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Clinical Signs of Scoliosis
- Arm gap
- Shoulder asymmetry
- Prominent scapula
- Rib hump
- Pelvic obliquity
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Characterization of Scoliotic Curves
- Direction of Convexity
- Apical Vertebra (C, CT, T, TL, L) --> most laterally displaced, most horizontal, and most rotated
- Cobb Ankle
- Primary (develop earlier, usually more rigid) vs. Compensatory Curve (more flexible, develop to realign the body)
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Structural vs. Non-Structural Curve
- Structural Curve
- Has a rigid rotary component
- Won't correct w/ lateral side bending
- Non-Structural/Functional Curve
- Has no rotary component OR rotary component will correct
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Etiology
- Idiopathic: Infantile (0-3 years), Juvenile (3-10 years), and Adolescent (10 years - skeletal maturity)
- Neuromuscular: CP, Muscular Dystrophy, Spina Bifida
- Congenital: failure of formation or segmentation of vertebral column
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Location
Determined by apex of the curve
- Cervical (C1-C6)
- Cervicothoracic (C7-T1)
- Thoracic (T2-T11)
- Thoracolumbar (T12-L1)
- Lumbar (L2-L4)
- Lumbosacral (L5-S1)
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Direction
Identified by either right or left by the convexity of the deformity (most are R curves)
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Risser Sign
Looks at excursion of apophyseal plate of iliac crest from lateral to medial
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Greatest Predictors of Curve Progression
- Skeletal maturity
- Curve magnitude
- Decompensation (malalignment)
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Factors That Influence Curve Progression (increased rate of progression)
- Younger age at diagnosis
- Double curve
- Lower the Risser Sign
- Curves w/ greater magnitude
- Female
- Curves that present prior to menarche
- Thoracic curves
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Adolescent Idiopathic Scoliosis Treatment Indications
- Curve magnitude <25 degrees -- observe
- Curve magnitude 25-45 degrees -- orthotic management
- Curve magnitude >45 degrees -- surgery
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Contraindications for Orthotic Management
- Curves > 45 degrees
- At or near skeletal maturity
- Extremem thoracic hypokyphosis
- High thoracic or cervicothoracic curves
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Manage Earlier If...
- Double major curve
- Curve has shown rapid progression (5-7 degrees in 6 months)
- High thoracic curve
- Juvenile or infantile idiopathic scoliosis
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