Title: Bone Wizardry / OMM Mastery / 5.Scoliosis and short leg syndrome
Tags: #BW_OMM::Content::Diagnosis #BW_OMM::Region::Lumbar #BW_OMM::Type::Cloze BoneWizardry bonewizardry-free omm omt #Scoliosis #ShortLegSyndrome #CobbAngle #Measuring #HeelLift #Treatment
On every note of this deck, unless a note says otherwise:
Review Links: - Bone Wizardry scoliosis
- Practice: Scoliosis QBank
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- AAFP adolescent idiopathic scoliosis
- AAFP scoliosis diagnosis and management
- AAFP acute low back pain

Q: [...]: an appreciable lateral deviation of the vertebral column from its normal straight vertical alignment.
A: Scoliosis
Q: 5% of school-age children develop scoliosis by age [...]
A: 15
Q: Curve that is sidebent left = scoliosis to the right = [...]
A: dextroscoliosis
Q: Curve that is sidebent [...] = scoliosis to the [...] = dextroscoliosis
A: left; right
Q: Curve that is sidebent right = scoliosis to the left = [...]
A: levoscoliosis
Q: Curve that is sidebent [...] = scoliosis to the [...] = levoscoliosis
A: right; left
Comment: Due to Fryette's laws, any sidebending of the spine will automatically induce rotation
Comment 2: However, only 10 % of those children have clinical symptoms related to their scoliotic curvatures.
Comment 3: The arrow points to the right in Dextroscoliosis
Comment 5: The arrow points to the left in Levoscoliosis
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: The curve name follows the direction of the convexity, not the sidebend. Sidebent left means the spine bows right, which is dextroscoliosis. Only about 10% of the 5% who screen positive develop actual symptoms.

Q: A Structural Curve is a spinal curve that is relatively [...] and [...], unresponsive to positional corrections.
A: fixed; inflexible
Q: A [...] is a spinal curve that is relatively fixed and inflexible, unresponsive to positional corrections.
A: Structural Curve
Q: A structural curve will not correct with sidebending in the [...] direction.
A: opposite
Q: A [...] is a spinal curve that is flexible and can be partially or fully corrected by sidebending to the opposite side.
A: functional curve
Q: A functional curve is a spinal curve that is [...] and can be partially or fully [...] by sidebending to the opposite side.
A: flexible; corrected
Comment: It is associated with vertebral wedging and shortened ligaments and muscles on the concave side of the curve.
Comment 4: An uncorrected functional curve may eventually progress into a structural
curve.
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: Structural curves are stuck; functional ones still respond to sidebending. An untreated functional curve can eventually become structural as soft tissue adaptations become permanent.

Q: It is generally recommended that children ages [...] years old be examined for scoliosis.
A: 10-15
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: Scoliosis screening targets ages 10-15 because that is the peak skeletal growth window. Idiopathic curves progress fastest during rapid growth. Catching a functional curve early gives the best window for conservative treatment.

Q: When measuring scoliotic curves, measure with [...] using the Cobb method.
A: x-ray
Q: Cobb method:
1. Draw [...] lines from the vertebral bodies of the extreme ends of the curve.
2. Draw perpendicular lines from these [...] lines and measure the acute (Cobb) angle.
A: horizontal; horizontal
Q: Cobb method:
1. Draw horizontal lines from the vertebral bodies of the extreme ends of the curve.
2. Draw [...] lines from these horizontal lines and measure the acute (Cobb) angle.
A: perpendicular
Q: When measuring scoliotic curves, measure with x-ray using the [...] method.
A: Cobb
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: Cobb angle is measured on X-ray using perpendicular lines dropped from the end vertebrae of the scoliotic curve. X-ray measurement is required for grading; clinical observation alone is not sufficient.

Q: Mild scoliosis has a Cobb angle of [...]
A: 5°-15°
Q: [...] scoliosis has a Cobb angle of 5°-15°
A: Mild
Q: Moderate scoliosis has a Cobb angle of [...]
A: 20° - 45°
Q: [...] scoliosis has a Cobb angle of 20° - 45°
A: Moderate
Q: Severe scoliosis has a Cobb angle of [...]
A: >50°
Q: [...] scoliosis has a Cobb angle of >50°
A: Severe
Q: Respiratory function is compromised if the thoracic curvature is [...]
A: >50°
Q: Cardiovascular function is compromised if the thoracic curvature is [...]
A: >75°
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: Cobb angle sets the treatment tier. Mild (5 to 15 degrees): PT and OMT. Moderate (20 to 45 degrees): add bracing. Severe curves past 50 degrees put respiratory function at risk; past 75 degrees cardiovascular function becomes involved. Those two organ thresholds are the exam payoff on this card.

Q: Most common cause of scoliosis: [...]
A: idiopathic
Name some neuromuscular causes of scoliosis:
1. Poliomyelitis
2. Cerebral palsy
3. Duchenne's muscular dystrophy
4. Meningomyelocele
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: Idiopathic is the default when no other cause is given. When the stem names a neurological disease, pivot to neuromuscular: cerebral palsy, poliomyelitis, Duchenne muscular dystrophy, meningomyelocele. Know both lists.

Q: Treatment of mild scoliosis: [...] and/or [...]
A: Physical therapy; OMT
Q: [...] exercises are a specific exercise series developed to address scoliotic postural decompensation.
A: Konstancin
Q: Konstancin exercises are a specific exercise series developed to address [...] postural decompensation.
A: scoliotic
Q: Treatment of moderate scoliosis: In addition to conservative management, [...] with a spinal [...] is often indicated.
A: bracing; orthotic
Q: Treatment of [...] scoliosis: In addition to conservative management, bracing with a spinal orthotic is often indicated.
A: moderate
Q: Treatment of severe scoliosis: [...] is indicated if there is respiratory compromise or if the scoliotic curve progresses quickly despite conservative management.
A: Surgery
Q: Treatment of [...] scoliosis: Surgery is indicated if there is respiratory compromise or if the scoliotic curve progresses quickly despite conservative management.
A: severe
Q: Treatment of severe scoliosis: Surgery is indicated if there is [...] compromise or if the scoliotic curve progresses quickly despite conservative management.
A: respiratory
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: Mild: PT and OMT, including Konstancin exercises. Moderate: add bracing with a spinal orthotic. Severe: surgery if respiratory compromise develops or the curve progresses quickly despite conservative management. Each tier adds to the prior treatment, it does not replace it.

Short leg syndrome may present with:
1. Sacral base unleveling
2. Vertebral sidebending and rotation
3. Innominate rotation
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: Short leg syndrome produces three findings in sequence: sacral base unleveling, vertebral sidebending and rotation, and innominate rotation. Board items test which combination appears with a short leg - all three can be present at once.

Q: Most common cause of hip replacement is [...]
A: short leg syndrome
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: Short leg syndrome is the most common cause of hip replacement. When a board stem gives unilateral hip degeneration requiring replacement and no traumatic cause, short leg syndrome is the structural diagnosis to name.

Q: Obtain standing [...] x-rays to quantify differences in the heights of the femoral head.
A: postural
Q: Obtain standing postural x-rays to quantify differences in the heights of the femoral head. If femoral head difference is [...] then consider a heel lift.
A: > 5mm
Comment: If femoral head difference is > 5mm then consider a heel lift.
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: Standing postural x-rays reveal the true femoral head height difference because weight-bearing loads the pelvis. If that difference exceeds 5mm, a heel lift is indicated. The 5mm cutoff is the clinical decision point this card is drilling.

Q: Heel lift guidelines:
The heel lift should be applied to the [...] of the short leg
A: side
Q: Heel lift guidelines:
The final lift height should be [...] - [...] of the measured leg length discrepancy
A: 1/2; 3/4
Q: The "fragile" patient should begin with a [...] heel lift and increase [...] every two weeks.
A: 1/16"; 1/16"
Q: The "fragile" patient should begin with a 1/16" heel lift and increase 1/16" every [...] weeks.
A: two
Q: The "flexible" patient should begin with [...] heel lift and increase [...] every two weeks.
A: 1/8"; 1/8"
Q: A maximum of [...] may be applied to the inside of the shoe. If > [...] is needed then this must be applied to the outside of the shoe.
A: 1/4"; 1/4"
Q: A maximum of 1/4" may be applied to the inside of the shoe. If > 1/4" is needed then this must be applied to the [...] of the shoe.
A: outside
Q: Maximum heel lift possible = [...]
A: 1/2"
Comment: There is some debate on this though.
Comment 2: Unless there was a recent sudden cause of the discrepancy (i.e. hip fracture or hip prosthesis).
Comment 3: Fragile means elderly, arthritic, osteoporotic or having acute pain
Comment 8: If more height is needed, an ipsilateral anterior sole lift extending from heel to toe should be used in order to keep the pelvis from rotating to the opposite side.
Topic: Scoliosis and short leg syndrome
Bone Wizardry Lock: Lift goes on the short leg side. Fragile patients (elderly, arthritic, osteoporotic, or in acute pain) start at 1/16 inch and increase 1/16 inch every two weeks. Flexible patients start at 1/8 inch and advance the same. Inside-shoe ceiling is 1/4 inch; total lift maximum is 1/2 inch.