HSS spring scoliosis

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HSS spring scoliosis
2013-04-28 09:54:20

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  1. how many dimensions of spine are screwy in scoliosis?
    3 - med/lat, rotation, sagital plane
  2. nonstructural deformity - 3 traits
    • flexible
    • no rotation
    • leg length discrepancy or habitual
  3. 3 traits of structural deformity
    • fixed
    • fixed rotation (rib hump/prominence)
    • adolescent idiopathic scoliosis or neuromuscular scoliosis
  4. how do you name a C curve? 2 qualities...
    • name it for the convex side (R/L)
    • and for the location of the apex of the curve (thoracic, cervical...)
  5. if there's a C curve, how will the shoulders and hips angle?
    shoulder is higher and hip is lower on convex side of C
  6. hip and shoulder angling with an S curve?
    shoulder and hip are higher on the same side
  7. in an S curve, 3 traits of the major curve?
    • it's the more severe curve
    • commonly in the T-spine
    • always has a rotational component
  8. 4 traits of the compensatory curve in an S curve
    • minor and less severe
    • it's the body's attempt to keep the head and trunk aligned vertically
    • develops in opp. dir. above and/or below major curve
    • may or may not have a rotational component
  9. what's a "double major curve?"
    • S curve where both curve are of equal severity and significance
    • both usually have rotation
  10. if there's a L thoracic curve, which way will the vertebrae and ribs rotate
    • Left - towards the convex side, in an effort to bring th body back up 
    • this creates a rib hump on the post L side
  11. which way do the SPs angle in a L thoracic curve?
    to the right
  12. 3 classifications by age of idiopathic pediatric scoliosis
    • infantile - 0-4 y/o
    • juvinile - 4-10 y/o
    • adolescent  - 10 y/o to skeletal maturity - 89% of all diagnosed idiopathic scoliosis
  13. what percent of the population gets adolescent idiopathic scoliosis (AIS)?
    • 2-3%
    • 4:1 girls to boys
  14. what angle do you have to have to get diagnosed with adolescent idiopathic scoliosi?
    radiograph showing at least 10 degrees
  15. where is AIS most common?
    • R thoracic
    • L lumbar
  16. what causes neuromuscular scoliosis?
    abnormal forces acting on the vertebrae of an individual with decreased postural control of spine -- seen in cerebral palsy and muscular dystrophy
  17. problems seen with neuromuscular scoliosis
    • hip sublux/dislocation (often comes w scoliosis - one condition triggers the other)
    • compomised pulmonary system
    • digestion - no appetite, nausea
  18. osteopathic scoliosis can result from the following bony abnormalities
    • wedge vertebra (it slants down on med or lat side)
    • hemi vert - it's just a triangular bit of vert on med or lat sid
    • unsegmented bar - in a bunch of vert the med, lat, or full bodies are connected/same piece of bone
    • fused ribs
    • or a tumor in the bone
  19. center sacral line ... what is this in radiology?
    line drawn perpendicular t the horizontal center of the sacrum (SP of S2)
  20. what's the "transitional (stable) vertebra"
    • the vert most clearly bisected by the center sacral line
    • this vert marks the transition from one curve to the next
  21. apical vertebra (apex)
    • the vertebra furthest from the midline (center sacral line) of the spine
    • it's the part of a curve that sticks out furthest
  22. Cobb angl
    formd by the intersection of the perpendicular lines drawn to the 2 most tilted vertebrae

    utilized to classify severity o curve and to monitor progression of curve

    if S curve, get 2 Cobb angles
  23. angles of mild, mod, and severe scoliosis
    • mild: <20 derees
    • mod: 20-50 w rotational deformity beginning
    • severe: >50 w signif rotational deformity
  24. purpose of having pt side-bend
    evaluates pre-op flexibility of the curve -- tells if it' structural or non-structural

    radiograph taken while pt's side-bent TOWARD convex side, and Cobb angle is measured now
  25. why might a surgeon pt not to correct a non-structural curve?
    if there's more than one curve -- not operating may decrease blood loss, preserve motion, decrease stress n remaining segments, decrease risk of non-union ... the doc might only fix the structural/fixed one, and hope the other may resolve itself
  26. Nash and Moe method of looking at scoliosis
    • looks at rotation of the vert by looking at the locations of the pedicles
    • 0=symmetrical distances from mid-line
    • 1=pedicle moving in
    • 2=moreso
    • 3=pedicle at midline
    • 4=ped crossed midline
  27. 2 traits of conservative management
    3 types of surgery
    • conservative: PT, bracing
    • surgery: posterior spinal fusion, anterior, or combo of AP
  28. symptoms to look for for scoliosis
    • asymmetry of shoulder and scap
    • pelvic obliquity
    • trunk curve
    • head off to one side
    • leg length discrepancy
    • knee recurvatum
  29. 4 types of spinal stabilization exercises
    • abdominal setting
    • Sahrmann's lower abs progression
    • physioball
    • quadruped

    and for stretching, lay the convex side on a physioball - this also increases mobility between ribs during expiration
  30. ab strengthening with the ball... some exercises?
    • supine, pass the ball from hands to feet and back
    • prone, thighs on the ball, hands on ground in a plank
  31. some scap exercises
    • use theraband for scap depression and core stabilization -- ex - seated, pull back into rows
    • slide ulnar side of forearms up and down wall
  32. principles of Scroth method
    • elongation
    • sagittal straightening
    • rotation
    • angular breathing
    • facilitation with stabilization
  33. what does Schroth require from pts?
    • it uses their cognitive, sensory-motor, and kinesiomotor training to improve a pt's scoliotic posture
    • pt must have sufficient insight into their body
  34. e-stim on convex side?
    found ineffective
  35. Negrini's "Scientific Exercise Approach to Scoliosis" (SEAS)
    • like Schroth
    • it can work
  36. when to brace?
    25-45 degree curve progressing more than 5-10 degrees in 6 mo
  37. goal of a brace?
    to prevent further curving, not to correct what's there
  38. how much do you have to wear a brace? who can wear it?
    • 23 hrs/day
    • the skeletally immature
  39. Risser sign
    • sign of skeletal immaturity
    • Graded I, II, III, IV, V
    • I - if ant portion of iliac cress is fully ossified,
    • II if more...
    • IV is almost all, 
    • V is the whole thing
  40. implications of Risser sign
    • the lower the sign the greater risk for further curve progression
    • but also the more receptive to bracing
  41. Milwaukee brace - for whom?
    • CTLSO
    • curves w apex higher than T8
  42. TLSO brace - for whom?
    curves w apex lower than T7
  43. 4 indications for surgery
    • failure of conservative managemnt
    • curves >50 degrees
    • cardiopulm complications
    • signif back pain
  44. what's fused in spinal fusion
    first and last vert of major curv w one level above and below
  45. details of post. spinal fusion (PSF)
    • most common
    • midline incision along spine
    • remove facet joints
    • fusion is achievd from bone graft from iliac crest and a bunch of tools
  46. ant spinal fusion (ASF) - used when? where's the inision? what is removed?
    • more severe curves
    • anterolat incision on convex side of curve
    • remove ligament and discs
    • bone grafts from rib are packed int disc space
  47. when would you wnat a combined ASF/PSF
    large and stiff curves
  48. post op day 1, what must pt urgently not do?
    BLT - bend, lift, twist
  49. POD 1, what activities are ok?
    • review spine precautions & brace edu
    • log rolling (to get out of bed)
    • dangling
    • incentive spirometry
    • amb as tolerated w walker
  50. POD 2-3 activities
    • progress amb distance
    • switch from walker to hand-held 150-300 ft
    • sitting, WC modifications
  51. POD 4-5 activities
    • indep tranfers via log rolling
    • indep amb w/o AD
    • indep stairs w 1 rail
    • indep w brace
    • discharge
  52. out patient PT post-op - 3 things to work on, 1 precaution
    • postural retraining
    • scap mobs, soft tissue release after incision heals
    • body mechanics

    precaution - hamstring/hip flexor stretching
  53. PT ideas both pre and post op
    • spinal stabilization
    • muscle strengthening
    • endurance
  54. how's the prospect for returning to sport after spinal fusion?
    • 60% go back at equal or higher level
    • pts are allowed to return 6-12 months post-op