1. Scoliosis

3. Scoliosis
Scoliosis is defined as an abnormal curvature and rotation of the spine

4. Types of Scoliosis Functional scoliosis
It is a curvature due to a problem that does not involve the spine, such as having legs that are different lengths or muscle spasms caused by pain. These can cause to lean to the side, creating the appearance of scoliosis.
The curvature is flexible and will go away if the problem that causes to lean to the side goes away.
Structural scoliosis
The spine curvature is not flexible and does not go away with a change in position.
There is no evidence that functional scoliosis will lead to structural scoliosis.

5. Cont…
Idiopathic structural scoliosis (80% of children with structural scoliosis )
Structural scoliosis associated with other conditions
In about two out of every 10 cases, children with structural scoliosis also have one of these conditions:
Born with vertebrae that do not develop normally (congenital scoliosis)
An underlying problem in the brain or spinal cord, such as a cyst or a tumor.
A problem with nerves or muscles, such as cerebral palsy or muscular dystrophy.

6. Signs of scoliosis .

7. Radiology PA view Lateral view Right and left bending view
Oblique view

8. Cobb method Measuring the degree of scoliosis : -
choose the most tilted vertebrae above and below the apex of the curve.
The angle between intersecting lines drawn perpendicular to the top of the top vertebrae and the bottom of the bottom vertebrae is the Cobb angle.

9. Cobb`s method

10. Treatment Early detection of the curve
A curve that is obvious in standing position has already approached 30 – 40 degree.
The treatment depends on the age of the patient and the severity of the curve

11. Cont.. Nonsurgical treatment : Generally accepted guidelines :
Curves of less than 20 degree in skeletally immature persons are examined every 6 months
Curves less than 20 degree in skeletally mature persons require no further evaluation
Curves of more than 20 degree in skeletally immature patients should be examined every 3 – 4 months
Orthotic TX. For curve more than 25 degree
Curves more than 30 – 40 degree in skeletally mature persons do not require Tx .but they are examined radiographically for progression every 2 – 3 years

12. Orthotic Tx .
Boston Brace

13. Milwaukee Brace

14. Charleston Bending Brace

15. Surgical treatment Indication :
Curves more than 50 degree in the mature patients
Curves more than 10 degree with marked rotations
Double major curves more than 30 degree
Idiopathic scoliosis

16. Cont… Distractive techniques Halopelvic a: pre-operation
b: after anterior release and halo-pelvic traction.
c: after second stage correction
d: follow-up 6 months later.

17. Halofemoral distraction
A-B: AP radiographs before treatment showing right thoracic scoliosis measured 92°.
C:Bending films showed right thoracic scoliosis corrected to 77°.
D:The right thoracic curve correction obtained with Halo-femoral traction treatment was 40.2%.
E-F:The major curve measured 35° after posterior spinal fusion
G-H: AP and lateral radiographs at 20-month follow-up showed solid spinal fusion with a 37° right thoracic curve.

18. Kyphosis
Also called as Scheuermann's disease; Roundback; Hunchback; Postural kyphosis
Defined as increase in normal posterior convexity of the thoracic spine

19. Cont…

20. Causes Degenerative disease (such as arthritis) Developmental problems
Trauma
Other causes of kyphosis include:
Certain endocrine diseases
Connective tissue disorders
Disk degeneration
Infection (such as tuberculosis)
Muscular dystrophy
Neurofibromatosis
Paget's disease
Polio
Spina bifida
Tumors

21. Symptoms Difficulty breathing (in severe cases) Fatigue Mild back pain
Round back appearance
Tenderness and stiffness in the spine

22. Types
Knuckle : prominence of single spinous process indicating collapse of single vertebra
Angular : 2 – 3 vertebral body are collapsed
Round : several vertebrae are involved and hence gives a round appearance

23. Investigations : - Treatment : - X – ray of the thoracic spine CT scan
MRI
Treatment : -
Mild : anterior hyperextension bracing
Severe : Surgical decompression

24. Cont…

25. Complications - Decreased lung capacity Disabling back pain
Neurological symptoms including leg weakness or paralysis
Round back deformity

26. Perthes' disease
It is a condition where the top of the thigh bone (the femoral head) softens and breaks down.
It occurs in some children and causes a limp and other symptoms.
The bone gradually heals and reforms as the child grows.
The aim of treatment is to ensure that the femoral head regrows back into its normal shape so that the hip joint can function well.

27. Cont…

28. Cont…
Occurs in a part of the hip joint called the 'femoral head'. Injury to the small blood vessels which supply the femoral head with blood. So, parts of the femoral head lose their blood supply. As a result, the bone cells in the affected area die and so the bone 'softens', and can fracture or become distorted.
Over several months the blood vessels regrow, and the blood supply returns to the bone tissue. New bone tissue is laid down, and so the femoral head regrows.

29. Cont…
Femoral head forms a good spherical (rounded) shape. This helps it fit well into the hip joint socket.
If the femoral head is less rounded, hip movements may be affected and there may be more 'wear and tear' on the hip joint.

30. Symptoms Limp. gradually worse over a few weeks.
Pain in the hip and groin area (radiate to the knee or thigh ).
Stiffness and reduced range of movement of the affected hip.
The affected leg may become slightly thinner (wasted), because it is not used as much as the other leg.
Shortening of leg

31. Diagnosed Examination of the hip, X-ray (both hips ) Others test :
MRI scan,
Bone scan and
Arthrogram (an X-ray where dye is injected into the joint space).
Blood tests, or a sample of fluid from the joint (to rule out other problems such as infection ).

32. Treatment
The aim of treatment is to promote the healing process and to ensure that the femoral head remains well seated in the hip socket as it heals and regrows.
Treatment depends on the age of the child and the severity of the condition.
Treatments may include 'observation', bed rest and crutches, a plaster cast or special leg brace, or surgery.

33. Nonsurgical Treatment
Anti-inflammatory ibuprofen
Encouraged to walk with crutches and participate in physical therapy.
Bed rest in traction .
With physical therapy, the child will be shown some simple exercises to do until the final stage of healing has occurred.
- Hip abduction
- Hip rotation

34. Observation and physiotherapy
In the past, children with Perthes' disease were treated with a plaster cast, a brace, or surgery. However, it is now known that at least half of cases heal well without any treatment, particularly children aged five and under, and milder cases. Most children with Perthes' disease can be treated by physiotherapy and home exercises - these are to keep the hip joint mobile and in a good position in the hip socket.
Regular reviews to check how the femoral head is healing. Advice may include to encourage swimming (to keep the hip joint active in the full range of movements), but
Avoid heavy impact on the joint such as running or jumping.
Bed rest and/or crutches : - if symptoms are bad.

35. Plaster casts or a special brace
Considered in more severe cases or in older children.
The aim is to keep the femoral head well positioned in the hip socket (slightly pointing outwards).
Special braces (also called called 'orthotic' devices') may be advised.

36. Surgery
Help to keep the femoral head well positioned, or can improve the shape and function of the joint if it has not healed well.

37. Examination pattern Total marks = 200 Pass marks = 120
Theory = 100 marks
Practical = 100 marks
Division of practical marks :
Internal assessment marks
Viva marks
Practical : 70 marks

38. Cont… Local examination : site of injury
Division of practical marks marks
Long case marks
Short case marks
Spotting marks
Long case
Case with or without diagnosis
Short history about that case
General examination
Systemic examination :
Respiratory system examination
CVS examination
Per abdominal examination
CNS examination
Local examination : site of injury

39. Cont… Differential diagnosis Investigation Provisional diagnosis
Management
Short case
Two short case = 30 marks
Systemic examination , example ;
1 . Motor system examination
2 . Sensory system examination
3 . Respiratory system examination
4 . CVS or P / A examination or percussion of chest or auscultation of heart and lungs or vitals examination or PILCCOD examination etc.
5. Upper limbs and lower limbs ( joints : shoulder , elbow , wrist , hip , knee , ankle ) examination .