scoliosis treatment?
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What does Cobb's Angle measure?
What does Cobb's Angle measure?
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Which gender tends to experience more curve progression in scoliosis?
Which gender tends to experience more curve progression in scoliosis?
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In which stage is further curve progression likely to be minimal or none?
In which stage is further curve progression likely to be minimal or none?
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What is the expected growth potential in a child whose epiphyseal plates are significantly fused?
What is the expected growth potential in a child whose epiphyseal plates are significantly fused?
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What factor is NOT explicitly mentioned as a determinant of curve progression?
What factor is NOT explicitly mentioned as a determinant of curve progression?
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What should be done every single day to help decrease the curve?
What should be done every single day to help decrease the curve?
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What Cobb angle degree is typically considered for surgical intervention?
What Cobb angle degree is typically considered for surgical intervention?
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What is a potential complication associated with surgery?
What is a potential complication associated with surgery?
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Which of the following is true about post-operative recovery?
Which of the following is true about post-operative recovery?
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What is one of the objectives of scoliosis surgical procedures?
What is one of the objectives of scoliosis surgical procedures?
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What type of grafts are used during the surgical procedure?
What type of grafts are used during the surgical procedure?
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What must be managed post-operatively to prevent complications?
What must be managed post-operatively to prevent complications?
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Which of the following is a common complication after surgery?
Which of the following is a common complication after surgery?
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What indicates a poor outcome if the fusion fails to heal?
What indicates a poor outcome if the fusion fails to heal?
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What should patients be aware of regarding blood loss during surgery?
What should patients be aware of regarding blood loss during surgery?
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What is the most common symptom of compartment syndrome?
What is the most common symptom of compartment syndrome?
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Which type of osteomyelitis occurs due to a pre-existing infection?
Which type of osteomyelitis occurs due to a pre-existing infection?
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What is the initial treatment for osteomyelitis?
What is the initial treatment for osteomyelitis?
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In which age group is osteomyelitis most frequently observed?
In which age group is osteomyelitis most frequently observed?
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Which organism is most common in cases of osteomyelitis in patients over 5 years old?
Which organism is most common in cases of osteomyelitis in patients over 5 years old?
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Which of the following is a potential cause of clubfoot?
Which of the following is a potential cause of clubfoot?
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What is the primary characteristic of positional clubfoot?
What is the primary characteristic of positional clubfoot?
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Which symptom is indicative of clubfoot?
Which symptom is indicative of clubfoot?
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How can clubfoot be diagnosed?
How can clubfoot be diagnosed?
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What type of clubfoot is associated with syndromic conditions such as spina bifida?
What type of clubfoot is associated with syndromic conditions such as spina bifida?
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What is the importance of early evaluation and treatment of clubfoot?
What is the importance of early evaluation and treatment of clubfoot?
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Which imaging technique is rarely used to assess clubfoot?
Which imaging technique is rarely used to assess clubfoot?
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What is a characteristic finding when palpating the heel of a clubfoot patient?
What is a characteristic finding when palpating the heel of a clubfoot patient?
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Why should treatment for clubfoot be initiated before bone calcification?
Why should treatment for clubfoot be initiated before bone calcification?
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What is the most common form of clubfoot, which occurs in otherwise healthy infants?
What is the most common form of clubfoot, which occurs in otherwise healthy infants?
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Study Notes
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
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Description
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.
