This document provides an overview of scoliosis, including: - Scoliosis is an abnormal curvature of the spine in the coronal, sagittal, and axial planes. - It most commonly develops in childhood and adolescence between ages 10-15. - Scoliosis is classified as either structural or non-structural. Structural scoliosis involves bone deformities while non-structural is temporary. - Assessment methods include Cobb's angle, scoliometer, and Adam's forward bend test. Treatment may involve bracing or surgery depending on curve severity.

1. SCOLIOSIS
Presented by-Shadab saba Khan
MPT 2
Paediatric Physiotherapy Department

2. INTRODUCTION
• Scoliosis is an abnormal lateral curvature of the spine.
• It is most often diagnosed in childhood or early adolescence.
• It is triplanar deformity of spine which involves the following planes:
1. Coronal plane – LATERAL CURVATURE
2. Sagittal plane – KYPHOSIS , LORDOSIS
3. Axial plane – ROTATION

3. INCIDENCE
• The primary age of onset for scoliosis is 10-15 years old, occurring
equally among both genders.
• Females are eight times more likely to progress to a curve magnitude
that requires treatment.
• Scoliosis effect about 5 million people in India that is 0.4 % of the
population the prevalence among children is much more higher

4. STRUCTURAL
NON-
STRUCTURAL
SCOLIOSIS

5. STRUCTURAL SCOLIOSIS
• It is the most common type of scoliosis.
• This type of scoliosis affects the spine’s structure and is considered
permanent it involves a side-to-side curvature of the spine along with
rotation of spine

6. • It primarily involves bony deformity which may be
congenital or acquired may be caused by –
• Wedge vertebra
• Hemivertebra
• Failure of segmentation
• Excessive muscle weakness

7. Structural scoliosis is further divided into …
• Idiopathic
• Neuromuscular

8. IDIOPATHIC SCOLIOSIS
1. Infantile scoliosis: Infantile scoliosis develops at the age of 0–3
years and shows a prevalence of 1 %.
2. Juvenile scoliosis: Juvenile scoliosis develops at the age of 4–10
years, comprises 10–15 % of all idiopathic scoliosis in children
3. Adolescent scoliosis: Adolescent scoliosis develops at the age of
11–18 years, accounts for approximately 90 % of cases of idiopathic
scoliosis in children.

9. NEUROMUSCULAR SCOLIOSIS
• Encompasses scoliosis that is secondary to neurological or
muscular diseases.
• Includes scoliosis associated with cerebral palsy, spinal cord
trauma, muscular dystrophy, spinal muscular atrophy and spina
bifida.
• This type of scoliosis generally progresses more rapidly than
idiopathic scoliosis and often requires surgical treatment.[1]

10. NON-STRUCTURAL SCOLIOSIS
• It is also known as functional scoliosis, results from a temporary
cause and only involves a side-to-side curvature of the spine (no spinal
rotation).
• scoliosis curve would likely go away on bending forward.
• It is due to :
• Postural scoliosis
• Compensatory scoliosis

11. • Postural scoliosis is postural imbalance
• Ex : limb length discrepancy
• Pelvic inequality
• Muscle spasm
• Abnormal foot arch this causes pelvic drop of one side

12. ASSESSMENT
• Cobbs angle
• Scoliometer
• Adam’s Forward bend test

13. COBBS ANGLE
• The Cobb’s Angle is used as a standard measurement to determine
and quantify the magnitude of spinal deformity specially to
determine the progression of scoliosis

14. PROCEDURE

15. Locate the most tilted vertebra at the top of the curve and
draw a parallel line to the superior vertebral end plate
Locate the most tilted vertebra at the bottom of the curve and
draw a parallel line to the inferior vertebral end plate
Two additional lines are drawn at a 90-degree perpendicular
angle to the first lines so they intersect
The angle formed between these two intersecting lines is a cobb’s
angle

17. CLINICAL SIGNIFICANCE
Cobbs Angle
10 degrees Minimum Angulation
10-15 degrees Require regular checkups
20-40 degrees Requires a brace
40-50 degrees Requires surgery

18. SCOLIOMETER
• It is an inclinometer designed to measure trunk
asymmetry, or axial trunk rotation. It’s used at
three areas:
• Upper thoracic (T3-T4)
• Middle thoracic (T5-T12)
• Thoraco-lumbar area (T12-L1 or L2-L3)
• If the sociometer measurement is more than 7
degree it is considered as abnormal

19. ADAM’S FORWARD BEND TEST
• It can be used to make a distinction between structural scoliosis or non-
structural scoliosis of the cervical to lumbar spine
• The patient needs to bend forward, starting at the waist until the back comes
in the horizontal plane, with the feet together, arms hanging and the knees in
extension.
• The examiner stands at the back of the patient and looks along the horizontal
plane of the spine searching for abnormality of spine

20. ON OBSERVATION
• Unequal shoulder levels
• Unequal scapula levels
• Rib hump
• Lateral curvature spine
• Unequal waist angles
• Local muscular aches
• Decreasing pulmonary function

22. RECENT ADVANCE
THE EFFECTIVENESS OF TWO DIFFERENT EXERCISE
APPROACHES IN ADOLESCENT IDIOPATHIC SCOLIOSIS: A
SINGLE-BLIND, RANDOMIZED-CONTROLLED TRIAL
• Authors : Hikmet KocamanID , Nilgu¨n Bek , Mehmet Hanifi
KayaID , Buket Bu¨ yu¨kturan
• Received: November 25, 2020
• Accepted: March 16, 2021
•

23. REFERENCES
• Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic
scoliosis. J Child Orthop. 2012;7(1):3–9.
• Cynthia C Norkin joint structure and function 5th edition
• David J Magee orthopedic physical assesment 6th edition
• https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Scoliosis
• Anwer S, Alghadir A, Shaphe A, Anwar D. Effects of exercise on spinal deformities and
quality of life in patients with adolescent idiopathic scoliosis. BioMed research
international. 2015;2015.
• Hacquebord JH, Leopold SS. In brief: The Risser classification: a classic tool for the
clinician treating adolescent idiopathic scoliosis. Clin Orthop Relat Res.
2012;470(8):2335–2338.

24. • Johari J, Sharifudin MA, Ab Rahman A, Omar AS, Abdullah AT, Nor S, Lam WC,
Yusof MI. Relationship between pulmonary function and degree of spinal
deformity, location of apical vertebrae and age among adolescent idiopathic
scoliosis patients. Singapore medical journal. 2016 Jan;57(1):33.
• Balestroni G, Bertolotti G. EuroQol-5D (EQ-5D): an instrument for measuring
quality of life. Monaldi Archives for Chest Disease. 2015 Dec 1;78(3).

25. THANK YOU

26. BRACES
• BOSTON BRACE
• Wilmington Brace
• Milwaukee Brace

27. MILWAUKEE BRACE
• The Milwaukee brace, which is the
original cervico-thoracic-lumbar-
sacral orthosis (CTLSO) invented in
the 1940s.
• Due to the effectiveness and relative
convenience of today’s more
modern braces, the Milwaukee
brace is rarely used anymore

28. BOSTON BRACE
• The Boston brace is made of
plastic and shaped to fit the
patient.
• It is a thoracic-lumbar-sacral
orthosis brace, meaning it covers
all of those regions of the spine —
from armpits to hips.
• The Boston brace is practically
invisible underneath clothing and
fits snugly around the body.

29. WILMINGTON BRACE
• The Wilmington brace is similar in
design to the Boston brace except it
closes in the front and is made with a
mold of the torso