Short Leg & Scoliosis Laura jabczenski, msii

Scoliosis – overview -A rotary deformation of the spinal vertebrae resulting in a sideways curve. -Sideways curves in the spine cause a “S” or “C” shape in the spine -Girlls are more affected than boys, 4:1 Girls with scoliosis are more than likely to progress and have symptoms

What is the number one cause of scoliosis? Congenital Anomaly Idiopathic Cerebral Palsy Trauma Somatic Dysfunction

Etiology of Scoliosis 1. Idiopathic (70-90% of cases) 2. Congenital Anomaly: abnormal shaped vertebrae at birth Hemi and wedge shaped 3. Neuromuscular syndromes: Cerebral Palsy Duchenne’s muscular dystrophy Polio 4. Acquired: CNS tumor, infection inflammation, irradiation Trauma, fracture, hip prosthesis Metabolic: osteolamalacia, Rickets SOMATIC DYSFUNCTION

The curve is identified and named for: Concavity, this is the way the vertebrae are rotated Concavity, this is the way the vertebrae are sidebent Convexity, this is the way the vertebrae are rotated Convexity this is the way the vertebrae are sidebent

The sidebending component is: On the Concavity On the convexity

Dextroscoliosis is: Rotated Right, concave right Rotated Left, concave right Rotated right, convex right Rotated left, convex right

Levoscoliosis is: Rotated Right, concave Right Rotated Left, concave left Rotated right, convex left Rotated left, convex left

How will levoscoliosis of the lumbar region affect postural imbalance? Pelvic side shift test shifts easier to the left leg Right leg shorter Pelvic side shift test shifts easier to the right leg Forward bend test humping on the low lumbar right

Pelvic side shift test: - physician induces lateral translation (in a coronal plane) to the standing patient's pelvis -will shift easier (free) to the long leg side If pt has levoscoliosis of the lumbar region, then: Left leg is short Right leg is long Paravertebral humping will appear on the side of the convexity (and side of rotation) Test will be positive on the right side

Scoliosis due to muscular dystrophy A 32 y/o Female with hx of scoliosis comes in complaining of SOB. Physical exam shows respiratory compromise without cardiovascular compromise. What scoliotic curve typically results in these findings? Scoliosis due to muscular dystrophy A spinal curve with a Cobb angle of 57 degrees A spinal curve with a Cobb angle of 27 degrees A spinal curve with a cobb angle of 80 degrees

Which is an incorrect determination of skeletal maturity Risser 1: 25% iliac apophysis ossification Risser 2: seen immediately after growth spurt Risser 4: 100% ossification Risser 5: iliac apophysis fuses to iliac crest

Where do viscerosomatic reflexes occur? At crossover points At the apex of the curve At the top of the curve At the bottom of the curve Crossover point: the conjuncture of two curves, where sidebending mechanics change.

Measurement of which of the following is the most reliable method of diagnosing short leg syndrome? Medial malleoli supine Shoulder levels standing PSIS seated PSIS standing Greater trochanters standing

Which of the following is a common short LEFT leg syndrome pattern? Concavity of lumbar spine on short side Anterior rotation of innominate on long leg side Sacral sidebending towards short side Torsion towards short side Rotation away from long side

A heel lift should be started only if sacral base unleveling (SBU) is: > 2 mm > 10 mm 1/16 inch > 4 mm

A 75 y/o F with hx of osteoporosis comes in C/O acute LBP A 75 y/o F with hx of osteoporosis comes in C/O acute LBP. After PE, you notice she has a short Right leg. What size heel lift do you prescribe? 1/8” 1/16” ½” ¼”

An 18 y/o F with a Type I dextroscoliosis presents to the OMM clinic for treatment. How do you do ME on this patient? Pt seated, Dr standing to patients L, monitors at the top of the curve, SB R, Rot L Pt seated, Dr standing to pt’s R, monitors at the apex of the curve, SB R, Rot L Pt seated, Dr standing to pt’s L, monitors at the apex, Flex, SB L, Rot R Pt seated, Dr standing to pt’s R, monitors at the apex, SB R, Rot R

In Lumbar on side, Pt lies dysfunction side _______ and the applied force is an increase in ___________ Up; rotation Up; SB Down; Rotation Down; SB

Pt has a TP when pressure is applied 3 cm lateral to the PSIS Pt has a TP when pressure is applied 3 cm lateral to the PSIS. Which TP did you find? Piriformis Iliopsoas Upper Pole L5 Glut Med

How would you treat a Superior Sacroiliac TP? Pt supine, hip is flexed, Abducted, Ext Rot Pt prone; Dr. on opposite side of TP; Hip Extended, adducted; internal/external rot for fine tuning Pt prone, physician on side of TP, supports pts extended thigh on his/her knee on the table; pt’s hip is moderately extended and slightly abducted Pt prone, affected leg dropped off the edge of the table, hip flexed to 90 degrees, slight adduction and internal rotation