Scoliosis-student version pdf.pdf

Navigating scoliosis scoliosis Lateral curvature of the spine > OR Excessive thoracic kyphosis (looks different) Many of scoliosis 2 main categories categories of scoliosis NOTE: Curves > 60° (Cobb’s) may cause heart and/or lung impingement and may require surge...

Navigating scoliosis scoliosis Lateral curvature of the spine > OR Excessive thoracic kyphosis (looks different) Many of scoliosis 2 main categories categories of scoliosis NOTE: Curves > 60° (Cobb’s) may cause heart and/or lung impingement and may require surgery Functional or Non- Structural structural Lateral curvature with rotation Curve straightens with forward of the vertebrae bending ( Test) Structural abnormalities may May be temporary/can usually cause the spine to curve be corrected w/ spinal Wedge-shaped vertebrae may mobilization/ , be congenital or stretching, strengthening, &. postural retraining While May be caused by mobilization/manipulation of inequality, pelvic Types of scoliosis (named by cause) Idiopathic Scoliosis: genetic or unknown cause with subcategories named by the. : 90% of idiopathic scoliosis Dx age 10-18; female>male Thoracic dextroscoliosis M/C Juvenile 9% *aka early onset scoliosis Dx age 3-10; female>male Thoracic dextroscoliosis M/C Infantile 1% *aka early onset scoliosis Dx before age 3; male>female; usually resolves on its own Types of scoliosis (named by cause) Congenital Scoliosis: spinal, rib, scapular deformity/fusion Hemivertebrae Klippel Feil Syndrome (rare/genetic/fused cervical vb) Sprengel’s deformity (scapula elevated/ may have abnormal attachments) Rib synostosis (1st rib fused to 2nd or cervical rib) Neuromuscular Scoliosis: caused by poor muscle control/paralysis/ diseases affecting the brain, spinal sord, and muscular system*early onset scoliosis Muscular ___________ Cerebral palsy __________ ____________ Types of scoliosis (named by cause) Degenerative (also called De Novo or Adult Onset Scoliosis) Facet/IVD degeneration spinal assymmetry Syndromic: due to asymmetries caused by a syndrome Ehlers-Danlos, Marfan’s, or other CT disorder Metabolic Rickets, osteomalacia, osteogenesis imperfecta Sheuermann’s Kyphosis (excessive thoracic kyphotic curve) Scoliosis may also be caused by anything that causes spinal asymmetry including trauma, space occupying lesions, dwarfism, etc. All lateral curvatures may also be described as dextroscoliosis (________ lateral curve) or levoscoliosis (________ lateral curve) Signs and symptoms Uneven shoulders Uneven ______ Head ______ Rib humping on one side Appearance of leaning to one side Back Pain/ muscle spasm More severe cases may experience loss of balance History of falls Low self esteem/ body image Adolescent idiopathic scoliosis Most common type of scoliosis Affects up to 4% of adolescents Onset in adolescence ___________yoa Idiopathic= Cause is __________ Curve increases during growth spurt Most common is a right adolescent idiopathic scoliosis Approximately 30% of patients have a __________ history of scoliosis Female>male 6:1 Risk increased for curve progression: Noticed/Dx before menarche/early onset Incomplete ___________ maturity (Risser sign30 yoa at birth Congenital scoliosis Caused by spinal defect (present at birth) that affects the structure of the vertebrae Vertebrae may be wedge- shaped Hemivertebrae Usually detected at an earlier age than adolescent Congenital sCOLIOSIS Congenital sCOLIOSIS `neuromuscular scoliosis Less severe curves typically not painful May notice a change in _________ as first sign Inability to walk  more severe cases (muscle atrophy) Occur secondary to neuromuscular disease: Cerebral Palsy Duchenne and Spinal Muscular Dystrophy Myelodysplasia Freidrich Ataxia Spina bifida Dx on Clinical Exam and x-ray (frequently curve is _______________) Degenerative scoliosis (>50Yoa) May be called Adult Onset or de Novo Scoliosis Patient’s ______________ Asymmetric vertebral degeneration IVD degeneration causes structural changes Most common in _________ spine Degenerative scoliosis symptoms LBP= dull ache/tightness Pain may radiate into the legs Numbness/_________ may radiate into the legs Sharp leg pain that subsides with rest Muscle fatigue As it progresses it may cause balance problems Early onset Scoliosis that is present before the age of ________ May not have any symptoms Look for signs of scoliosis Genetic origin may be different from Adolescent Idiopathic Scoliosis Sheuermann’s kyphosis Excessive _____________ Curvature of the Spine Secondary to structural spinal deformity Typically diagnosed during adolescence Symptoms usually stay consistent: Back Pain & Stiffness Muscle fatigue & Poor Posture Worsening of symptoms may occur in severe cases Treatment of scoliosis Rehabilitation is EXTREMELY IMPORTANT in the Tx of scoliosis: Stretch Concavity Balance Ball Exercises to improve balance, proprioception, NMR (neuromuscular re-education) ______________ Exercises to improve chest expansion Postural Retraining: Side Shift Exercise (significant curvature improvement long lasting) Shift torso towards concavity repeatedly while standing Maintain position while sitting Mamyama T, Kitagawal T, Takeshita K, Nakainura K. Side shift exercise for idiopathic scoliosis after skeletal maturity. Stud Health Technol Inform. 2002;91:361-4. PMID: 15457756. Treatment of scoliosis Massage Therapy & Hydrotherapy Bracing may be indicated in severe cases Osseous Mobilization/Manipulation ________________ Scoliosis responds better than structural (may still be able to decrease pain and spasm) Adam’s Test: curve __________ with forward bending Gentle Manipulation More severe cases may respond better to mobilization than manipulation (personal experience) Flexion Distraction Adjusting severely malformed vertebrae may be contraindicated HVLA is contraindicated at levels that are fused Treatment of scoliosis Bracing may be indicated in severe cases or if risk of progression is high Milwaukee brace- CTLSO (cervico-thoraco-lumbo-sacral orthosis) Boston Brace- low profile TLSO Copes Brace- dynamic TLSO brace with air filled pads to place at corrective locations within the brace