Trunk rotation and hip joint range of rotation in adolescent girls with idiopathic scoliosis: does the "dinner plate" turn asymmetrically ?

<p>Abstract</p> <p>Background</p> <p>In patients with structural idiopathic scoliosis the body asymmetries involve the pelvis and the lower limbs; they are included in many theories debating the pathogenesis of idiopathic scoliosis.</p> <p>Methods</p> <p>Hip joint range of motion was studied in 158 adolescent girls, aged 10–18 years (mean 14.2 ± 2.0) with structural idiopathic scoliosis of 20–83° of Cobb angle (mean 43.0° ± 14.5°) and compared to 57 controls, sex and age matched. Hip range of rotation was examined in prone position, the pelvis level controlled with an inclinometer; hip adduction was tested in five different positions.</p> <p>Results</p> <p>In girls with structural scoliosis the symmetry of hip rotation was less frequent (p = 0.0047), the difference between left and right hip range of internal rotation was significantly higher (p = 0.0013), and the static rotational offset of the pelvis, calculated from the mid-points of rotation, revealed significantly greater (p = 0.0092) than in healthy controls. The detected asymmetries comprised no limitation of hip range of motion, but a transposition of the sector of motion, mainly towards internal rotation in one hip and external rotation in the opposite hip. The data failed to demonstrate the curve type, the Cobb angle, the angle of trunk rotation or the curve progression factor to be related to the hip joint asymmetrical range of motion.</p> <p>Conclusion</p> <p>Numerous asymmetries around the hip were detected, most of them were expressed equally in scoliotics and in controls. Pathogenic implications concern producing a "torsional offset" of muscles patterns of activation around the spine in adolescent girls with structural idiopathic scoliosis during gait.</p

Corrective Bracing for Severe Idiopathic Scoliosis in Adolescence: Influence of Brace on Trunk Morphology

Aim. The aim of the work was to study whether wearing a corrective brace by adolescent girls with severe idiopathic scoliosis can influence external shape of the trunk. Methods. Comparison of clinical deformity of two groups of girls matched for age and Cobb angle: group (1) of 23 girls, aged 14.9 ± 1.3 years, Cobb angle 55.0° ± 6.8°, who refused surgical treatment and have been wearing Chêneau brace for more than 6 months, compared with group (2) of 22 girls, aged 14.1 ± 1.8 years, Cobb angle 59.7° ± 14.6° never treated with corrective bracing. Clinical deformity was assessed with the Bunnell scoliometer (angle of trunk rotation ATR) and surface topography (posterior trunk symmetry index POTSI and Hump Sum HS). Results. The ATR in the primary curvature was 11.9° ± 3.4° (5°–18°) in group 1 versus 15.1° ± 5.6° (6°–25°) in group 2 (P = 0.027). The HS was 16.8° ± 3.8 versus 19.2° ± 4.6, respectively, P = 0.07. The POTSI value did not differ between groups. Conclusion. Girls with Cobb angle above 45 degrees, who have been subjected to brace treatment, revealed smaller clinical deformity of their back comparing to nontreated girls having similar radiological curvatures

Supine fulcrum bending test and in-cast correction of Scheuermann juvenile kyphosis

Background: Patients with Scheuermann disease often require conservative management with a series of corrective casts, followed by anti-kyphotic brace. Flexibility of the kyphosis can be assessed during a supine fulcrum bending test. The aim of the study was to analyze the radiological flexibility of kyphosis and immediate in-cast correction in a series of patients conservatively treated.Methods: Eighty-six adolescents were conservatively treated for Scheuermann disease of thoracic location. Charts of 55 patients, 39 boys and 16 girls, were accessible. The mean age was 14.6±1.6 years. On the lateral full-cassette standing radiograph, the angle of thoracic and lumbar lordosis were measured. The flexibility of kyphosis was assessed on a supine fulcrum bending lateral radiograph. The in-cast kyphosis angle was measured on a standing lateral radiograph.Results: In 18 patients, a mild non-progressive scoliotic curvature was present; it did not exceed a Cobb angle measurement of 25°. The initial kyphosis angle was 59.2°±9.3°. The lordosis angle was 76.3°±9.3°. The kyphosis angle on supine fulcrum bending test was 30.4°±9.7°. The kyphosis angle in the reclining cast was 44.3°±12.5°. There was no correlation between age and the supine bending correction. There was a correlation between the correction obtained with the supine bending test and the immediate correction in the cast (r=0.64, p=0.0012).Conclusions: The reduction of the kyphosis Cobb angle by supine fulcrum bending was 50% on average, while in the cast in standing position, only half of this correction was maintained