Tag Archives: KYPHOSIS

Spinal curvatures

Deformities of the spine: Lordosis, Kyphosis, and Scoliosis

ICD-9: 737.20 LORDOSIS

ICD-9: 737.10 KYPHOSIS

ICD-9: 737.30 SCOLIOSIS

Video: How to Correct a Scoliosis With Exercise and Stretching

Description

⚡ Lordosis ⚡ is an abnormal inward curvature of the lumbar or lower spine. This condition is commonly called “swayback.” Kyphosis is an abnormal outward curvature of the upper thoracic vertebrae. Commonly, this curvature is known as “humpback” or “round back.” Scoliosis is an abnormal sideward curvature of the spine to either the left or right. Some rotation of a portion of the vertebral column also may occur. Scoliosis often occurs in combination with kyphosis and lordosis. These three spinal deformities may affect children as well as adults.

Spinal curvatures

FIGURE. Spinal curvatures

Etiology

Lordosis, kyphosis, and scoliosis may be caused by a variety of problems, including congenital spinal defects, poor posture, a discrepancy in leg lengths (especially in scoliosis), and growth retardation or a vascular disturbance in the epiphysis of the thoracic vertebrae during periods of rapid growth. Kyphosis may be the result of collapsed vertebrae from degenerative arthritis, or it may occur following a history of excessive sport activity. Obesity and osteoporosis can be contributing factors for lordosis. These three spinal deformities also may result from tumors, trauma, infection, osteoarthritis, tuberculosis, endocrine disorders such as Cushing disease, prolonged steroid therapy, and degeneration of the spine associated with aging. Lordosis, kyphosis, and scoliosis also may be idiopathic.

Signs and Symptoms

The onset of lordosis, kyphosis, and scoliosis frequently is insidious. Signs and symptoms may eventually include chronic fatigue and backache. Scoliosis is often detected by individuals when they notice that their clothing seems longer on one side than on the other. Or they may notice when looking in a mirror that the height of their hips and shoulders appears uneven.

Diagnostic Procedures

Physical examination and anterior, posterior, and lateral x-rays of the spine are the most commonly used procedures to detect these spinal deformities.

Treatment

Treatment varies according to the nature and severity of the spinal curvature, the age of onset, and the underlying cause of the disorder. The goal is to slow the progression of the disease. Physical therapy, exercise, and back braces may all play a role in the treatment of these conditions. Spinal bracing, if closely watched and properly constructed and fitted, may be able to halt the progression of the curve in scoliosis. Surgery may be necessary, however, in cases of adolescent scoliosis if the curvature seriously interferes with mobility or breathing. Spinal fusion, using bone grafts and metal rods, is sometimes performed to straighten the spine in this situation. Surgery is rarely necessary for correction of kyphosis. Analgesics may be prescribed to alleviate the pain that frequently accompanies these disorders.

Complementary Therapy

Kyphosis may respond well to massage. Physical therapy and exercises to strengthen abdominal muscles can decrease lumbar lordosis. Hamstring stretch can reduce muscle contractures, or a permanent shortening of muscle. Stress proper posture. In scoliosis, it is helpful for individuals to turn their whole body, rather than just their head, when looking to the side; yoga is helpful to some.

CLIENT COMMUNICATION

Emotional support is essential. Instruct clients on the use of any brace and to avoid vigorous sports. Meticulous skin care is important to prevent irritation and skin breakdown due to the brace rubbing against the skin.

Prognosis

The prognosis of an individual with lordosis, kyphosis, or scoliosis depends on the underlying cause of the particular disease, how early it is detected, and whether it responds to treatment. In some cases, a spinal deformity may be arrested but not corrected. Pulmonary insufficiency, degenerative arthritis of the spine, and sciatica may arise as complications of spinal deformities.

Prevention

Prevention of lordosis, kyphosis, and scoliosis includes correction of any underlying cause and maintaining good posture. Weight loss can reduce the risk of lordosis. Scoliosis screening in public schools is mandated by law in some states.

Lordosis

 

Kyphoscoliosis: Causes, Symptoms, and Treatment

What is kyphoscoliosis?

Kyphoscoliosis is an abnormal curve of the spine on two planes: the coronal plane, or side to side, and the saggital plane, or back to front. It’s a combined spinal abnormality of two other conditions: kyphosis and scoliosis.

Scoliosis causes the spine to curve abnormally on the coronal plane, meaning it twists sideways. Kyphosis causes the spine to curve abnormally on the saggital plane, meaning it twists forward or backward, similar to a hunchback. People with kyphoscoliosis have a spine that curves both to the side and forward or backward at the same time.

This condition can occur at any age, including at birth. According to a case report about the condition, 80 percent of cases are idiopathic. This means there’s no known cause of the condition.

Symptoms of kyphoscoliosis vary. Sometimes people with the condition may only have an abnormal hunch or slouch. In more severe cases, there can be negative effects on the lungs and heart. The muscles may not be able to function properly for day-to-day activities.

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What causes kyphoscoliosis?

Many cases of this condition have no known cause. In other cases, this spinal condition is the result of:

  • Prolonged bad posture. Poor posture over time may result in postural kyphoscoliosis. It can be treated with extensive physical therapy.
  • Tuberculosis (TB). TB can weaken the spine.
  • Osteochondrodysplasia. This is a type of skeletal dysplasia, a condition that impairs the growth of spinal bones, cartilage, and connective tissue.
  • Degenerative diseases. Examples include osteoporosis and osteoarthritis (OA).

People 50 years of age and older are likely to develop this spinal abnormality if degenerative diseases like OA are already present.

What are the symptoms?

The most obvious physical symptom of kyphoscoliosis is a hunched or uneven back. This spinal condition comes with a number of other mild symptoms, including:

  • hunched back
  • uneven shoulder blades
  • arms or legs longer on one side
  • body image issues

In more severe cases, kyphoscoliosis can affect the lungs, nerves, and other organs. More severe symptoms include:

  • disfigurement
  • back pain
  • trouble breathing
  • weakness or paralysis
  • stiffness
  • fatigue
  • decreased appetite
  • neurological issues
  • heart issues

5 kyphoscoliosis treatment methods

Treatment for spine abnormalities can vary depending on:

  • severity of the spine curvature
  • ability to maintain a healthy posture
  • age
  • other medical conditions
  • impact on day-to-day routines

There are many noninvasive treatment methods for kyphoscoliosis. If these don’t work, however, your doctor may recommend surgery.

1. Checkups

Early detection of spine problems is key to preventing your condition from getting worse. It’s common for children to develop minor spine curvatures, which may never need treatment or will go away with age.

Still, it’s important to have regular medical checkups to monitor the spine for changes. Treatment will vary from one person to the next based on the severity of their condition.

2. Scoliosis bracing

As an alternative to surgery, doctors may recommend using a back brace. Bracing isn’t an effective treatment method for adults whose bones have stopped growing.

It’s important to note that bracing won’t cure scoliosis or kyphoscoliosis. It can help prevent any future damage, though. Braces are typically worn throughout the day. They become more effective as they’re worn more frequently.

3. Pain management

Spinal abnormalities and any other back injury can cause extensive discomfort, stiffness, and can impact day-to-day activities. Doctors may recommend cortisone injections and other pain medication to help provide temporary relief.

However, these medications can have major side effects if used too frequently. For that reason, injections are only provided once or twice a year.

4. Physical therapy

Active physical therapy involves exercises that increase spine strength and flexibility. The most effective treatment involves exercises meant to improve the spine’s range of motion and balance.

5. Surgery

If you have severe kyphoscoliosis, doctors may recommend surgical correction. While it may not be able to cure spinal abnormalities, spinal surgery can help prevent the condition from progressing and causing any additional harm.

A common surgical option is a spinal fusion. It’s a procedure that connects bones in the spine together with metal rods or screws to prevent independent movement. This allows old and new spinal material to form together.

Doctors can also install an adjustable rod. This is an option recommended for younger people who haven’t finished growing. This rod can be adjusted every six months to match the length of the spine.

As with any surgery, there are complications. They can include:

  • infection
  • nerve damage
  • inability to heal
  • excessive bleeding
  • paralysis

What’s the outlook?

It’s important to see your doctor if you notice symptoms of kyphoscoliosis. Early detection and treatment are key to recovery.

Kyphosis Exercises: Treat а Rounded Upper Back

What is kyphosis?

Kyphosis occurs when there is excessive curvature of the spine, eventually causing a hump-like appearance in the upper back.

Between 20 and 40 percent of elderly adults experience kyphosis. The greatest change in the thoracic curve occurs in women between the ages of 50 and 70.

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Causes and treatment

Some of the causes of kyphosis include:

  • degenerative changes
  • compression fractures
  • muscular weakness
  • altered biomechanics

Dr. Nick Araza, a chiropractic wellness practitioner at Santa Barbara Family Chiropractic, says that he associates kyphosis with poor posture and bad movement patterns. He says that just 20 minutes of bad posture can cause negative changes to your spine.

As you spend time in a flexed (bent) position, your head begins to retain a forward position. This causes increased stress and weight on your spine and neck. The head should be directly over the body, creating a straight line from your shoulders to your ears.

By practicing proper posture and engaging in exercises to strengthen the back and neck, you can lighten the load. This will give your spine a break.

Why is exercise important?

Exercise, combined with good posture and chiropractic care, may help improve your rounded upper back.

Researchers looked at the effect of spinal extension exercises on kyphosis. They found that strong back muscles are better able to counteract the forward pull on the spine. That means exercises that strengthen the extensor muscles can decrease the angle of kyphosis.

The same study found that after one year of exercise, the progress of kyphosis in women ages 50 to 59 was delayed compared to those who did not complete the extension exercises.

Exercises to try

Araza recommends these five exercises to help prevent or improve a rounded upper back. Consistency is key. These exercises should be repeated a minimum of three to four times per week to see results over time.

Always consult a doctor before starting an exercise routine and be sure to listen to your body. If an exercise or stretch is causing increased pain, stop and seek help.

1. Mirror image

For this exercise, simply do the opposite movement of the posture that you’re trying to correct.

  1. Stand tall, against a wall if needed.
  2. Tuck your chin slightly and bring your head back directly over your shoulders.
  3. Feel as if you’re bringing your shoulder blades back and down. Hold this position for 30 seconds to 1 minute. Take a break if you begin to feel pain.

If it’s challenging to get your head to touch the wall while maintaining a chin tuck position, you can put a pillow behind you and press your head into the pillow.

2. Head retraction

This exercise is done lying on the floor and is great for the muscles of the neck that are often stretched out and weak.

  1. Pull your chin back toward the floor, as if you’re trying to make a double chin.
  2. Hold for 15 seconds. Repeat 5 to 10 times.

3. Superman

  1. Lying on your stomach, extend your hands in front of your head.
  2. Keeping your head in a neutral position, looking toward the floor, lift your arms, and legs up toward the ceiling.
  3. Feel as if you’re reaching far away from your body with your hands and feet. Hold for 3 seconds and repeat 10 times.

4. Life extension

The goal of this exercise is to stretch the tight muscles of the chest and strengthen the weak muscles of the back.

  1. Begin standing tall, knees soft, core engaged, chest upright, and shoulder blades back and down.
  2. Once you find yourself in an ideal posture, raise your arms up into a Y position with your thumbs pointed behind you.
  3. In this position, take two to three deep breaths, focusing on maintaining this posture on exhale.

5. Thoracic spine foam rolling

  1. Lie on the floor with a foam roller under you, across your mid back.
  2. Gently roll up and down on the foam roller, massaging the muscles of your back and thoracic spine.

You can try this with your arms extended over your head in the life extension position described above. Do this for at least 30 seconds to 1 minute.

The takeaway

By making small changes to take care of your posture today and prevent kyphosis, you can reap the health benefits for years to come. So, take a break from your phone, practice good posture, and work toward a greater quality of life.

Kyphosis: Causes, Symptoms and Diagnosis

What Causes Kyphosis?

Kyphosis, also known as roundback or hunchback, is a condition in which the spine in the upper back has an excessive curvature. The upper back, or thoracic region of the spine, is supposed to have a slight natural curve. The spine naturally curves in the neck, upper back, and lower back to help absorb shock and support the weight of the head. Kyphosis occurs when this natural arch is larger than normal.

If you have kyphosis, you may have a visible hump on your upper back. From the side, your upper back may be noticeably rounded or protruding. In addition, people with hunchback appear to be slouching and have noticeable rounding of the shoulders. Kyphosis can lead to excess pressure on the spine, causing pain. It may also cause breathing difficulties due to pressure put on the lungs.

Kyphosis in elderly women is known as dowager’s hump.

Common causes of kyphosis

Kyphosis can affect people of any age. It rarely occurs in newborns because it’s usually caused by poor posture. Kyphosis caused by poor posture is called postural kyphosis.

Other potential causes of kyphosis include:

  • aging, especially if you have poor posture
  • muscle weakness in the upper back
  • Scheuermann’s disease, which occurs in children and has no known cause
  • arthritis or other bone degeneration diseases
  • osteoporosis, the loss of bone strength due to age
  • injury to the spine
  • slipped discs
  • scoliosis, or spinal curvature

The following conditions less commonly lead to kyphosis:

  • infection in the spine
  • birth defects, such as spina bifida
  • tumors
  • diseases of the endocrine system
  • diseases of the connective tissues
  • polio
  • Paget’s disease
  • muscular dystrophy

When to seek treatment for kyphosis

You should seek treatment if your kyphosis is accompanied by:

  • pain
  • breathing difficulties
  • fatigue

Much of our bodily movement depends on the health of the spine, including our:

  • flexibility
  • mobility
  • activity

Getting treatment to help correct the curvature of your spine may help you reduce the risk of complications later in life, including arthritis and back pain.

Treating kyphosis

Treatment for kyphosis will depend on its severity and underlying cause. Here are some of the more common causes and treatments:

  • Scheuermann’s disease: A child may receive physical therapy, braces, or corrective surgery.
  • Infection: Your doctor will probably prescribe antibiotics for you.
  • Tumors: Typically, tumors are only removed if there’s concern for spinal cord compression. If this is present, the surgeon may try to remove the tumor, but frequently this destabilizes the bone. In such cases, a spinal fusion is often also necessary.
  • Osteoporosis: It’s essential to treat bone deterioration to prevent kyphosis from worsening.
  • Poor posture: You will not need aggressive treatments.

The following treatments may help relieve the symptoms of kyphosis:

  • medication, to relieve pain, if necessary
  • physical therapy, to help build strength in the core and back muscles
  • yoga, to increase body awareness and build strength, flexibility, and range of motion
  • weight loss, to relieve excess burden on the spine
  • braces, especially in children and teens
  • surgery, in severe cases

Risks of untreated kyphosis

For most people, kyphosis does not cause serious health problems. This is dependent on the cause of the kyphosis. If kyphosis is caused by poor posture, you may suffer from pain and breathing difficulties. These will only get worse later in life.

You can treat kyphosis early by:

  • strengthening the muscles of the back
  • seeing a physical therapist

Your goal will be to improve your posture long-term to decrease pain and other symptoms.

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Physical examination of the shoulder

The shoulder girdle is composed of three joints and one “articulation”:

  1. the sternoclavicular joint
  2. the acromioclavicular joint
  3. the glenohumeral joint (the shoulder joint)
  4. the scapulothoracic articulation

The shoulder girdle

Fig. The shoulder girdle.

The humerus has very minimal osseous support

Fig. The humerus has very minimal osseous support. Notice the shallow glenoid fossa in the shoulder as compared to the deep acetabular socket of the hip.

All four work together in a synchronous rhythm to permit universal motion. Unlike the hip, which is a stable joint having deep acetabular socket support, the shoulder is a mobile joint with a shallow glenoid fossa. The humerus is suspended from the scapula by soft tissue, muscles, ligaments, and a joint capsule, and has only minimal osseous support.

Examination of the shoulder begins with a careful visual inspection, followed by a detailed palpation of the bony structures and soft tissues comprising the shoulder girdle. Range of motion determination, muscle testing, neurologic assessment, and special tests complete the examination.

INSPECTION

Inspection begins as the patient enters the examining room. As he walks, evaluate the evenness and symmetry of his motion; the upper extremity, in normal gait, swings in tandem with the opposite lower extremity. As the patient disrobes to the waist, observe the rhythm of his shoulder movement. Normal motion has a smooth, natural, bilateral quality; abnormal motion appears unilaterally jerky or distorted, and often represents the patient’s attempt to substitute an inefficient, painless movement for one that was once efficient but has since become painful. Initial inspection should, of course, include a topical scan for blebs, discoloration, abrasions, scars, and other signs of present or previous pathology.

As you inspect, compare each area bilaterally, noting any indications of pathology as well as the condition and general contour of the anatomy. The easiest way to determine the presence of abnormality is by bilateral comparison, for such comparison more often than not reveals any variation that may be present. This method is one of the keys to good physical examination, and holds true not only for inspection, but for the palpation, range of motion testing, and neurologic portions of your examination as well.

Erb's palsy

Fig. Erb’s palsy.

Asymmetry is usually quite obvious. For example, one arm may hang in an unnatural position, either adducted (toward the midline) across the front of the body, or abducted away from it, leaving a visible space in the axilla. Or, the arm may be internally rotated and adducted, in the position of a waiter asking for a tip (Erb’s palsy).

The clavicle is almost subcutaneous and clearly etches the overlying skin

Fig. The clavicle is almost subcutaneous and clearly etches the overlying skin.

Now, turn your attention to the most prominent bone of the shoulder’s anterior aspect, the clavicle. The clavicle is a strut bone that keeps the scapula on the posterior aspect of the thorax and prevents the glenoid from turning anteriorly. It rises medially from the manubrial portion of the- sternum and extends laterally to the acromion. Only the thin platysma muscle crosses its superior surface. The clavicle is almost subcutaneous, clearly etching the overlying skin, and a fracture or dislocation at either terminal is usually quite obvious. In the absence of the clavicle, the normal ridges on the skin which define it (clavicular contour) are also absent, and exaggerated rounded shoulders are a visible result.

Next inspect the deltoid portion of the shoulder, the most prominent mass of the shoulder girdle’s anterior aspect. The rounded look of the shoulder is a result of the draping of the deltoid muscle from the acromion over the greater tuberosity of the humerus. Normally, the shoulder mass is full and round, and the two sides are symmetrical. However, if the deltoid has atrophied, the underlying greater tuberosity of the humerus becomes more prominent, and the deltoid no longer fills out the contours of the shoulder mass. Abnormality of shoulder contour may also be caused by shoulder dislocation if the greater tuberosity is displaced forward, as is usually the case; the shoulder loses its full lateral contour and appears indented under the point of the shoulder. The arm is held slightly away from the trunk.

Dislocation of the shoulder

Fig. Dislocation of the shoulder.

The deltopectoral groove lies medial to the shoulder mass and just inferior to the lateral concavity of the clavicle. The groove is formed by the meeting of the deltoid muscle fibers and the pectoralis major muscle and is one of the most efficient locations in the shoulder’s anterior region for surgical incision. It also represents the surface marking for the cephalic vein, used for a venous cut-down if no other vein is easily accessible.

Now, direct your attention to the posterior aspect of the shoulder girdle. Tbe most prominent bony landmark is the scapula, a triangular bone that rests upon the thoracic cage. The outline of its ridges upon the skin makes the scapula easy to locate. In its resting position, it covers ribs two to seven; its medial border lies approximately two inches from the spinous processes. The smooth, triangular area of the spine of the scapula is opposite spinous process T3. The scapula conforms to the shape of the rib cage, contributing to the slightly kyphotic shape of the thoracic spine. Any asymmetry in the relationship between the scapulae and the thorax may indicate weakness or atrophy of the serratus anterior muscle and may present as a winged effect. Another cause of scapular asymmetry is Sprengel’s deformity, wherein the scapula has only partially descended from the neck to the thorax. This high-riding scapula may cause an apparent webbing or shortening of the neck.

The scapulae—Sprengel’s deformity—partially undescended scapula

Fig. The scapulae—Sprengel’s deformity—partially undescended scapula.

Lateral curvature of the spine (scoliosis)

Fig. Lateral curvature of the spine (scoliosis).

The posterior midline of the body, with its visible spinous processes, lies midway between the scapulae. Notice whether the spine is straight, without lateral curvature (scoliosis). A spinal curvature may make one shoulder appear lower than the other, with the dominant side being more muscular. Occasionally, the thoracic spine is excessively rounded or kyphotic, usually a result of Scheuermann’s disease or juvenile kyphosis.

Excessively kyphotic thoracic spine—Scheuermann's disease or juvenile kyphosis

Fig. Excessively kyphotic thoracic spine—Scheuermann’s disease or juvenile kyphosis.