SCOLIOSIS Presentation, assessment, types and Treatment, Management

CONTENTS :-
 Introduction
 Definition
 Epidemiology
 Anatomy
 Classification
 Pathology
 Diagnosis
 Examination
 Treatment
 Sign & Symptoms
 Risk Factors
 Aims
 Physiotherapist Management

Introduction of SCOLIOSIS
 Scoliosis is the sideways curvature of the spine.
 Scoliosis is a side-to-side curve of your spine.
 A person with scoliosis will have a
sideways C or S-shaped curve in
their spine.
 Scoliosis is an abnormal lateral
curvature of the spine.

DEFINATION
 Scoliosis is defined by the Cobb's angle of spine curvature.
 It is most often diagnosed in early childhood or adolescence.
 When viewed from the side
there will normally be a slight
round back (kyphosis) in the
upper back and a mild
swayback (lordosis) in the lower
back.

 It is triplanar deformity of spine which involves the
following planes:
1. Coronal Plane – Lateral Curvature
2. Sagittal Plane – Kyphosis , Lordosis
3. Axial Plane – Rotation
 The primary age of onset for scoliosis is 10-15 years old,
occurring equally among both genders.
 Females are eight times more likely to progress to a
curve magnitude that requires treatment.
 Scoliosis effect about 5 million people in India that is 0.4
% of the population the prevalence among children is
much more higher.
Epidemiology

Clinically Relevant Anatomy
 The vertebral column normally
consists of 24 separate bony
vertebrae, together with 5 fused
vertebrae that form the sacrum, and
usually, 4 fused vertebrae that form
the coccyx
 7 cervical vertebrae
 12 thoracic vertebrae
 5 lumbar vertebrae.

CLASSIFICATION
 It is of two types:
1. Non-structural (temporary)
2. Structural (permanent)
A. Non-structural scoliosis: This is a mobile or transient
scoliosis.
It has three subtypes, as discussed below:
I. Postural scoliosis: It is the commonest overall type, often
seen in adolescent girls.
II. Compensatory scoliosis: In this type, the scoliosis is
compensate for the tilt of the pelvis (e.g., in a hip disease
or for a short leg).
III. Sciatic scoliosis: This is as a result of unilateral painful
spasm of the paraspinal muscles, as may occur in a case
of prolapsed intervertebral disc.

B. Structural scoliosis: It is a scoliosis with a
component of permanent deformity.
The following are the different subtypes:
1. Idiopathic Scoliosis: It is the commonest type of
structural scoliosis.
• “Idiopathic” means the cause is unknown.
• Research does indicate that it runs in families and
has a genetic (hereditary) link.
 Infantile scoliosis: Age 0-3 years.
 Juvenile scoliosis: Age 4-10 years.
 Adolescent scoliosis: Age 11-18 years.
 Adult idiopathic scoliosis: Diagnosed any time after
age 18 when skeletal growth is complete.

2. Congenital scoliosis: This is a rare spine abnormality.
 It occurs when vertebrae (the bones that make up your
spine) don’t form as they should during embryonic
development.
3. Neuromuscular scoliosis: This type of scoliosis
generally progresses more rapidly than idiopathic
scoliosis and often requires surgical treatment.
• Abnormalities in the muscles and nerves.
• It usually happens alongside neurological (nerve) or
muscular conditions like an
• Injury
• Cerebral Palsy
• Spina Bifida
• Muscular Dystrophy

PATHOLOGY
 The main pathology is lateral curvature of a part of the spine. This is
called the primary curve.
 The spine above or below the primary curve undergoes compensatory
curvature in the opposite direction.
These are called the compensatory
or secondary curves.
 The lateral curvature is associated
with rotation of the vertebrae.
 In curves of the thoracic spine,
rotation of the vertebrae leads to
prominence of the rib cage on the
convex side, giving rise to a rib hump.

 Scoliosis is usually confirmed through a
• Physical Examination
• X-ray
• Spinal Radiograph
• CT Scan
• MRI
DIAGNOSIS

Examination
 Adam’s Forward bend test
 Cobbs angle
 Scoliometer
1. The Adam forward bend test can be used to make a
distinction between structural scoliosis or non-structural
scoliosis of the cervical to lumbar spine.
Procedure:
• The test can be performed in the standing and sitting position.
• The patient needs to bend forward, starting at the waist until the back comes in
the horizontal plane, with the feet together, arms hanging and the knees in
extension.
• The examiner stands at the back of the patient and looks along the horizontal
plane of the spine searching for abnormality of spine.

2. The Cobb angle: is a standard measurement to
determine and quantify the magnitude of spinal
deformity specially to determine the progression of
scoliosis.
Procedure:
• Locate the most tilted vertebra at the top of the curve and
draw a parallel line to the superior vertebral end plate.
• Locate the most tilted vertebra at the bottom of the curve and
draw a parallel line to the inferior vertebral end plate.
• Two additional lines are drawn at a 90-degree perpendicular
angle to the first lines so they intersect.
• The angle formed between these two intersecting lines is a
cobb’s angle.

3.. The scoliometer is an inclinometer designed to
measure trunk asymmetry, or axial trunk rotation.
It’s used at three areas:
 Upper thoracic (T3-T4)
 Middle thoracic (T5-T12)
 Thoraco-lumbar area (T12-L1 or L2-L3)
 If the measurement is equal to 0°, there is a symmetry at the
particular level of the trunk.
 An asymmetry at the particular level of the trunk is found, if the
scoliometer measurement is equal to any other value.
 If the sociometer measurement is
more than 7 degree it is considered
as abnormal.

TREATMENT
 Scoliosis treatments vary, depending on the size of the
curve.
 Children who have very mild curves usually don't need
any treatment at all, although they may need regular
checkups to see if the curve is worsening as they grow.
 Bracing or surgery may be needed if the spinal curve is
moderate or large.
 Factors to be considered include:
• Maturity. If a child's bones have stopped growing, the risk of curve
progression is low. That also means that braces have the most effect
in children whose bones are still growing. Bone maturity can be
checked with hand X-rays.
• Size of curve. Larger curves are more likely to worsen with time.
• Gender: Girls have a much higher risk of progression than do boys.

Braces
 A brace may be recommended by the doctor for children
with moderate scoliosis whose bones are still growing.
 Although wearing a brace won't cure scoliosis or reverse
the curvature.
 it will typically stop the curve from getting worse.
 Brace is shaped to fit the body and is composed of
plastic.
 This brace goes under the arms, around the rib
cage,
lower back, and hips, and it is nearly undetectable
under
clothing. Eg Milwaukee brace.

SCOLIOSIS Presentation, assessment, types and Treatment, Management

Surgical Treatment
 Severe scoliosis typically progresses with time
 A specialist may suggest scoliosis surgery to reduce the severity of the
spinal curve and prevent it from getting worse.
 The most common type of scoliosis surgery is spinal fusion.
 In spinal fusion two or more of the vertebrae are fused together, so they
can't move independently.
 Pieces of bone or a bone-like material are placed between the vertebrae.
 Metal rods, hooks, screws, or wires typically hold that part of the spine
straight and still while the old and new bone material fuses together.
 If the scoliosis is progressing rapidly at a young age, surgeons can install
a rod that can adjust in length as the child grows.
 This growing rod is attached to the top and bottom sections of the spinal
curvature and is usually lengthened every six months.
 Complications of spinal surgery may include bleeding, infection, pain, or
nerve damage.
 Rarely, the bone fails to heal and another surgery may be needed.

Signs & Symptoms
Signs & Symptoms of scoliosis may include:
 Uneven shoulders.
 Shoulder blades that stick out.
 Head that doesn’t center above your pelvis.
 Uneven waist.
 Elevated hips.
 Constant leaning to one side.
 Uneven leg length.
 Back pain
 Leg pain, numbness or weakness.
 Core muscle weakness.
 Difficulty standing upright.
Over time, you may notice:
 Height loss.
 Uneven alignment of your pelvis and hips.
 One side of the rib cage jutting forward.

Risk factors
 The risk factors for scoliosis include:
 Age: Signs and symptoms often start during a growth spurt just
before puberty.
 Gender: Females have a higher risk of scoliosis than males.
 Genetics: People with scoliosis often have a close relative with
the condition.
Complications Of Scoliosis
 Without treatment, severe cases of scoliosis can lead to:
 Long-lasting pain.
 Physical deformity.
 Organ damage.
 Nerve damage
 Arthritis
 Spinal fluid leakage
 Difficulty breathing.

Aims
The aims of physical therapy are:
 Autocorrection 3D
 Coordination
 Equilibrium
 Ergonomical corrections
 Muscular endurance/ strength
 Neuromotor control of the spine
 Increase of ROM
 Respiratory capacity/ education
 Side-shift
 Stabilization

Physical Therapy Management
To manage scoliosis work in three planes: the sagittal, frontal and
transverse.[15]
Conservative therapy consists of:
• physical exercises
• bracing
• manipulation
• electrical stimulation
• Insoles
The physical therapist has three important tasks:
• Inform,
• Advise
• Instruct
 Important to do the correct exercises
 Inform the patient &/or parents about his/her situation.

SCOLIOSIS Presentation, assessment, types and Treatment, Management

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