What is Scoliosis?

Overview
Scoliosis is a curving of the spine. The spine curves away from the middle or sideways.
Alternative Names
Spinal curvature; Kyphoscoliosis

Causes
There are three general causes of scoliosis:
Congenital (present at birth) scoliosis is due to a problem with the formation of the spine bones (vertebrae) or fused ribs during development in the womb or early in life.
Neuromuscular scoliosis is caused by problems such as poor muscle control or muscle weakness, or paralysis due to diseases such as cerebral palsy, muscular dystrophy, spina bifida, and polio.
Idiopathic scoliosis is scoliosis of unknown cause. Idiopathic scoliosis in adolescents is the most common type.
Some people may be prone to curving of the spine. Most cases occur in girls. Curves generally worsen during growth spurts. Scoliosis in infants and young children are less common, and commonly affect boys and girls equally.

Symptoms
A doctor may suspect scoliosis if one shoulder appears to be higher than the other, or the pelvis appears to be tilted. Untrained observers often do not notice the curving in the earlier stages.
Other symptoms can include:
Backache or low-back pain
Fatigue
Shoulders or hips appear uneven
Spine curves abnormally to the side (laterally)
There may be fatigue in the spine after prolonged sitting or standing. Pain will become persistent if there is irritation to the soft tissue and wear and tear of the spine bones.
Note: Kyphoscoliosis also involves abnormal front to back curvature, with a "rounded back" appearance.

Tests & diagnosis
The health care provider will perform a physical exam, which includes a forward bending test that will help the doctor define the curve. The degree of curve seen on an exam may underestimate the actual curve seen on an x-ray, so any child found with a curve is likely to be referred for an x-ray. The health care provider will perform a neurologic exam to look for any changes in strength, sensation, or reflexes.
Tests may include:
Scoliometer screening (a device measures the curvature of the spine)
Spine x-rays (taken from the front and the side)
MRI (if there are any neurologic changes noted on the exam or if there is something unusual in the x-ray )

Treatment
Treatment depends on the 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.
As 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. There are many different kinds of braces used. The Boston Brace, Wilmington Brace, Milwaukee Brace, and Charleston Brace are named for the centers where they were developed.
Each brace looks different. There are different ways of using each type properly. The selection of a brace and the manner in which it is used depends on many factors, including the specific characteristics of the curve. The exact brace will be decided on by the patient and health care provider.
A back brace does not reverse the curve. Instead, it uses pressure to help straighten the spine. The brace can be adjusted with growth. Bracing does not work in congenital or neuromuscular scoliosis, and is less effective in infantile and juvenile idiopathic scoliosis.
The choice of when to have surgery will vary. After the bones of the skeleton stop growing, the curve should not get much worse. Because of this, the surgeon may want to wait until your child’s bones stop growing. But your child may need surgery before this if the curve in their spine is severe or is getting worse quickly. Curves of 40 degrees or greater usually require surgery.
Surgery involves correcting the curve (although not all the way) and fusing the bones in the curve together. The bones are held in place with one or two metal rods held down with hooks and screws until the bone heals together. Sometimes surgery is done through a cut in the back, on the abdomen, or beneath the ribs. A brace may be required to stabilize the spine after surgery.
The limitations imposed by the treatments are often emotionally difficult and may threaten self-image, especially of teenagers. Emotional support is important.
Physical therapists and orthotists (orthopedic appliance specialists) can help explain the treatments and make sure the brace fits comfortably.

Prognosis
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.
The greater the initial curve of the spine, the greater the chance the scoliosis will get worse after growth is complete. Severe scoliosis (curves in the spine greater than 100 degrees) can cause breathing problems.
Mild cases treated with bracing alone do very well. People with these kinds of conditions tend not to have long-term problems, except an increased rate of low back pain when they get older. People with surgically corrected idiopathic scoliosis can 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.

Complications
Emotional problems or lowered self-esteem may occur as a result of the condition or its treatment (specifically, wearing a brace)
Failure of the bone to join together (very rare in idiopathic scoliosis)
Low back arthritis and pain as an adult
Respiratory problems from severe curve
Spinal cord or nerve damage from surgery or severe, uncorrected curve
Spine infection after surgery
When to contact a doctor
Call your health care provider if you suspect your child may have scoliosis.

Prevention
Routine scoliosis screening is now done in middle and junior high schools. Because of screening, many cases that would have previously gone undetected until they were more advanced, have been diagnosed at an earlier stage.

https://health.google.com/health/ref/Scoliosis

What is Arthrogryposis?

What is Arthrogryposis?

Arthrogryposis is a term used to describe a number of rare, non-progressive conditions characterized by stiff joints and abnormal muscle development. It is also referred to as arthrogryposis multiplex congenita or amyloplasia.


What causes Arthrogryposis?

The exact cause of arthrogryposis is unknown, though a number of different theories have been proposed. Some believe that arthrogryposis is caused by mechanical obstructions to intrauterine movement during pregnancy. Others believe that it may be a result of an early viral infection during development. Still others believe that arthrogryposis is the result of failure of the central nervous system and/or muscular system to develop appropriately. Arthrogryposis is not thought to be a genetic or hereditary condition.


How common is Arthrogryposis?

Arthrogryposis is a rare condition, though the exact frequency with which it occurs is unknown. Previous studies have estimated that it affects one to three of every 10,000 live births.


How is Arthrogyposis diagnosed?

Arthrogryposis is diagnosed by treating physicians after a thorough medical history and careful physical examination. X-rays are often taken to confirm the diagnosis and to evaluate stiff or dislocated joints. Additional tests, including blood tests, muscle biopsies, and other imaging studies, are often used to further make the diagnosis. Patients with arthrogryposis often have involvement of the upper limbs. Typically, these patients will have shoulders that are internally rotated and adducted, elbows that are stiff in extension or flexion, and wrists and fingers that are flexed.

How is Arthrogyposis treated?

Early in life, patients with joint abnormalities are typically treated with stretching exercises and splinting to improve motion. Splinting and occupational/hand therapy are the treatment of choice for patients with mild to moderate deformity.

Some patients may have persistent functional difficulties despite a rigorous physical therapy regimen. In certain situations, surgery is recommended to improve limb position and function. These procedures may include muscle releases, tendon transfers, or bony fusions. Posterior elbow release and triceps lengthenings, for example, may be performed after two years of age in improve elbow flexion. Tendon transfers to restore active elbow flexion may be considered in some children after five to seven years of age. Wrist flexion deformities may be treated with tendon transfers and/or bony procedures to change the alignment of the wrist. Finally, surgical procedures to rearrange the skin between the thumb and index finger may benefit selected patients with tightness between the thumb and palm. While improvements can be made, most patients will have persistent muscular and/or joint limitations due to the underlying condition.