Ortho Scolio

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Presentation Transcript

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Yabes, Yamylene Anne A. BSN 3-10 RLE 4

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What is lateral curving deviation of the spine Causes congenital idiopathic neuromuscular

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cervical vertebrae make up the neck. thoracic vertebrae comprise the chest section and have ribs attached. lumbar vertebrae are the remaining vertebrae below the last thoracic bone and the top of the sacrum. sacral vertebrae are caged within the bones of the pelvis, and coccyx represents the terminal vertebrae or vestigial tail.

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The curves, along with the intervertebral disks, help to absorb and distribute stresses that occur from everyday activities such as walking or from more intense activities such as running and jumping.

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What is Congenital due to a problem with the formation of vertebrae or fused ribs during prenatal development STAGE 3 – 3rd week neural tube forms which becomes the spinal cord STAGE 3 – 7th week Skeletal system developed - Cartilage at this point

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What is Idiopathic unknown cause, and appears in a previously straight spine most common type in adolescents most common in females curves worsen during growth spurts

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What is Neuromuscular caused by problems such as poor muscle control or muscular weakness or paralysis due to diseases such as cerebral palsy muscular dystrophy spina bifida polio

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Is it Inspection exposed: spine entire back buttocks legs Scoliometer measurements examiner inspects spinal curves trunk symmetry

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Scoliometer - a device for measuring the curvature of the spine

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Is it Inspection Scoliometer measurements examiner inspects spinal curves trunk symmetry note any differences in the height of the shoulders or iliac crests shoulder and hip symmetry andamp; vertebral column are inspected with Px: erect flexion will help the doctor define the curve

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During the test, the px bends forward with the feet together and knees straight while dangling the arms. Any imbalances in the rib cage or other deformities along the back could be a sign of scoliosis.

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Is it Inspection Spine Xray The degree of curve seen on an exam may underestimate the actual curve, so any child found with a curve is likely to be referred for an x-ray. MRI if there are any neurologic changes noted on the exam or if there is something unusual in the x-ray to look for any changes in strength, sensation, or reflexes

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What do we expect to see in The spine curves abnormally to the side (laterally) Shoulders not level Asymmetric waistline Asymmetric gluteal folds Prominent scapula Backache or low-back pain Fatigue after prolonged sitting or standing

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How do we manage Treatment depends on: cause of the scoliosis the size and location of the curve, and how much more growing the patient is expected to do. Most cases of adolescent idiopathic scoliosis (less than 20 degrees) require no treatment, but should be checked often, about every 6 months.

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How do we manage Treatment Surgery Depending upon the severity and responsiveness to other treatment involves correcting the curve (although not all the way) and fusing the bones in the curve together. Bone grafts laid across the exposed surface of each vertebra. These grafts will regenerate grow into the bone fuse the vertebrae together The bones are held in place with one or two metal rods held down with hooks and screws, which also helps to support the fusion of the vertebrae.

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How do we manage Treatment Curves get worse (above 25 to 30 degrees in a child who is still growing) bracing is usually recommended to help slow the progression of the curve. different kinds: The Boston Brace Wilmington Brace Milwaukee Brace Charleston Brace are named for the centers where they were developed

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Boston Brace For full time wearing first brace to utilize symmetrical standardized modules eliminating the need for casting. extends from below the breast to the beginning of the pelvic area in front and just below the scapula to the middle of the buttocks in the back It is designed to keep the lumbar area of the body in a flexed position by pushing the abdomen in and flattening the posterior lumbar contour. Pads are strategically placed to provide pressure to the curve, and areas of 'relief' or 'voids' are provided opposite the areas of pressure.

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Wilmington Brace Also known as duPont brace

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Milwaukee Brace particularly for high thoracic curves Metal bars in the front and back of the brace extend the length of the torso and are attached to a form-fitting plastic pelvic girdle and to a throat mold or ring which encircles the neck Straps attached to the metal bars hold pressure pads, which are precisely placed depending on the individual's curve pattern. While the bars hold the body erect, the neck ring keeps the head centered over the pelvis and the pads push against the curve.

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Charleston Brace For night use molded to conform to the patient's body while bending towards the convexity of the curve, thus 'over-correcting' the curve during the eight hours it is worn.

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What is Expectations The outcome depends on the cause, location, and severity of the curve. The greater the curve, the greater the chance the curve will get worse after growth has stopped. Mild cases treated with bracing alone do very well. People with these kinds of conditions tend not to have long-term problems, except maybe an increased rate of low back pain when they get older. People with surgically corrected idiopathic scoliosis also do very well and can lead active, healthy lives. Patients with neuromuscular scoliosis have another serious disorder (like cerebral palsy or muscular dystrophy) so their goals are much different. Often the goal of surgery is simply to allow a child to be able to sit upright in a wheelchair. Babies with congenital scoliosis have a wide variety of underlying birth defects. Management of this disease is difficult and often requires many surgeries.

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Complications Emotional problems or lowered self-esteem as a result of the condition or its treatment (specifically bracing) Spinal cord or nerve damage from surgery or severe, uncorrected curve Failure of the bone to join together  (very rare in idiopathic scoliosis) Spine infection after surgery Low back arthritis and pain as an adult Respiratory problems from severe curve

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www.yamyyabes.deviantart.com Brunner andamp; Suddarth’s Textbook of Medical-Srugical Nursing 10th Edition, Volume 2 http://www.nlm.nih.gov/medlineplus/ency/article/001241.htm http://www.images.google.com

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