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