Thoracic kyphosis/ Thoracic hyperkyphosis

what is kyphosis? what is thoracic kyphosis?
what is criteria to diagnose? what are differential diagnosis? what are types of kyphosis? what is management? what is physical therapy management of kyphosis?

1. THORACIC KYPHOSIS By: Dr. Zunaira ahmad

2. Excessive antero -posterior thoracic curvature of spine >40 Angle increases with age (50-59%) Common in females than males. Normal kyphotic angle 20-40 ˚ in younger 48-50 ˚in women 44 ˚ in male Definition

3. Categories Scheuermann’s Disease Juvenile form of hyperkyphosis . Defect of the vertebral body growth plate at the cortical level, resulting in weakened vertebral body and causing wedging. Postural  Kyphosis Most frequent form, no vertebrae deformities visible. Result of poor posture, weakened muscles and ligaments of the spine. Congenital Kyphosis Bone defect detected at birth . Age-related Hyperkyphosis Kyphosis angle increases with age, resulting in age-related hyperkyphosis .

4. Clinical Presentation Most prominent symptom appearance of a rounded back (an exaggerated anterior curvature of the thoracic spine). Change in back posture is mostly gradual over time. Thoracic back pain Respiratory compromise.. Restricted spinal ROM Osteoporotic fractures. Having difficulty getting up from a chair, out of bed, or out of the bathtub Walking more slowly Feeling "off-balance," and/or losing your balance, or almost falling Feeling more tired than usual (fatigue) Having difficulty breathing (in more severe cases

5. Postural impairments Structural alignment impairments Flexible and respond to positional changes fixed alignments of the bony structures persists regardless of the position of the individual. eg Scheuermann’s disease

6. Differential Diagnosis Scheuermann’s disease Osteoporosis Trauma-related spinal changes eg  vertebral fracture Tumor Infection Degenerative disc disease

7. Diagnostic Procedures Plain radiography Anteroposterior: for the evaluation of the vertebral bodies L ateral radiographs:  helpful in assessing vertebral body height, disk height, endplate irregularity, erosions, and alignment. Reformatted CT scans MRI

8. Examination Typical signs Pain and dysfunction of both spine and shoulder Loss of range of movement and increased stiffness Reduced physical function Respiratory compromise Increased risk of osteoporotic fracture Increased mortality rates in the elderly

9. Examine in sagittal plane in standing and relaxed position. The standing position : Ankles and toes are placed in a neutral anatomical posture. The lower limbs are stretched straight limiting an excessive recurvatum. The trunk and upper limbs are relaxed, palms of the hands on the lateral thighs, the eye is looking horizontally. Tragus to wall test can be used Normal average distance = less than 10cm

10. MANAGEMENT

11. Medical Management A ntiresorptive or bone-building medications Osteoporosis treatment

12. S urgical procedures Osteotomy (a surgical operation in which a bone is cut to shorten, lengthen, or change its alignment.) Vertebroplasty Kyphoplasty

13. Pain management :  heat, ice, (TENS). Bracing: A Milwaukee Brace Taping: Tape from the anterior aspect of the acromioclavicular joint, over the muscle bulk of the upper trapezius, and diagonally over the spinous process of T6 Breathing exercises  Thoracic joint mobilizations Self-mobilization techniques e.g. diaphragmatic breathing on foam roller for expanding the rib cage. Physiotherapy Management

14. Stretching: Chest stretching on foam roller: lengthening pectoralis muscles Prone hip extension/ knee flexion: lengthening iliopsoas and rectus femoris Supine knee extension with hip at 90° flexion: lengthening hamstrings Muscle strengthening: Prone trunk lift to neutral : Strengthening spinal extensors, middle- and lower trapezius Prone trunk lift to neutral with weighted backpack : Strengthening spinal extensors Quadruped alternate arm/leg lift: Strengthening spinal extensors, scapula and trunk stabilization, reducing anterior tightness Thoracic correction exercises Balance exercises Gait training