1. Short Leg & Scoliosis
Laura jabczenski, msii

4. 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

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

6. 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

7. 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

8. The sidebending component is:
On the Concavity
On the convexity

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

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

11. 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

12. 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

13. 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

14. 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

16. 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.

17. 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

18. 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

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

21. 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”

25. 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

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

27. 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

28. 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