Chapter 5 - Scoliosis and Short Leg

Question 1

At what age should children be examined for scoliosis?

Answer 1

10-15

Question 2

Steps to examine for scoliosis (3)

Answer 2

1. Examine levelness of occiput, shoulders, crests, PSIS, trochanters
2. Bend forward at waist and look for prominent rib angles
3. Screen for lumbosacral dysfunctions that may cause a short leg

Question 3

Cobb angle - how to measure (3)

Answer 3

1. Draw “horizontal” lines along the vertebral body of the extreme ends
2. Draw perpendicular lines from each of those lines
3. Measure the angle of the intersection of those lines

Question 4

Severity of scoliosis…

• Mild
• Moderate
• Severe

Answer 4

Mild = 5-15 degrees
Moderate = 20-45 degrees
Severe = 50+ degrees

Question 5

Scoliosis - when is respiratory function compromised?

Scoliosis - When is cardiovascular function compromised?

Answer 5

50 degrees

75 degrees

Question 6

Congenital cause of scoliosis

Progressive?

Answer 6

Malformation of vertebrae

Most often progressive

Question 7

Neuromuscular causes of scoliosis (4)

Answer 7

Polio, Cerebral Palsy, Duchenne’s, Meningomyelocele

Question 8

Acquired causes of scoliosis (6)

Answer 8

Tumor, infection, osteomalacia, sciatica, psoas syndrome, short leg syndrome

Question 9

Scoliosis 5-15 degrees - treatments

Goals?

Answer 9

PT, OMT, Konstancin exercises

Improve FLEXIBILIY and strengthen trunk and abdominal msuculature

Question 10

Scoliosis 20-45 degrees - additional treatment?

Answer 10

BRACE W/ SPINAL ORTHOTIC

Question 11

Scoliosis 50+% - treatment?

Answer 11

Surgery IF respiratory compromise OR progression

Question 12

Definition of short leg syndrome

Answer 12

1. Sacral base unleveling
2. Vertebral SB and R dysfunction
3. Innominate rotation dysfunction

Question 13

MC cause of anatomic short leg syndrome

Answer 13

Hip replacement

Question 14

6 compensatory findings in short leg syndrome

Answer 14

1. Sacral base unleveling (lower on short leg side)
2. Anterior innominate on short leg side
3. Posterior innominate on long leg side
4. Lumbar SB away, R toward
5. Ferguson’s angle increased 2-3 degrees
6. IL ligaments –> SI ligaments stressed on short leg side

Question 15

Short leg syndrome - treatments

When is heel lift considered?

Answer 15

1. OMT at spine and LEs to remove SDs
2. Standing X-rays to assess femoral head heights

Heel lift IF femoral head difference is > 5mm

Question 16

Heel lift - final lift height? (if chronic)

If acute/sudden?

Answer 16

1/2 - 3/4 of the measured discrepency

FULL discrepency amount

Question 17

Heel lift - fragile people?

Who are these people? (4)

Answer 17

1/16 inch (1.5mm), then increase 1/16 every 2 weeks

Elderly, arthritic, osteoporotic, acute pain

Question 18

Heel lift - flexible people?

Answer 18

1/8 inch (3.2mm), the increase 1/8 every 2 weeks

Question 19

Heel lift - maximum inside the shoe?

Answer 19

1/4 inch

Question 20

Heel lift - maximum TOTAL?

If more height is needed? Why?

Answer 20

1/2 inch

Ipsilateral anterior sole lift from heel to toe - to prevent pelvic rotation to opposite side