Scoliosis: Examination and Management

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  1. Clinical Signs of Scoliosis
    • Arm gap
    • Shoulder asymmetry
    • Prominent scapula
    • Rib hump
    • Pelvic obliquity
  2. 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)
  3. 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
  4. 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
  5. 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)
  6. Direction
    Identified by either right or left by the convexity of the deformity (most are R curves)
  7. Risser Sign
    Looks at excursion of apophyseal plate of iliac crest from lateral to medial
  8. Greatest Predictors of Curve Progression
    • Skeletal maturity¬†
    • Curve magnitude
    • Decompensation (malalignment)
  9. 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
  10. Adolescent Idiopathic Scoliosis Treatment Indications
    • Curve magnitude <25 degrees -- observe
    • Curve magnitude 25-45 degrees -- orthotic management
    • Curve magnitude >45 degrees -- surgery
  11. Contraindications for Orthotic Management
    • Curves > 45 degrees
    • At or near skeletal maturity
    • Extremem thoracic hypokyphosis
    • High thoracic or cervicothoracic curves
  12. 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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Scoliosis: Examination and Management
2014-02-18 03:52:30
Scoliosis Examination Management
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