Week 11
Scoliosis Screening Ppt
Scoliosis: one or more laterally curvatures of the spine
~85% of the cases are placed in a category known as Idiopathic scoliosis
In the remaining 1.5% of occurrence, scoliosis can be attributed to some 35 disease processes.
I.e. SPinal bifida, cerebral palsy and muscular dystrophy are fairly common causes of scoliosis
International Scoliosis Research center, Inc: 85% of all scoliosis are caused by trauma to the pelvic mechanism in the formative years from 5-10 y/o
Kyphosis: An abnormal backward protrusion of the spine
commonly called “round back” and can be caused by a variety of diseases and conditions
The cause of mos is also unknown
Some cases results from inherited vertebral deformities or muscle weakening problems
Idiopathic Scoliosis (ISP)
most commonly occurs in periods of growth spurts
1st month of life
Between 6-24 months
Between 5-8 y/o
Height peak at puberty
11-14 y/o
Rule out anomalies, neurological causes, spondylolisthiasis
Least support factor considerations:
L5 wedge
Sacral inferiority (unlevel sacral base)
Leg length inequality
Fallen arch
Spinal screenings are important part of prevention, ages 12-16 y/o
Scoliosis considerations:
must be defines by when it was initially Diagnoses
The appropriate cause for the scoliosis must b determined
The location of the scoliosis must be taken into account
ICD10 Codes:
Infanile idiopathic scoliosis= M41.00
Cervical region= M41.02
Cervicothoracic= M41.03
Thoracic= M41.04
Thoracolumbar= M41.05
Lumbar= M41.06
Lumbosacral= M41.07
Juvenile Idiopathic= M41.11
Adolescent Idiopathic= M41.12
Other causes of Scoliosis:
Congenital due to bony malformation
Other idiopathic (detected before patient reaches skeletal maturity
Neuromuscular
Evaluation: inspection & palpating
Note postural asymmetries:
Shoulder, hip, height, winging of scapula, head tilt, skin folds, pelvic sway, spinal deviations, skin changes, muscle hypertonicity and postural pattens
AROM:
Observe patient perform lateral flexion
Note if generalized restriction or normal C curve of spine
If there is a “break point” when side bending
The valu of the side bending to determine whether a curve is structural or non-structural
Flexible vs Fixed
Asymmetry is a lack of proportion or symmetry between the right and left sides of the body
Flexible asymmetry may be due to common postural variations results from a high degree of flexibility in the spine or differences in muscle development as seen in a pitcher or tennis player.
Flexible asymmetry does not persist as the patient assumes flexed positions in the screening procedure
Fixed spinal deformities manifest a persistent asymmetry that is identifiable in all positions in the screening procedure
Patients who exhibit asymmetry when in a flexed position are at risk of having a fixed deformity, ad require further evaluation
Orthopedi tests and measurements:
Adam’s test
Scoliometer measurement
Evaluate leg length inequality
Long sit test
Allis sign
Actual & apparent leg length measurement
Standing: greater trochanter to floor
Navicular drop tests
Siting and standing
Sagittal plane analysis:
The Sagittal profile.
The distance from the plumb-line is measured at the spinous processes of C7, T12, and L3 with respect to the most prominent points of the dorsal kyphosis
Imaging (full spine X-ray)
When scoliometer reading is greater than 5*
Measure Cobb angle
Observe for congenital malformation of vertebrae, unlevel sacral base
Risser’s sign
Skeletal maturity
Grades the development of iliac rest Apophyseal according to th riser sign
The iliac crest is divided into 4 quarters, and the excursion or stage or maturity is the amoun of progression
In this example, the excursion is 50% (the Risser Sign II)
Evaluate leg length inequality
Scoliosis Management:
depends of the curve
May need to co-managed or referred for surgical intervention
Risk of progression (highest to lowest)
Unilateral unsegmene bar with contralateral hemivertebrae
Unilateral unsegmented bar
Fully segmented hemivertebra
Partially segmented hemivertebra
Incarcerated hemivertebra
Unsegmented hemivertebra
Curve progression:
Rapid and relentless
Rapid
Stready
Less rapid
Slowly progressing
Little progression
3 approaches:
Observation
<20*
Bracing
20-40*
Surgery
>40*, cardiopulmonary symptoms
Conservative management:
Passive for strengthening to convex musculature (Russian Stim)
Myofascial release
Address sacral subluxation
Blocking methods
Table features if doing flexion distractions
Orthotic bracing
Exercise
Autocorrection
Scroth exercise program
Balance training
Scoliosis Screening Ppt
Scoliosis: one or more laterally curvatures of the spine
~85% of the cases are placed in a category known as Idiopathic scoliosis
In the remaining 1.5% of occurrence, scoliosis can be attributed to some 35 disease processes.
I.e. SPinal bifida, cerebral palsy and muscular dystrophy are fairly common causes of scoliosis
International Scoliosis Research center, Inc: 85% of all scoliosis are caused by trauma to the pelvic mechanism in the formative years from 5-10 y/o
Kyphosis: An abnormal backward protrusion of the spine
commonly called “round back” and can be caused by a variety of diseases and conditions
The cause of mos is also unknown
Some cases results from inherited vertebral deformities or muscle weakening problems
Idiopathic Scoliosis (ISP)
most commonly occurs in periods of growth spurts
1st month of life
Between 6-24 months
Between 5-8 y/o
Height peak at puberty
11-14 y/o
Rule out anomalies, neurological causes, spondylolisthiasis
Least support factor considerations:
L5 wedge
Sacral inferiority (unlevel sacral base)
Leg length inequality
Fallen arch
Spinal screenings are important part of prevention, ages 12-16 y/o
Scoliosis considerations:
must be defines by when it was initially Diagnoses
The appropriate cause for the scoliosis must b determined
The location of the scoliosis must be taken into account
ICD10 Codes:
Infanile idiopathic scoliosis= M41.00
Cervical region= M41.02
Cervicothoracic= M41.03
Thoracic= M41.04
Thoracolumbar= M41.05
Lumbar= M41.06
Lumbosacral= M41.07
Juvenile Idiopathic= M41.11
Adolescent Idiopathic= M41.12
Other causes of Scoliosis:
Congenital due to bony malformation
Other idiopathic (detected before patient reaches skeletal maturity
Neuromuscular
Evaluation: inspection & palpating
Note postural asymmetries:
Shoulder, hip, height, winging of scapula, head tilt, skin folds, pelvic sway, spinal deviations, skin changes, muscle hypertonicity and postural pattens
AROM:
Observe patient perform lateral flexion
Note if generalized restriction or normal C curve of spine
If there is a “break point” when side bending
The valu of the side bending to determine whether a curve is structural or non-structural
Flexible vs Fixed
Asymmetry is a lack of proportion or symmetry between the right and left sides of the body
Flexible asymmetry may be due to common postural variations results from a high degree of flexibility in the spine or differences in muscle development as seen in a pitcher or tennis player.
Flexible asymmetry does not persist as the patient assumes flexed positions in the screening procedure
Fixed spinal deformities manifest a persistent asymmetry that is identifiable in all positions in the screening procedure
Patients who exhibit asymmetry when in a flexed position are at risk of having a fixed deformity, ad require further evaluation
Orthopedi tests and measurements:
Adam’s test
Scoliometer measurement
Evaluate leg length inequality
Long sit test
Allis sign
Actual & apparent leg length measurement
Standing: greater trochanter to floor
Navicular drop tests
Siting and standing
Sagittal plane analysis:
The Sagittal profile.
The distance from the plumb-line is measured at the spinous processes of C7, T12, and L3 with respect to the most prominent points of the dorsal kyphosis
Imaging (full spine X-ray)
When scoliometer reading is greater than 5*
Measure Cobb angle
Observe for congenital malformation of vertebrae, unlevel sacral base
Risser’s sign
Skeletal maturity
Grades the development of iliac rest Apophyseal according to th riser sign
The iliac crest is divided into 4 quarters, and the excursion or stage or maturity is the amoun of progression
In this example, the excursion is 50% (the Risser Sign II)
Evaluate leg length inequality
Scoliosis Management:
depends of the curve
May need to co-managed or referred for surgical intervention
Risk of progression (highest to lowest)
Unilateral unsegmene bar with contralateral hemivertebrae
Unilateral unsegmented bar
Fully segmented hemivertebra
Partially segmented hemivertebra
Incarcerated hemivertebra
Unsegmented hemivertebra
Curve progression:
Rapid and relentless
Rapid
Stready
Less rapid
Slowly progressing
Little progression
3 approaches:
Observation
<20*
Bracing
20-40*
Surgery
>40*, cardiopulmonary symptoms
Conservative management:
Passive for strengthening to convex musculature (Russian Stim)
Myofascial release
Address sacral subluxation
Blocking methods
Table features if doing flexion distractions
Orthotic bracing
Exercise
Autocorrection
Scroth exercise program
Balance training