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It may also include an abnormal rotation of the spine. There are two basic types of scoliosis: idiopathic, which is the more common and accounts for 80–85 percent of cases; and scoliosis that is caused by a disease, injury, or temporary condition. Idiopathic means that the cause of the disorder is unknown. The 15–20 percent of cases of Scoliosis that do have causes are divided into two categories, structural and nonstructural (also called functional). A child with nonstructural or functional scoliosis has a spine that is structurally normal but looks curved at the moment because of a difference in leg length or muscle spasms. It can be treated by therapy for the underlying cause. Structural scoliosis is caused by certain neuromuscular diseases, including Marfan syndrome, muscular dystrophy, and polio; or by infectious diseases or tumors on the spinal column. In adults it may be caused by osteoporosis or compression fractures. Scoliosis is an abnormal curvature of the spine from side to side and usually rotated inward or outward as well. It is best understood as a complex three-dimensional distortion of the spine’s normal pattern. The normal human spine does have an S-shaped curve when viewed from the side; that is, the twenty-five vertebrae in the human spinal column are not arranged in a straight line from the neck to the tailbone but curve inward slightly in the neck region, outward in the chest area, and inward again in the lower back. When viewed from the center of the patient’s back, however, the vertebrae should lie in a straight line. Any curvature of 10 degrees or more to the left or right is considered scoliosis.
The severity of Scoliosis varies; some children do not require treatment at all and others do well simply having their growth and any changes in the spine monitored by their doctor. Still others require treatment, most often with either specially designed braces or surgery. Adults with scoliosis are more likely than children to have deformities severe enough to cause noticeable pain and difficulties with breathing.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). • Abnormal development of the spine prior to birth. some common symptoms include: • Protruding shoulder blades or a hump near the rib cage (caused by rotation of the spine inward) • Uneven development of the back muscles • Uneven hip and shoulder levels • Uneven development of the breasts in adolescent girls • Fatigue or pain in the spine after long periods of sitting or standing • Unequal distance between the arms and the body . In adults. The symptoms of Scoliosis vary in severity from child to child. A person with a family member who has scoliosis has a 20 percent greater chance of developing scoliosis themselves.Scoliosis can occur at any age. • Injury. Although only one specific gene has been linked to scoliosis. These include polio. Marfan syndrome. • Diseases that affect connective tissue. In other cases. • Osteoporosis and other diseases that may weaken bones in older adults. Babies who are born with scoliosis are said to have congenital scoliosis. What may have started out as a slight or moderate curve in the spine may have become worse in the absence of treatment. adult scoliosis results from osteoporosis or other disorders that affect an older person’s bones and muscles. Most cases of congenital scoliosis are caused by either abnormally shaped vertebrae or fusion of the baby’s ribs. • Infectious diseases. The curvature of the spine generally worsens during growth spurts. The disorder is known to run in some families.000 children in the United States have scoliosis severe enough to require treatment. Scoliosis is most likely to affect children over the age of ten. and C-shaped curves are more common than S-shaped curves. Scoliosis may result from a condition that actually began in childhood and was not diagnosed or treated while the person was still growing. • Genetic factors. but most studies of it focus on children and adolescents. Some cases of scoliosis are the result of injuries to a baby’s spine during a difficult childbirth. however. or the skeleton. girls are twice as likely as boys to develop scoliosis. muscular dystrophy. scoliosis affects boys and girls equally. Curves that face the right side of the child’s body are more common than those that face left. which are the age groups most commonly affected. In young children. in adolescence. • Tumors on the spinal column. Nursing Care Plan Signs and Symptoms Scoliosis may have a number of different causes. there are likely to be others involved. between three and five out of every 1. or cerebral palsy. the muscles.
If properly fitted. whether the patient is likely to continue growing. has idiopathic scoliosis. Surgical . Nursing Care Plan Diagnosis Diagnosis of Scoliosis begins with a family history as well as a history of the child’s medical problems. or has a curve that is getting noticeably worse. If the patient is an adult. and has a curvature of 25 degrees or less. breathing disorders. or that it is due to an adult-onset disorder like osteoporosis. and the type or cause of the scoliosis: • Observation. Adult patients may be given a neurological examination as well as an x ray if their scoliosis is causing difficulties in bowel or bladder habits. or unusual sensations in the arms or legs. general weakness. With the knees locked. participate in a full range of school and social activities. The doctor then evaluates the spine for the appearance of straightness. and injuries that may have affected the spine. is a girl who has not yet had her first period. Surgery may be needed when the child has stopped growing. Treatment of scoliosis is based on the degree of the curvature of the patient’s spine. If the child is still growing. these are brownishwhite spots that indicate the scoliosis may be the result of a birth defect. The doctor will also examine the child’s skin for café-au-lait spots. the patient slowly bends over at the waist and tries to touch the toes. Nursing Care Plan Treatment Many children are diagnosed with mild Scoliosis as part of a school screening program and may not need special treatment. X-ray photographs can also be used to measure the improvement in the spine during treatment. A child who must wear a brace can.• Head may be tilted off-center • Tendency to walk with a rolling gait In adults. the doctor will look for evidence that the scoliosis is the result of a childhood problem that was never treated. birth defects (if any). the doctor will recommend braces. or has a curvature that is getting worse rapidly. • Bracing. If the child’s doctor thinks that he or she should be treated. braces can prevent the need for surgery in 90 percent of cases. has a curvature that is greater than 45 degrees. has idiopathic scoliosis with a curve greater than 25–30 degrees. • Surgery. the doctor will usually check the child’s growth during an office visit every four to six months. If the child has at least two years of growth left. the child will usually be referred to an orthopedic specialist. scoliosis is more likely to be associated with the development of a hump in the upper back. his or her age. The patient faces forward with feet straight ahead and palms inward against the sides of the body. and pain. however. The most common diagnostic test for Scoliosis in adults as well as children is the Adam Forward Bending Test. An x ray may be taken to allow the doctor to measure the exact degree of abnormal curvature.
improves overall well-being. and reduces the risk of osteoporosis in girls and women. exercise programs. . vitamin supplements. Although physical exercise should not be used as a treatment to correct the curvature of the spine. and electrical stimulation. These discoveries in turn may shed light on the causes of idiopathic scoliosis and possibly lead to the development of new treatments. is lowering the need for surgery as a treatment for the disorder. In general. In general.treatment of scoliosis involves fusing several vertebrae together to correct the curvature and may require inserting metal rods next to the spine to reinforce the fusion. mild cases of scoliosis treated with bracing alone do very well. Prevention Scoliosis cannot be prevented in the great majority of cases because its causes are still not fully understood. Adult patients with scoliosis are usually treated with surgery either for pain control or to relieve pressure on the heart and lungs from the deformed spine. The Future Doctors expect that the number of cases of adult-onset scoliosis will increase in the years ahead because of the growing number of people over 65 in the general population. These patients do not usually have long-term health problems except for a slightly increased risk of pain in the lower back when they get older. Other forms of treatment for Scoliosis that are not considered effective include dietary changes. the prognosis is better for smaller curves than for larger ones. healthy lives. chiropractic manipulation of the spine. Nursing Care Plan Prognosis The prognosis of Scoliosis depends on the risk that the curvature of the patient’s spine will progress (get worse). and better for patients whose bones are mature than for those whose spines are still growing. it is likely that researchers will identify other genes related to the condition. After the discovery in 2007 of the first gene linked to scoliosis. however. Regular exercise helps to keep the body fit and healthy. The prognosis of patients with scoliosis related to neuromuscular diseases like muscular dystrophy or cerebral palsy is determined by the outcome of their disease rather than by treatment for the scoliosis by itself. People with surgically corrected idiopathic scoliosis also do very well and can lead active. Earlier diagnosis and treatment of scoliosis in children. it is an important part of overall health care for children with scoliosis.
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