ORTHOPEDIC NURSING

SCOLIOSIS
SCOLIOSIS
• is the lateral curvature of the spine.
o Thoracic
o Lumbar
o Thoracolumbar segment.
• Rotation of the vertebrae column around its axis -
may cause rib cage deformity.
Cerebral palsy (CP) is a disorder that affects muscle tone,
2 TYPES: movement, and motor skills (the ability to move in a
• Functional scoliosis coordinated and purposeful way).
o not a fixed deformity of the vertebral column
o Result of poor posture/discrepancy in leg Categorized by the shape of the curve
lengths. 1. Structural scoliosis:
• Structural scoliosis • Spine curves from side to side
o Deformity of the vertebral bodies. • Vertebrae rotates, twisting the spine.
1. Idiopathic 2. Nonstructural scoliosis:
2. Congenital • Spine curves from side to side
3. Paralytic • No twisting of the spine

3 TYPES:
• Idiopathic scoliosis – unknown cause
o Classified into 3 groups (based on age at the time
of diagnosis)
o Infantile – before 3 y/o
o Juvenile – between 3y/o -10 y/o
o Adolescent – 10 y/o - teen years
• Congenital scoliosis – unknown cause
o Malformation of one or more vertebral bodies
Asymmetric growth

Potential nursing diagnoses

• Self-esteem disturbance
• Physical mobility disturbance
• Self-care deficit
• Body image disturbance
• Paralytic / musculoskeletal/ neuromuscular scoliosis
o Develops several months after asymmetrical TESTS
paralysis of the trunk muscles. 1. Adams Forward bending test
o Causes 2. Inclinometer (Scoliometer)measures distortions of
▪ A traumatic spine injury the torso.
▪ Neurological or muscle 3. MRI
disorders
▪ Traumatic brain injury
▪ Poliomyelitis (Polio)
▪ Cerebral palsy
“Neuromuscular” implies there is some type of
problem with the muscles that support the spine.

4. X – rays of the spine in the upright position.

o Anterior

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o posterior
o lateral

MILD SCOLIOSIS
• less than 25 degrees, not serious, exam done/3 mos.
• requires no treatment other than monitoring.
o exercise program may strengthen torso muscles
and prevent curve progression.

EXERCISES FOR MILD SCOLIOSIS

• Cobb Method. -nearly always calculates the degree

of the curve.

MODERATE SCOLIOSIS (BETWEEN 25 AND 40 DEGREES)

• Requires spinal exercises and brace.

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• Alternatively, the patient may undergo TENS.
• A brace halts progression in most patients but
doesn’t reverse established curvature.
Milwaukee brace
• Effective for 30–40-degree curves
not associated with extreme deformity
• 4–6-year program
• Wear for 23 hours –
1 hour for personal hygiene
• Wear protective shirt under brace.
• Skin care to pressure areas.
DANGEROUS CURVE (A CURVE OF 40 DEGREES OR MORE)
• requires surgery (spinal fusion, usually with
instrumentation) because a lateral curve
progresses at the rate of 1 degree/year even after
skeletal maturity.
SEVERE SCOLIOSIS (OVER 70 DEGREES).
• Severe twisting of the spine- ribs press against
the lungs, restrict breathing, and reduce oxygen
levels.
• The distortions may also cause dangerous changes
in the heart.
VERY SEVERE SCOLIOSIS (OVER 100 DEGREES).
• Both the lungs and heart can be injured.
• Are susceptible to lung infections and pneumonia.
• Increase mortality rate.
Management
1. Observation – periodic physical and radiographic
examinations to detect curve progression
⮚ Child is not skeletally mature
⮚ Curves less than 25 degrees
2. Brace Management – goal is to prevent
progression of the curve
⮚ Requires faithful compliance on the part
of the child for success.
⮚ Milwaukee brace - the brace needs to be
worn 23 hours a day, with relief during
bathing and exercise only.
MILWAUKEE BRACE
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CHÊNEAU BRACE
- is fabricated in polypropylene and has an anterior
opening with Velcro straps for fastening.
- used to obtain a three-dimensional correction of
the scoliotic deformity, with emphasis not only on
the coronal and transverse planes, but also on the
sagittal plane.

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3. Serial casting - may be used in children with

infantile scoliosis only.
Candidates are generally those whose scoliosis is
progressing.
⮚ Younger than 2 - every two months for
children
⮚ 3 y/o - every 3 months
⮚ 4 years and older - every 4 months
4. Exercise therapy – to help maintain flexibility in SURGICAL CORRECTION
the spine and prevent muscle atrophy during The goals of scoliosis surgery are threefold:
prolong bracing. • Straighten the spine as much as possible in a safe
manner.
• Balance the torso and pelvic areas
• SMaintain the correction long-term.

EXERCISES WHILE WEARING THE BRACE

SPINAL FUSION

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• Teach proper skin care.

• Instruct patient to wear a cotton shirt under
the brace to avoid rubbing.

3. Preventing postoperative complications

• Teach deep breathing exercises, explain
positioning and methods of pain control.
• Post-op. Keep patient flat and log roll only to
prevent any flexion at back.
• Neurovascular assessments and monitor vital
signs.
• Monitor for Superior mesenteric artery (SMA)
syndrome.
COUTREL-DUBOSSET INSTRUMENTATION
• uses hooks and rods in a cross-linked pattern to
realign the spine and redistribute the
biomechanical stress.

COMPRESSION

• Cause: Mechanical changes in the position of

the patient’s abdominal contents during
surgery
• Notify physician.
s/s – emesis, abdominal distention
• Monitor drainage or bleeding from incision
site.
• Maintain indwelling catheter for first couple
of days, until patient is out of bed. Monitor I
and O.
• Assist patient with ambulation slowly, when
allowed.

Promoting compliance with treatment

Family education and health maintenance

NURSING INTERVENTIONS
1. Promoting positive body image
• Encourage the child to express.
⮚ feelings and concerns about body image.
⮚ concerns about wearing a brace.
⮚ options for brace wearing (e.g., wearing
baggy clothes)
• Child to discuss scoliosis with his/her peers,
including disease process and treatment.
• Provide peer support.

2. Maintain skin integrity.

Scoliosis Awareness Philippines aims to provide
• Assess
information to people with Scoliosis and to raise
➢ skin integrity
awareness among the general public.
➢ for proper fit of brace/cast.

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COMMON UPPER EXTREMITY PROBLEMS
• Impingement syndrome CONSERVATIVE TREATMENT
• Carpal tunnel syndrome • Ice therapy
• Ganglion • Rule of icing:
• Dupuytren’s contracture o 15 minutes on, no more, no less.
o Don't put the ice directly on the skin—it'll
1. IMPINGEMENT SYNDROME cause freezer burn.
• Lesions that involve the rotator cuff of the • Sling – to immobilize the affected joint.
shoulder
• Cause:
• Repetitive overhead movement of the
arm - Acute trauma resulting in irritation.

ACROMIOPLASTY

• STAGE I – EDEMA AND HEMORRHAGE OF

SUBACROMIAL BURSA.

• STAGE II AND III- PARTIAL OR COMPLETE

ROTATOR CUFF TEAR CARPAL TUNNEL SYNDROME
• is a pinched nerve (called the Median nerve) in
SHOULDER ABDUCTION the wrist.
➢ Common - females
➢ 30-60 y/o
➢ Cause:
1. Performing repetitive
hand & wrist movements,
2. Repeatedly exposed to
• cold temperature
• vibrations
• extreme direct pressure.

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• S/S- pain, numbness, paresthesia, and weakness

of the median nerve.
• Assessment: →
➢ Phalen’s Test- hold the wrist in acute
flexion for 60 seconds.
➢ Numbness and burning in the fingers
(+)

COMMON AMONG
⮚ SECRETARY
TINEL’S SIGN
⮚ MEDICAL TRANSCRIPTIONIST
ASSESSMENT OF CARPAL TUNNEL SYNDROME
⮚ PIANIST
• Pain, numbness and tingling when percussing
lightly over the median nerve is positive for CTS.
TREATMENT
• Rest is the best treatment.
➢ Splinting of the wrist in neutral
extension for 1-2 weeks to rest the
hand.

• NSAIDs to reduce inflammation and prevent nerve

compression.
• Injection of hydrocortisone and lidocaine
(Xylocaine)
• Vitamin B6 -for normal function of nerve cells

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- well-known nutritional treatment for CTS.
• Surgery to relieve compression on the nerve. DUPUYTREN’S CONTRACTURE
A flexion deformity
SURGERY • slowly progressive contracture of the palmar
fascia which severely impairs the function of the
4th,5th, and middle finger.

Cause: Inherited autosomal dominant trait

• Most common among males,50 y/o
• Begins as a nodule in the palmar fascia→ fibrous
thickening extends to involve the skin in the distal
GANGLION palm.
• A collection of gelatinous material near the • Starts in one hand→ both hands.
tendon sheaths and joints,
• Round, firm, cystic swelling (dorsum of the wrist.)
• Common in women younger than 50 y/o
• Locally tender and may cause an aching pain.

S/S – stiffness, cramping, aching discomfort, morning

numbness in the affected finger.

Prevention: finger stretching exercises and intranodal

injections of steroid

Treatment: palmar and digital fasciotomy

• Treatment: aspiration, steroid injection, excision

• Post op. Compression dressing and immobilization
splint

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