- Scheuermann's disease is a structural kyphosis of the thoracic or thoracolumbar spine of unknown etiology that typically presents during adolescence. It is characterized by vertebral wedging and a thoracic kyphosis of greater than 40 degrees.
- Treatment involves bracing or exercises during skeletal growth to prevent progression, while severe or painful cases may require anterior spinal fusion or posterior instrumentation to correct the deformity. The goal of treatment is to control the deformity and restore anterior vertebral height through hyperextension forces.
This document discusses slipped capital femoral epiphysis (SCFE), a condition where the femoral head slips posteriorly and inferiorly through the growth plate. Key points:
- It typically affects obese adolescents age 10-14 and is more common in males.
- Risk factors include obesity, hormonal issues, and genetic factors.
- Radiographs can detect the slip and grade its severity.
- Treatment involves immediate non-weight bearing, and may include screw fixation, osteotomies, or epiphysiodesis with bone grafting to prevent further slippage.
- Complications can include avascular necrosis, chondrolysis, and residual deformity/osteoarthritis if
This document discusses paralytic scoliosis, providing classifications and treatments. Paralytic scoliosis is defined as an increased lateral curvature of the spine due to paralysis of spinal muscles. It can be neuropathic or myopathic. Conservative treatment includes bracing, but surgical treatment with spinal fusion is often needed for curves over 10 degrees that are progressing. Surgical treatment aims to stabilize the paralyzed spinal segment through anterior and posterior fusion. Paralytic scoliosis in conditions like polio, cerebral palsy, arthrogryposis, and Friedreich's ataxia is also addressed.
Developmental Dysplasia of Hip final.pptxsudarshan731
This document provides information on Developmental Dysplasia of the Hip (DDH), including its definition, risk factors, diagnosis, and management approaches. DDH is a spectrum of abnormalities where the hip joint does not properly form during development before or after birth. Risk factors include breech positioning and female sex. Diagnosis involves clinical examination and imaging like ultrasound and x-rays. Management is based on age and severity, ranging from harness treatment in infants, to closed or open reduction and casting in older children, and osteotomies or salvage procedures in older children and adults. The goal is early diagnosis and treatment to reduce dislocation and prevent complications like avascular necrosis.
This document provides information on several pediatric hip conditions:
1) Developmental dysplasia of the hip (DDH) is a dysplasia or dislocation of the hip that develops in infants, and can range from shallow acetabulum to complete dislocation. It occurs in approximately 1 in 1000 live births and is more common in females.
2) Perthes disease is a disorder of the hip that affects children ages 4-8, causing the death of bone in the femoral head. It presents with limping, groin pain, and decreased range of motion.
3) Slipped capital femoral epiphysis (SCFE) is a slip of the femoral epiphysis relative to the femoral neck
This document provides an overview of scoliosis, including:
- Definitions and classifications of scoliosis types like idiopathic, congenital, neuromuscular, etc.
- Descriptions of curve patterns, measurements, and radiographic assessments.
- Clinical features and evaluations like trunk examination, scoliometer use, and Adams forward bend test.
- Etiology, progression risks, and long-term effects of different scoliosis types.
- Common curve classifications including King's type and Cobb angle measurement method.
It serves as a reference for the clinical presentation, evaluation, and management considerations for different scoliosis conditions.
1) Scoliosis is a lateral curvature of the spine greater than 10 degrees with rotation of the vertebrae in the frontal and sagittal planes.
2) It affects 2% of children at some point in life, with 10% requiring corrective surgery. Girls are more commonly affected than boys.
3) Scoliosis can be structural, involving vertebral abnormalities, or non-structural due to factors like posture or leg length discrepancy. Treatment options include observation, bracing, and surgery depending on the severity and progression of the curvature.
Developmental dysplasia of the hip (DDH) is a condition where the ball and socket joint of the hip do not develop properly. It can affect one or both hips and is more common in females. Treatment depends on the age of the patient, ranging from hip harnesses or splints for young infants to closed or open surgical reduction for older patients. Common spinal deformities discussed include scoliosis, kyphosis, lordosis, torticollis, and flat back. Scoliosis causes an abnormal lateral curvature of the spine. Treatment involves observation, bracing, or surgery depending on the severity of the curvature. Kyphosis and lordosis refer to abnormal curvatures of the thoracic and lumbar
This document discusses slipped capital femoral epiphysis (SCFE), a condition where the femoral head slips posteriorly and inferiorly through the growth plate. Key points:
- It typically affects obese adolescents age 10-14 and is more common in males.
- Risk factors include obesity, hormonal issues, and genetic factors.
- Radiographs can detect the slip and grade its severity.
- Treatment involves immediate non-weight bearing, and may include screw fixation, osteotomies, or epiphysiodesis with bone grafting to prevent further slippage.
- Complications can include avascular necrosis, chondrolysis, and residual deformity/osteoarthritis if
This document discusses paralytic scoliosis, providing classifications and treatments. Paralytic scoliosis is defined as an increased lateral curvature of the spine due to paralysis of spinal muscles. It can be neuropathic or myopathic. Conservative treatment includes bracing, but surgical treatment with spinal fusion is often needed for curves over 10 degrees that are progressing. Surgical treatment aims to stabilize the paralyzed spinal segment through anterior and posterior fusion. Paralytic scoliosis in conditions like polio, cerebral palsy, arthrogryposis, and Friedreich's ataxia is also addressed.
Developmental Dysplasia of Hip final.pptxsudarshan731
This document provides information on Developmental Dysplasia of the Hip (DDH), including its definition, risk factors, diagnosis, and management approaches. DDH is a spectrum of abnormalities where the hip joint does not properly form during development before or after birth. Risk factors include breech positioning and female sex. Diagnosis involves clinical examination and imaging like ultrasound and x-rays. Management is based on age and severity, ranging from harness treatment in infants, to closed or open reduction and casting in older children, and osteotomies or salvage procedures in older children and adults. The goal is early diagnosis and treatment to reduce dislocation and prevent complications like avascular necrosis.
This document provides information on several pediatric hip conditions:
1) Developmental dysplasia of the hip (DDH) is a dysplasia or dislocation of the hip that develops in infants, and can range from shallow acetabulum to complete dislocation. It occurs in approximately 1 in 1000 live births and is more common in females.
2) Perthes disease is a disorder of the hip that affects children ages 4-8, causing the death of bone in the femoral head. It presents with limping, groin pain, and decreased range of motion.
3) Slipped capital femoral epiphysis (SCFE) is a slip of the femoral epiphysis relative to the femoral neck
This document provides an overview of scoliosis, including:
- Definitions and classifications of scoliosis types like idiopathic, congenital, neuromuscular, etc.
- Descriptions of curve patterns, measurements, and radiographic assessments.
- Clinical features and evaluations like trunk examination, scoliometer use, and Adams forward bend test.
- Etiology, progression risks, and long-term effects of different scoliosis types.
- Common curve classifications including King's type and Cobb angle measurement method.
It serves as a reference for the clinical presentation, evaluation, and management considerations for different scoliosis conditions.
1) Scoliosis is a lateral curvature of the spine greater than 10 degrees with rotation of the vertebrae in the frontal and sagittal planes.
2) It affects 2% of children at some point in life, with 10% requiring corrective surgery. Girls are more commonly affected than boys.
3) Scoliosis can be structural, involving vertebral abnormalities, or non-structural due to factors like posture or leg length discrepancy. Treatment options include observation, bracing, and surgery depending on the severity and progression of the curvature.
Developmental dysplasia of the hip (DDH) is a condition where the ball and socket joint of the hip do not develop properly. It can affect one or both hips and is more common in females. Treatment depends on the age of the patient, ranging from hip harnesses or splints for young infants to closed or open surgical reduction for older patients. Common spinal deformities discussed include scoliosis, kyphosis, lordosis, torticollis, and flat back. Scoliosis causes an abnormal lateral curvature of the spine. Treatment involves observation, bracing, or surgery depending on the severity of the curvature. Kyphosis and lordosis refer to abnormal curvatures of the thoracic and lumbar
This document discusses spondylolisthesis, including:
- It defines spondylolisthesis as the forward slippage of one vertebra on its adjacent caudal segment.
- Several classification systems are described including the Wiltse, Newman and Macnab classification based on etiology and topography.
- Risk factors for slip progression include developmental spondylolisthesis with lysis, isthmic spondylolisthesis from repetitive loading, and increased pelvic tilt.
- Treatment involves conservative care with bracing or exercise initially. Surgical options include direct repair of pars defect, decompression with or without fusion and instrumentation depending on the grade of slippage.
This document discusses slipped capital femoral epiphysis (SCFE), a disorder where the femoral head is displaced from the femoral neck through the growth plate. It covers the etiology, risk factors, classification, signs and symptoms, investigations including x-rays, and treatment options. The main treatment approaches are conservative management with traction or surgical management with in situ pinning to stabilize the epiphysis and promote growth plate closure. The goal of treatment is to prevent further slipping and allow for functional recovery without long-term complications like osteonecrosis.
Detailed history and its evaluation , examination of spine in general and local with special tests in cervical , thoracic outlet syndrome , lumbar spine and SI joint with diagrams, neurological examination both sensory and motor.
This document discusses idiopathic scoliosis, including its definition, prevalence, genetics, etiology, presentation, evaluation, classification, treatment options including observation, bracing, and surgery, and potential complications. Idiopathic scoliosis is a lateral curvature of the spine without a clear cause, affecting 2-3% of individuals. Evaluation involves radiographs and MRI to assess curve magnitude and rule out underlying issues. Treatment depends on curve size, progression risk, and remaining growth potential, ranging from observation to bracing to surgery.
This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. Risk factors include breech presentation and family history. Diagnosis involves clinical tests like Barlow and Ortolani in newborns and ultrasound or x-ray in older infants. Treatment depends on age and includes Pavlik harness in newborns, closed or open reduction and casting in infants, and osteotomies if needed in older children. Complications can include avascular necrosis. Proper screening and treatment can prevent long term issues from untreated DDH.
Ankylosing spondylitis is a type of inflammatory arthritis associated with the HLA-B27 gene. It typically causes stiffness and fusion of the spine over time. Diagnosis involves evidence of sacroiliac joint inflammation on imaging and a positive HLA-B27 test in most cases. Treatment focuses on exercises to maintain mobility, nonsteroidal anti-inflammatory drugs, and TNF inhibitors for severe cases. Surgery may be needed to correct spinal deformities or replace affected hips in advanced ankylosing spondylitis.
1) The document discusses the anatomy and structure of the spine as well as common spinal deformities like scoliosis.
2) Scoliosis is a lateral curvature of the spine that is usually accompanied by some rotational deformity. It can be classified based on cause and location.
3) Treatment depends on the severity and progression of the curvature and may involve bracing, casting, or surgery to correct or prevent worsening of the deformity.
Case discussion of perthes disease-Dr. Siddharth Deshwal PG OrthopaedicsSIDDHARTHDESHWAL3
This document discusses the case of a child with Perthes disease. Key points include:
- Perthes disease typically affects children ages 4-10 years old and presents with limping or hip/groin pain.
- Imaging shows stages of the disease from initial involvement to reossification. Staging systems like Caterall and Salter-Thompson are used to classify the extent of epiphyseal involvement.
- Treatment aims to contain the femoral head in the acetabulum during healing to promote a spherical head shape and prevent deformity. Containment is usually only beneficial in the early revasularization stage.
A 31-year-old man presented with low back pain radiating to his lower limbs that had been ongoing for two years since a motorcycle accident. Physical examination found tenderness at L5 and positive straight leg raise, Lasegue, and bowstring tests on the right side. MRI revealed herniation of the nucleus pulposus at L3-L4 and L4-L5. The diagnosis was low back pain due to herniated discs at L3-L4 and L4-L5. Treatment of analgesics and planned discectomy was recommended.
This document provides information on orthotic management of scoliosis. It defines scoliosis as a lateral curvature of the spine greater than 10 degrees with vertebral rotation. The document describes different types of scoliosis including congenital, idiopathic, neuromuscular, and degenerative. Treatment options include observation for mild curves, bracing for curves between 25-40 degrees using devices like TLSO or Milwaukee braces, and surgery for curves over 40 degrees. Bracing aims to prevent curve progression until skeletal maturity and has been shown to successfully treat some curves.
This document discusses various spinal deformities including scoliosis, kyphosis, and lordosis. It describes the anatomy, causes, classifications, treatments, and outcomes of each condition. Infantile, juvenile, and adolescent idiopathic scoliosis are addressed. Scheuermann's kyphosis and congenital kyphosis are also summarized. Lordosis is defined and clinical features and treatments are provided.
This document discusses vertebral fractures and spinal cord injuries. It begins by describing the anatomy of the vertebral column and typical vertebrae. It then discusses different types of lumbar vertebral fractures including wedge compression fractures, burst fractures, flexion-distraction injuries, and fracture-dislocations. Emergency management of spinal injuries is outlined including immobilization techniques. Spinal cord injuries are also summarized, covering topics like pathophysiology, classifications, consequences, and specific syndromes like central cord syndrome. Acute phase conditions like spinal shock and neurogenic shock are defined.
Scoliosis is a lateral curvature of the spine. It can be classified as structural or postural based on whether the deformity is correctable. The most common type is adolescent idiopathic scoliosis, which usually presents as a right thoracic curve in females during puberty. Patient evaluation involves history, physical exam including Adams forward bend test and scoliometer, and radiographic assessment using the Cobb method. Classification systems like King's, Lenke and others characterize the curve pattern to guide treatment, which may include bracing, casting or surgery depending on the severity and progression risk.
This document provides information on slipped capital femoral epiphysis (SCFE), including:
- SCFE involves slippage of the femoral epiphysis posteriorly and inferiorly due to weakness of the growth plate.
- It most commonly affects obese adolescent boys and girls during periods of rapid growth.
- Clinical features include pain in the groin or knee and limited range of motion of the hip.
- Treatment involves closed or open reduction and internal fixation using pins or screws to stabilize the slip.
- The goals of treatment are to prevent further slippage and allow healing to occur without complications like avascular necrosis.
1. The document discusses shoulder pain and provides a differential diagnosis. It covers anatomy of the shoulder joint, muscles, nerves and bursae.
2. Common causes of shoulder pain discussed include degenerative arthritis, rotator cuff tears, shoulder instability, adhesive capsulitis, bursitis and tendonitis.
3. The differential diagnosis section covers the history, examinations, tests and investigations for various shoulder conditions. It describes conditions like rotator cuff tears, shoulder dislocations, impingement syndrome and frozen shoulder.
This document discusses cervical spine injuries and their classification, as well as treatments for cervical trauma including cervical traction and halo orthosis immobilization. It separates cervical injuries into upper cervical injuries from the skull base to C2, and sub-axial injuries from C3 to C7. It provides details on traction techniques and halo application, indicating they are effective non-surgical treatments for fractures like hangman's fractures and stable fractures. Complications of traction and halo use include failure to reduce, neurological changes, loosening, infection and nerve palsies.
This document discusses different types of scoliosis including infantile, juvenile, adolescent, and adult scoliosis. It describes the key characteristics, assessment methods including radiographic evaluation, and treatment approaches for each type. Treatment may include bracing, casting, or surgery depending on the curve magnitude, progression risk, and remaining growth potential. Juvenile idiopathic scoliosis often progresses more than adolescent scoliosis and is less responsive to bracing, so surgery is more common. Infantile scoliosis is assessed using rib-vertebral angle difference and phase, and casting is used before bracing or surgery for progressive curves.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
This document discusses spondylolisthesis, including:
- It defines spondylolisthesis as the forward slippage of one vertebra on its adjacent caudal segment.
- Several classification systems are described including the Wiltse, Newman and Macnab classification based on etiology and topography.
- Risk factors for slip progression include developmental spondylolisthesis with lysis, isthmic spondylolisthesis from repetitive loading, and increased pelvic tilt.
- Treatment involves conservative care with bracing or exercise initially. Surgical options include direct repair of pars defect, decompression with or without fusion and instrumentation depending on the grade of slippage.
This document discusses slipped capital femoral epiphysis (SCFE), a disorder where the femoral head is displaced from the femoral neck through the growth plate. It covers the etiology, risk factors, classification, signs and symptoms, investigations including x-rays, and treatment options. The main treatment approaches are conservative management with traction or surgical management with in situ pinning to stabilize the epiphysis and promote growth plate closure. The goal of treatment is to prevent further slipping and allow for functional recovery without long-term complications like osteonecrosis.
Detailed history and its evaluation , examination of spine in general and local with special tests in cervical , thoracic outlet syndrome , lumbar spine and SI joint with diagrams, neurological examination both sensory and motor.
This document discusses idiopathic scoliosis, including its definition, prevalence, genetics, etiology, presentation, evaluation, classification, treatment options including observation, bracing, and surgery, and potential complications. Idiopathic scoliosis is a lateral curvature of the spine without a clear cause, affecting 2-3% of individuals. Evaluation involves radiographs and MRI to assess curve magnitude and rule out underlying issues. Treatment depends on curve size, progression risk, and remaining growth potential, ranging from observation to bracing to surgery.
This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. Risk factors include breech presentation and family history. Diagnosis involves clinical tests like Barlow and Ortolani in newborns and ultrasound or x-ray in older infants. Treatment depends on age and includes Pavlik harness in newborns, closed or open reduction and casting in infants, and osteotomies if needed in older children. Complications can include avascular necrosis. Proper screening and treatment can prevent long term issues from untreated DDH.
Ankylosing spondylitis is a type of inflammatory arthritis associated with the HLA-B27 gene. It typically causes stiffness and fusion of the spine over time. Diagnosis involves evidence of sacroiliac joint inflammation on imaging and a positive HLA-B27 test in most cases. Treatment focuses on exercises to maintain mobility, nonsteroidal anti-inflammatory drugs, and TNF inhibitors for severe cases. Surgery may be needed to correct spinal deformities or replace affected hips in advanced ankylosing spondylitis.
1) The document discusses the anatomy and structure of the spine as well as common spinal deformities like scoliosis.
2) Scoliosis is a lateral curvature of the spine that is usually accompanied by some rotational deformity. It can be classified based on cause and location.
3) Treatment depends on the severity and progression of the curvature and may involve bracing, casting, or surgery to correct or prevent worsening of the deformity.
Case discussion of perthes disease-Dr. Siddharth Deshwal PG OrthopaedicsSIDDHARTHDESHWAL3
This document discusses the case of a child with Perthes disease. Key points include:
- Perthes disease typically affects children ages 4-10 years old and presents with limping or hip/groin pain.
- Imaging shows stages of the disease from initial involvement to reossification. Staging systems like Caterall and Salter-Thompson are used to classify the extent of epiphyseal involvement.
- Treatment aims to contain the femoral head in the acetabulum during healing to promote a spherical head shape and prevent deformity. Containment is usually only beneficial in the early revasularization stage.
A 31-year-old man presented with low back pain radiating to his lower limbs that had been ongoing for two years since a motorcycle accident. Physical examination found tenderness at L5 and positive straight leg raise, Lasegue, and bowstring tests on the right side. MRI revealed herniation of the nucleus pulposus at L3-L4 and L4-L5. The diagnosis was low back pain due to herniated discs at L3-L4 and L4-L5. Treatment of analgesics and planned discectomy was recommended.
This document provides information on orthotic management of scoliosis. It defines scoliosis as a lateral curvature of the spine greater than 10 degrees with vertebral rotation. The document describes different types of scoliosis including congenital, idiopathic, neuromuscular, and degenerative. Treatment options include observation for mild curves, bracing for curves between 25-40 degrees using devices like TLSO or Milwaukee braces, and surgery for curves over 40 degrees. Bracing aims to prevent curve progression until skeletal maturity and has been shown to successfully treat some curves.
This document discusses various spinal deformities including scoliosis, kyphosis, and lordosis. It describes the anatomy, causes, classifications, treatments, and outcomes of each condition. Infantile, juvenile, and adolescent idiopathic scoliosis are addressed. Scheuermann's kyphosis and congenital kyphosis are also summarized. Lordosis is defined and clinical features and treatments are provided.
This document discusses vertebral fractures and spinal cord injuries. It begins by describing the anatomy of the vertebral column and typical vertebrae. It then discusses different types of lumbar vertebral fractures including wedge compression fractures, burst fractures, flexion-distraction injuries, and fracture-dislocations. Emergency management of spinal injuries is outlined including immobilization techniques. Spinal cord injuries are also summarized, covering topics like pathophysiology, classifications, consequences, and specific syndromes like central cord syndrome. Acute phase conditions like spinal shock and neurogenic shock are defined.
Scoliosis is a lateral curvature of the spine. It can be classified as structural or postural based on whether the deformity is correctable. The most common type is adolescent idiopathic scoliosis, which usually presents as a right thoracic curve in females during puberty. Patient evaluation involves history, physical exam including Adams forward bend test and scoliometer, and radiographic assessment using the Cobb method. Classification systems like King's, Lenke and others characterize the curve pattern to guide treatment, which may include bracing, casting or surgery depending on the severity and progression risk.
This document provides information on slipped capital femoral epiphysis (SCFE), including:
- SCFE involves slippage of the femoral epiphysis posteriorly and inferiorly due to weakness of the growth plate.
- It most commonly affects obese adolescent boys and girls during periods of rapid growth.
- Clinical features include pain in the groin or knee and limited range of motion of the hip.
- Treatment involves closed or open reduction and internal fixation using pins or screws to stabilize the slip.
- The goals of treatment are to prevent further slippage and allow healing to occur without complications like avascular necrosis.
1. The document discusses shoulder pain and provides a differential diagnosis. It covers anatomy of the shoulder joint, muscles, nerves and bursae.
2. Common causes of shoulder pain discussed include degenerative arthritis, rotator cuff tears, shoulder instability, adhesive capsulitis, bursitis and tendonitis.
3. The differential diagnosis section covers the history, examinations, tests and investigations for various shoulder conditions. It describes conditions like rotator cuff tears, shoulder dislocations, impingement syndrome and frozen shoulder.
This document discusses cervical spine injuries and their classification, as well as treatments for cervical trauma including cervical traction and halo orthosis immobilization. It separates cervical injuries into upper cervical injuries from the skull base to C2, and sub-axial injuries from C3 to C7. It provides details on traction techniques and halo application, indicating they are effective non-surgical treatments for fractures like hangman's fractures and stable fractures. Complications of traction and halo use include failure to reduce, neurological changes, loosening, infection and nerve palsies.
This document discusses different types of scoliosis including infantile, juvenile, adolescent, and adult scoliosis. It describes the key characteristics, assessment methods including radiographic evaluation, and treatment approaches for each type. Treatment may include bracing, casting, or surgery depending on the curve magnitude, progression risk, and remaining growth potential. Juvenile idiopathic scoliosis often progresses more than adolescent scoliosis and is less responsive to bracing, so surgery is more common. Infantile scoliosis is assessed using rib-vertebral angle difference and phase, and casting is used before bracing or surgery for progressive curves.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
2. • Structural kyphosis of thoracic or thoracolumbar spine
• Unknown etiology
• Incidence: 0.4-10% of adolescent ( 10- 14 years of age)
• Onset: during prepubertal growth spurt, apparent at around 10-12
years of age
• Sex: M>/=F
3. Definition
• Normal kyphosis of thoracic spine(scoliosis research society)
– 20-45 degree( T1- T12)
• Angulation >45 degree – hyperkyphosis
• Normal lumbar lordosis :- 50-70 degree ( L1-S1)
• Normal thoraco lumbar junction : 0-10 degree
• Sagittal gravity line passes through spinous process of T1, T 12 and
sacral promontory.
4. • Characterised by
vertebral wedging
thoracic kyphosis of >40 degree
>5 degree anterior wedging of 3 consecutive adjacent vertebral
bodied at apex of kyphosis
Schmorl’s nodes
Irregualr end plate
Narrowing of vertebral disc space
Increased vertebral AP diameter at apex
5.
6. History
• Initially known as “Apprentice or muscular kyphosis”
• Holger Werfel Scheuermann (1921) described as “ Kyphosis dorsalis
juvenilis”
7. Aetiopathogeneis ( theories)
• Scheuermann vertebral epiphyseal disturbance theory
• Schorml et al – vertebral wedging caused by herniation of disc
material into vertebral body
• Ferguson et al – anterior vascular groove in v. body- structural
weakness- wedging- kyphosis
• Bradford et al – secondary to vertebral osteoporosis during juvenile
period
• Ippolito and ponseti et al :- biomechanical abnormality of collegen
and matrix od v. body end plate cartilage
8. • Frank Damborg et al : genetic theory
• Mechanical factors:
supported by bracing therapy as treatment, commonly seen in heavy
weight lifting or manual labour
9. Anatomic and histological changes
• Gross:
* thickened ALL
* narrowed vertebral disks
* wedging of vertebral bodies
10. • Histology
* abnormality of cartilaginous endplate include disorganized
endochondral ossification
• Collagen
* proteoglycan ratio in endplate matrix is low
* results in alteration in ossification of endplate causing altered
vertical growth
12. Typical scheurmann disease
• Most common
• Usually involve thoracic spine
• Involve >/= 3 consecutive vertebrae each wedged >/= 5 degree
• Producing structural kyphosis
13. Atypical scheuermann disease
• Usually located in the thoracolumbar junction or lumbar spine
• Vertebral end plate changes, disc space narrowing, anterior schmorl
nodes
• Doesnot necessarily have 3 consecutively wedged vertebrae of 5
degree
14. Clinical features
• PAIN
• DEFORMITY and its progression
• NEUROLOGIC COMPROMISE
• CARDIOPULMONARY COMPROMISE
• COSMETIC and POSTURAL PROBLEM
15. Pain
• MC complaints in adult
• Located just distal to the apex of the deformity in the paraspinal
location
• Commonly activity related pain
• Relieved immediately with rest and usually are not activity limiting
• Hyperlordosis distal to thoracic deformity and degenerative disc and
facet arthropathy predispose low back apin.
16. • Adolescent present with progressive low back pain and may interfere
with activities of daily living, pain radiating to buttocks and lower
extremities, and may awaken from sleep
18. Neurologic compromise
• Cord compression secondary to scheuermann disease is rare, may
need sx.
• Variable onset
• Ranging from acute onset of unilateral radiculopathy to insidious
onset of spastic paraplegia
• Cause is that spinal cord is draped over apex of deformity
• Can also due to extradural cysts, acute thoracic disk herniations( 4-
7%)
19. Cardiopulmonary complaints
• Extremely rare on initial presentation
• Restrictive pulmonary disease in kyphosis > 100 degree, with apex in
upper thoracic region
20. Physical examination
• Erect patient demonstrate increased thoracic kyphosis with sloping
shoulders
• Forward posturing of head and neck ( due to increased cervical
lordosis)
• increased lumbar lordosis with weakened abdominal muscles causing
mildly protuberant abdomen
• Adam’s forward bend test :-slight truncal asymmetry associated with
mild scoliosis,, side view gives “ A” frame deformity due to abrupt
angulation
21. • Deformity is not easily corrected with postural changes or passive
manipulation
• Lumbar lordosis is usually reversible, flexible and corrects with
forward bending. But cervical lordosis may become fixed.
• Neurological exam may normal
• Tight or contracted hamstring and pectoral muscles
• Arms and legs appear relatively long compared to trunk
23. 1. Standing PA view
• May show mild scoliosis that rarely > 25 degree and show minimal
vertebral rotation
• Allows assessment of skeletal maturity (RISSER SIGN- BY DEGREE OF
OSSIFICATION OF ILIAC APOPHYSIS)
24. 2. Lateral 36 inch (90cm) spine erect
• with hips and knee extended, arms resting at shoulder height on a
crossbar infront.
• Reveals thoracic kyphosis over 40 degree ( Cobb technique)
• To r/o associated conditions
• Radiographic criteria by Sorenson
1) >5o of anterior wedging of 3 consecutive vertebral bodies at apex
2) irregular vertebral apophyseal lines with flattening and wedging
3) narrowing of intervertebral spaces and variable presence of
schmorl’s nodes
26. Lumbar scheuermann’s disease
• Lateral view show decreased lumbar lordosis and possible kyphotic
deformity at thoraco lumbar junction
• Lumbar vertebrae is scalloped with lucent defects at anterosuperior
corners
• Schmorl nodes and endplate irregularity
27. MRI
• For atypical or rapidly progressive kyphosis or any neurological signs
or symptoms
• Mainly for preoperative evaluation
28. Natural history
• Untreated kyphosis may progress if deformity is severe
• Adults with mild residual kyphosis will have little, if any are not likely
to seek treatment
• Pain in adults due to degenerative spondylosis often sequel of
untreated scheuermann disease, usually resistant to non operative
treatment and not usually seen kyphosis<60o
• Pulmonary compromise if curve >100o
• Type II scheuermann almost never require sx
30. Thoracic type
• Pure thoracic:- apex at mid thoracic spine
• When kyphosis <750 , chance of progression is less without significant
pain
• When >800 continues to progress with increased pain
• Common in adolescent as well as adult
• Thoracolumbar pattern with its apex at thoracolumbar Jn has high
propensity to progress and can be significantly painful.
34. Non operative treatment
Indications
• Relative skeletal immaturity ( </= rise grade II) and a progressive
deformity that cosmetically or functionally unacceptable ( usually
>600)
Goals
• To control the deformity
• To reconstitute the anterior vertebral height by applying hyper
extension forces
36. • Apical vertebra at or above T7 : Milwaukee brace
• Apical vertebra below T7 : thorocolumbar sacral orthosis (TLSO),
usually supplemented with anterior sternal or infraclavicular
outtriggers
• With a decrease in lumbar lordosis, patient encouraged to actively
hyperextend the spine to maintain the head in a more upright
position
• Initially bracing is recommended for 18 hours a day, radiographs every
6 months.
• Brace treatment continue until skeletal maturity.
38. Cast treatment
• When passive correction on lateral bolster radiograph is <40%, brace
TX is not likely to be effective
• Need total compliance and desire of the adolescent to achieve
correction
• Risser casts applied in a serial fashion to produce more correction
• Following 6-9 month period of casting , then treated with Milwaukee
brace or other brace to maintain the correction upto skeletal maturity
39. Surgical management
Indications
• Kyphosis: >80o in T spine, >650 in T-L spine
• Symptomatic ( pain, neurologic deficit, cosmetic) of T spine > 750 or T-
L spine >600 not controlled by non operative methods
• Significant sagittal imbalance
40. Determining level of fusion
• From standing lateral radiograph
• Upper limit must include most proximal vertebra that is tilted into the
kyphosis, generally upto T2
• Caudal should include first lordotic disk space, commonly includes
one level distal to thee measured end vertebra of kyphosis
42. Anterior release and fusion
• Indication : when kyphosis is rigid on hyperextension films
• Level of anterior release:include the rigid apical based on
hyperextension films
• Technique: right sided thoracotomy / thoracoscopic
• Procedure: disc spaces exposed and curetted preserving the bony
endplate, bone graft placed at each disc space
44. posterior instrumentation alone
• skeletally immature ( risser grade III) and has some anterior growth
potential remaining and if the kyphosis is corrected to <500 on
hyperextension lateral film
• chances of loss of correction is high
45. Principle of posterior instrumentation
• Correcting maneuver used is cantilevering the rod on to spine and
segmental compression from apex to ends
• Include minimum of 8 anchors above and below the apex
• 3-5 pairs of pedicle hook- transverse process claws cephalad and
similar number of pedicle screws caudal to apex
46. Surgical technique
• LUQUE instrumentation: degmental sublaminar wiring
• Multisegmnet hook rod system
• Pedicle screw system
• Harrington rod system
• amount of correction achieved increased by osteotomizing the
facets, excising the ligamnetum flavum( PONTE OSTEOTOMY)