OandP 7

  1. Cervical scoliosis:
    apex of curve at or between C1 and C6
  2. CT curve:
    apex of curve at C7, C8 or T1
  3. Thoracic curve:
    • apex of curve at or between T2 and T11
    • Most common
  4. TL curve:
    apex of curve at L2, L3 or L4
  5. LS curve:
    • apex of curve at L5 or S1
    • Double curves also common
  6. Euler’s theory of elastic buckling
    • curve progression
    • ----slow plastic deformity without load
    • ----congenital
    • ----spine curve whether they cure or not
    • critical load
    • ----where the spine begins to bend and the spine commences
    • ----C/S a lot
    • curve magnitude of spine increases, ability to carry load without deformity decreases as magnitude of critical load decreases
    • ----as the curve gets bigger it cant accept as much and bends more
  7. Predictors of curve progression
    • Curve Pattern
    • ----Double curve Progress faster
    • Curve Magnitude
    • ----Larger curve, only going to get bigger
    • Age
    • ----Younger w/ dx greater chance of bigger curve bc greater chance of skeletal growth
    • Menarche Status
    • ----Increased change of curve if dx’ed before puberty
  8. Predictors of curve progression
    • (+) Risser Sign
    • ----fusion at the pelvic epiphysis
    • ----1-5
    • ----5 is fused
    • Rib Vertebral Angle Difference (RVAD)
    • ----Resolving curve
    • --------RVAD < 20’
    • --------convex ribs do not overlap vertebral body (don’t articulate with vertebral body any more)
    • ----Progressive curve
    • --------RVAD > or = 20’
    • --------convex ribs overlap vertebral body
    • Imaging
    • ----X-ray taken with orthosis donned determines pad position and overall efficiency in terms of curve reduction
    • --------Want max control at apex
    • --------Don’t lordosis at T/S
    • type and location of curve
    • quantify degree and magnitude of rotation
    • assess trunk balance/decompensation
    • determine skeletal age either Risser sign or wrist/hand bone age
  9. Pt assessment
    • Subjective history
    • ----Onset
    • ----Premorbid factores
    • ----Age
    • ----Who dx
    • ----Family hx
    • ----Have they worn orthoses in past
    • ----Pain
    • Postural Exam (in standing)
    • ----Frontal plane
    • --------Head neck position
    • --------Shoulder position (Dominant should be lower)
    • --------Muscle girth
    • ----Sagittal Plane
    • Balance
    • Scoliometer
    • ----Measures degree of rotation deformity
    • Adams Test
    • LLD
    • MMT trunk and LE
    • Abdominal reflexes
    • ----Absent or diminished might indicate intraspinal pathology
    • Integumentary check
  10. Orthotic intervention for scoliosis Indications/ Contraindications
    • Indications
    • ----Treat 3D progressive deformity or curvature of the spine
    • ----Cobb angle: measure degree of curvature
    • --------Curve < 25’
    • ------------ observe and re-eval every 6 mo including ht/wt, X-ray to measure curve progression and estimated time until skeletal maturity
    • --------Curve > 25’ or if increases > or = 5’ over 6 months
    • Contraindications
    • ----thoracic lordosis or skeletal mature curves >45’ or <25
    • ----Need surgery after skeletal maturity
  11. Factors determining orthotic prescription
    • location of apex of curve 1’ factor
    • skeletal age
    • curve magnitude
    • compliance
    • orthotic acceptance by child and parents
  12. Orthotic principles of scoliosis management
    • End point control
    • ----fixation that occurs 2’ mechanical constraint of orthosis on trunk
    • ----substantially improves spinal stability by increasing critical load
    • ----able to support without further deformation
    • Transverse loading
    • ----applied at apex of curve increases critical load
    • ----curves < 25’ application of non-translatory transverse support raises critical load from 50% to 70% of normal and could prevent further deformity
    • ----curves <15’ application of transverse support raises critical load from 20% to 30% which is not sufficient to prevent progression
    • Correction of the curve
    • ----Increase critical load beyond level provided by transverse support
    • ----Larger the initial curve, greater need to reverse magnitude to prevent curve prevention
    • ----Degree of correction dependent upon placement of pads, i.e. magnitude/direction/ duration or corrective forces
  13. Types of scoliosis
    • Idiopathic
    • Neuromuscular (paralytic)
    • Congenital
  14. Idiopathic scoliosis
    • most common
    • unknown etiology
    • most likely 2’ underlying mechanisms, one related to curve development and second related to curve progression
    • potential contributors: growth velocity, genetics, musculoskeletal irregularities, muscle strength imbalances, vestibular and CNS dysfunction, biochemical factors
    • orthotic management may be enough to prevent surgery
Card Set
OandP 7
OandP 7