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Scoilosis
- 1. Scoliosis and itsorthotic management
- 3. Scoliosis isdefined as the lateral curvature of the spine in the frontal plane of the body which means that the vertebral column bends from side to side. This deformity which often develops in childhood can lead to structural deformity of pelvis , vertebrae and thoracic cage . 3 dimensional deformity affecting all the 3 planes Can be difficult to visualize with 2 dimensional radiographs
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- 8. According toMedtronic study , scoliosis affect 2 % of women and 0.5% of men in the general population . Now a days present scoliosis population is growing People especially women are the one who suffer from it, most of them don’t known how does it start nor they require it in fact some individuals already have scoliosis but they are not aware of it .
- 9. True causestill unknown …… Genetics Growth hormone secretions Connective tissue structure Vestibular dysfunction Melatonin secretion Platelet microstructure 100%patients have proprioception mechanism defects 27 % of cases show brain stem defects
- 10. Mild scoliosis– less than 20 degree Moderate-curves from 20 to 40 degree or 50 degree Severe –curves of 40 to 50 degree or greater
- 11. Develops betweenage 8 to 15 7 times more in females 80 % of scoliosis origin is unknown
- 12. Mid backpain Lower back pain Neck pain Headache Decrease pulmonary dysfunction
- 14. It isan irreversible lateral curvature of the spine . Vertebral bodies rotate towards the convex side of the curve . Rib hump is prominent on forward bending .
- 16. Most commonform of scoliosis right sided thoracic curves more common Three types depending on the age of onset Prevalence = 0.3 _ 15.3% Risk factors Hormonal factors (melatonin) may play a role Female gender Growth velocity
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- 18. 1-Infantile scoliosis – Onset less than 3 years . No active treatment is necessary for the non-progressive variety of infantile idiopathic scoliosis, the curves resolving spontaneously without treatment. 2-Juvenile scoliosis- Occur in 4 – 12 girls . Milwaukee brace is the orthosis of choice because it is easily adjustable for growth, and in addition, due to its open design, it does not compress the thorax with possible tubular thorax and respiratory restriction.
- 19. Adolescent -Theindications for orthotic treatment are a growing child who presents with a curve of 30 to 40 degree . The choices for orthotic treatment are the Milwaukee brace and theTLSO (Thoraco-lumbo- sacral orthosis). The first successful orthosis for the treatment of adolescent idiopathic scoliosis was the Milwaukee brace
- 20. Neuromuscular scoliosis Neuropathic •Upper and lower motor neuron Myopatheic • Muscular dystrophies
- 21. Non structuralscoliosis metabolic scoliosis Postural Secondary to nerve root
- 22. It isan reversible curve of spine Curve disappear in supine or prone position Curve disappear in forward or bending position CAUSES : Leg length discrepancy Habitual asymmetry Muscular spasm
- 23. Congenital Failure offormation Failure of segmentation Mixed
- 24. The criticaltime is the time of segmentation during first six weeks of pregnancy congenital scoliosis is divided into, Failure of formation 1- Partial failure of formation- wedged vertebrae 2 Complete failure of formation – hemi vertebrae Failure of segmentation 1- Unilateral failure of segmentation 2- Bilateral failure of segmentation
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- 27. Age andmanner in which it was noted . The perinatal history , developmental mile stones Clinical signs of progression
- 28. Rib hump Shoulder are different heights Head is not cantered directly above the pelvis Appearance of the raised prominent hip Rib cages are at different heights Uneven waist changes in look or texture of skin overlying the spine Leaning of entire body to one side Unequal Gap between the arm and trunk .
- 30. See gaitand ability to walk on toes / heels Motor and sensory testing of the lower and upper extremities Check reflexes , asymmetry or a pathologic reflex (e:g clonus ,a positive babinski s’ ,or a positive Hoffmann sign ) A asymmetric abdominal reflex is the most common neurological abnormality noted with an common neurological intracranial lesion such as syrinx ( fluid filled cyst within the spinal cord ) and spinal cord tumor
- 32. AP standingright and left bending and lateral radiographs of the entire length of the spine with an extra long x ray cassette Measure curves by cobb method The rotational deformity by a special stagnara view in which x ray is positioned parallel to the rib hump.
- 34. Choose themost tilted vertebrae above and below apex of the curve Angle between intersecting lines drawn perpendicular to the top of the superior vertebrae and bottom of the inferior vertebrae is the cobb angle .
- 37. An inclinometer( scoliometer)measures distortions. The patient bend over arms and palms pressed together until a curve can be observe in the upper back. Scoliometer is place on the back and measure the apex The patient continue on bending until the curve can be seen in the lower back The apex of the curve can be measured.
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- 40. In general,treatment with a back brace will be recommended for patients with a curve that measures 25 to 40 degrees, and a lot of growth remaining (patients who are skeletally immature). The primary goal of orthotic treatment (a back brace) for scoliosis is to stop the progression of the spinal curve. Bracing does not typically reduce the degree of the curve/amount of angulation already present.
- 41. These severaltypes of braces are use , Milwaukee brace Thoraco lumbo sacral orthosis(TLSO) Charleston night time bending brace
- 42. zero to30 degree treated with the signs of progression usually treated with stretching exercises 30 to 45 degree orthotic intervention above 45 surgical intervention
- 43. The Milwaukeebrace also called the cervical thoracolumbosacral orthosis can be used for nearly all curvatures . Thoracolumbosacral orthosis has a shell is molded to patient and corrective One paid applies pressure at the apical rib second paid over the lumbar prominence if a double curve pattern is present . If there is decompensation to the left or right side a trochanteric extension can be use . If shoulder symmetry is significant shoulder ring is applied
- 44. For isolatedlumbar curves a lumbosacral orthosis the Boston brace is use The Charleston night bending force brace is use for patients need correction only at night The underarm brace which is also known as the lumbosacral orthosis (LSO) can be used to treat lumbar scoliosis .
- 45. Milwaukee brace Low Prof Milwaukee brace for Scoliosis Madeof semi- rigid plastic and foam.
- 46. Boston brace •Provides corrective forces tothe Thoraco-lumbar spine •Incorporates abdominal pressure.
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Editor's Notes
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