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Scoliosis

Scoliosis

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Published by sophuie

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Published by: sophuie on Aug 17, 2009
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09/25/2014

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I.Definition
Scoliosis
(fromGreek:
meaning "crooked") is a medical condition inwhich a person'sspineis curved from side to side, shaped like an "
s
or 
c
", and may alsobe rotated. To adults it can be very painful. It is an abnormal lateral curvature of thespine. On an x-ray, the spine of an individual with a typical scoliosis may look more likean "S" or a "C" than a straight line.
II.Etiology
It is typically classified as: 1.)
(caused by vertebral anomalies presentat birth), 2.)
(sub-classified as infantile, juvenile, adolescent, or adultaccording to when onset occurred), 3.)
Neuropathic
( associated with conditions suchas poliomyelitis,cerebral palsy, paralysis and neurofibromatosis), 4.)
myopathic
(rusultsfrom conditions such as muscular dystrophy and myopathies), and 5.)
osteopathic
(results from conditions such as fractures, bone diseases, arthritis and infection).
III.Epidemiology
1.
Prevalence: 2% of adolescent population2.Age
a.
Girls: After 9-10 years old
 b.
Boys: After 11-12 years old3.Gende
a.
Boys and girls affected equally
 b.
Girls are much more likely to significantly progress
IV.Anatomy and Physiology
The Spinal Column
 The spinal column consists of individual bones called
vertebrae,
thebuilding blocks, which provide support for the spine. These vertebrae areconnected in the front of the spine by
intervertebral discs
. Discs are very strongtissues, which are filled with a gel. Discs help to support the spine, and also allowit to move. Many
ligaments and muscles
attached to the back of the spine(posterior aspect)
 
provide power for movement.
Vertebrae in the Spinal Column
 
 
You may have heard your doctor using such terms as lumbar spine, or L5.These terms are easy and important to understand. The spinal column consistsof:
1.
seven 
vertebrae (C1–C7) i.e. neck
2.
twelve 
vertebrae (T1–T12) i.e. upper back
3.
five
vertebrae (L1–L5) i.e. lower back
4.
five bones (that are joined, or "fused," together in adults) to form the bony
5.
three to five bones fused together to form the 
or tailbone.To understandscoliosis,which causes the spine to curve to the left or right, you firstneed to understand what a normal spine looks like. There are four regions in your spine:
Cervical Spine:
This is your neck, which begins at the base of your skull. Itcontains 7 small bones (vertebrae), which doctors label C1 to C7 (the 'C' meanscervical). The numbers 1 to 7 indicate the level of the vertebrae. C1 is closest tothe skull, while C7 is closest to the chest.
Thoracic Spine:
Your mid-back has 12 vertebrae that are labeled T1 to T12 (the'T' means thoracic). Vertebrae in your thoracic spine connect to your ribs, makingthis part of your spine relatively stiff and stable. Your thoracic spine doesn't moveas much as the other regions of your spine, like the cervical spine.
Lumbar Spine:
In your low back, you have 5 vertebrae that are labeled L1 to L5(the 'L' means lumbar). These vertebrae are your largest and strongestvertebrae, responsible for carrying a lot of your body's weight. The lumbavertebrae are also your last "true" vertebrae; down from this region, youvertebrae are fused. In fact, L5 may even be fused with part of your sacrum.
Sacrum and Coccyx:
The sacrum has 5 vertebrae that usually fuse byadulthood to form one bone; the coccyx—most commonly known as your tailbone—has 4 (but sometimes 5) fused vertebrae.From behind, the normal spine appears straight. However, when viewed from theside, you'll see that the spine has both inward and outward curves. These curves helpour back carry our weight and are also important for flexibility.There are two types of curves in your spine:kyphosisandlordosis.You can see those from the side view.
means the spine curves inward;
means thespine curves outward. There are two kyphotic and two lordotic spinal curves in a normalspine. Your neck (cervical spine) and low back (lumbar spine) have a lordotic curve. Your mid back (thoracic spine) and pelvis (sacrum) have a kyphotic curve.
 
V. Pathophysiology:VI. Manifestation
1.
Whole body leaning to one side
2.
Uneven shoulder height
3.
One hip sticks up higher than the other (Parents often first notice possiblescoliosiswhen they see that one pant leg is shorter than the other.)
4.
Uneven rib cage
5.
Rib protrusion on one side of the spine
o
Scoliosis screening should begin at age 6 years
o
Right thoracic and left lumbar curvature is the norm
o
Landmarks
Shoulder height
Scapular prominence
Flank crease
Pelvic symmetry
o
Scoliometer (measures trunk rotation)
o
Determine growth spurt
Assessment Tools
MeasureSitting Height(Truncal Height) q3 months
ObtainRisser Grading(Iliac XRay)
o
Functional exam
o
Red Flags
Left thoracic curve (possible spinal cord lesion)
VII. Diagnostic Test
1.
The
Adam's Forward Bending Test
helps identify an unusual curve, but it can'ttell you how severe the curve is. For that, you'll need to go to a doctor. Usingdifferent tests, the doctor will be able to see and measure the curve.
2.
Plumb line test:
This is a quick visual check to see if the spine is straight. Inscoliosis, the plumb line will fall to the left or right of the spine instead of throughthe middle of the buttocks.
3.
Scoliometer:
If the doctor sees a rib hump, he or she can use a scoliometer tomeasure the size of the hump. It's a painless and non-invasive test.

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