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Idiopathic Scoliosis in Adolescents, Clinical examination - Coggle Diagram

- - - - correctable,
        
        compensatory,
        
        sciatic,
        
        postural
    - - Idiopathic
      - Known cause
        
        congenital scoliosis,
        
        paralytic scoliosis
      - Mystifying facts
        Do you know the difference between scoliosis and spinal asymmetry?
        
        Lateral curve < 10° — is spinal asymmetry.
        
        Lateral curve > 10° — is scoliosis
    - - Postural scoliosis
        
        Structural scoliosis
        
        Idiopathic
        
        infantile,
        
        juvenile,
        
        adolescent
        
        3.Neuropathic
        
        Poliomyelitis,
        
        cerebral palsy,
        
        neurofibromatosis
        
        Myopathic
        
        muscular dystrophy,
        
        arthrogryposis
        
        Osteopathic
        
        congenital hemivertebrae,
        
        fused vertebrae
      - Types of idiopathic scoliosis
        
        Infantile
        
        more than70-90 %
        
        < 3 years
        
        Curve progressive or resolving
        
        Tx
        
        Curve less than 20°
        
        observation
        
        more than 20°
        
        2 more items...
        
        Juvenile
        
        15 %
        
        4-10 yrs
        
        thoracic curve usually to the R
        
        tx
        
        less than 20°
        
        2 more items...
        
        adolescent
        
        2-3 %
        
        10-16 yrs
        
        F:M= 3.6:1
        
        tx
        
        1 more item...
        
        table
        
        Clinical Feature
        
        observation
        palpation for
        
        shoulders and
        
        iliac crest
        
        scapulae,
        
        ribcage and
        
        flanks
        
        are observed for symmetry.
        
        The spinous processes
        
        1 more item...
        
        are inspected to determine
        whether they are at the same level
        
        ATR
        
        Rib hump or abnormal paraspinal
        muscular prominence
        
        Rib hump leads to asymmetry of the trunk and is called angle trunk rotation (ATR).
        
        it is measured by using a scoliometer.
        
        indicates spinal rotation
        
        Adam’s test
        
        The patient is then made to bend
        forward to see for the disappearance of the curve
        
        Scoliotic Facts
        
        Structural curve:
        
        This is a laterally curved spine
        
        that lacks normal flexibility
        
        Primary curve
        
        This is the earliest curve to appear.
        
        Compensatory curve or
        secondary curve
        
        2 more items...
        
        Biomechanics
        
        Lateral curvature causes rotation of the vertebral bodies
        
        The vertebral body
        
        2 more items...
- - - - Hairy patches
        
        Dimples (signs of spinal dysraphism)
        
        Nevi
      - Rib rotational deformity
        
        Adam forward bending test
        
        Forward bending sitting test
    - - Motor examination (UL and LL)
        .
        
        Reflexes
        (abnormal abdominal reflexes, clonus, Hoffman sign, Babinski sign)
        .
        
        Gait analysis
- - - - The radiological parameters of importance are
        
        Cobb’s angle
        
        Nash and Moe’s method to measure
        vertebral rotation
        
        the positions of the spinous process and the pedicles are noted.
        .
        
        Normally, the spinous process lies in the center.
        .
        
        The apical vertebrae are graded for rotation on a scale from 0-4, depending upon the pedicle shadows and the position of spinous process
        .
        
        The spinous processes are identified and classified according to the amount of rotation
        
        Reisser’s sign
        
        This is a classification of the ossification
        of the iliac epiphysis,
        .
        
        which usually starts from the anterior superior iliac spine and progresses posteriorly towards the posterior iliac spine.
        .
        
        Reisser’s stage 4 corresponds with cessation of spine growth and stage 5 correlates with cessation of height increase.
        .
        
        The importance of this sign is the completion of
        growth can be radiologically assessed which indicates no possibility of the curve progression
        
        Reisser’s classification table
        
        the upper & lower vertebrae are identified
        .
        
        The upper end vertebra is the highest one whose superior border converges towards the concavity of the curve
        .
        
        and the lower end vertebra is the one whose inferior border converges towards the concavity.
        .
        
        Intersecting perpendicular line from the superior
        surface of the superior end vertebrae and from the inferior surface of the inferior end vertebrae is drawn
        .
        
        The angle of deviation of these perpendiculars from a straight line is the
  - - - Vertebrae in structural scoliosis are displaced to the convexity of the curve;
        .
        
        When there are 3 curves, middle one is structural.
        .
        
        When there are 4 curves, 2 middle ones are structural.
        ,
        
        The greater curve or the one towards which the trunk is shifted is the structural curve.
        .
        
        The curve that is flexible and corrective is the non-structural curve.
      - secondary curves
        
        but in secondary curve, vertebrae are displaced to the concavity of the secondary curve.
    - - Nonsurgical treatment
        
        Orthotic treatment
        (Milwaukee brace, Boston brace, etc)
        
        Exercises,
        
        traction and
        
        electrical stimulation
        
        Generally accepted guidelines for observation
        
        for skeletally mature persons
        
        require no further evaluation.
        
        do not require treatment
        
        However, they are examined
        radiographically for progression
        every 2-3 years.
        
        1 more item...
        
        for skeletally immature persons
        
        are examined every 6 months
        
        should be examined every 3-4 months.
        
        2 more items...
        
        Curves of less than 20°
        
        Curves more than 20°
        
        for curves more than 25°.
        
        1 more item...
        
        Surgical treatment`
        
        The proper indications for surgery
        
        Curves > 50° in the mature patients
        
        Curves > 10° with marked rotations
        
        Double major curves > 30
        
        The most common form of surgical intervention in
        idiopathic scoliosis.
        
        is the segmental instrumentation with
        multiback system (CD)
      - Methods of scoliosis treatment