Dr.
Tehreem Nasir
TORTICOLLIS
Persistent neck deviation
to one side
Stressand emotional events
may exacerbate symptoms
Women effected more often
than men (4.5:1)
May occur in children or adults
Congenital Torticollis
Infants appear healthy at delivery
Over days to weeks, soft-tissue swelling appears over an injured
sternocleidomastoid, Injury may be due to birth trauma or
intrauterine malpositioning.
Mass gradually regresses and leaves a fibrous band in place of
the sternocleidomastoid muscle, causing contracture of the neck.
Acute Torticollis
May be due to number of underlying conditions such as Trauma
Develops overnight
Young and middle-aged adults.
Painful neck spasms with tenderness
Symptoms usually resolve spontaneously within 2 weeks
Treatment: Heat, massage, supportive cervical collar,
muscle relaxants, and analgesics
Idiopathic Spasmodic Torticollis
No clear etiology, although a lesion of the thalamus has been
suspected
A type of focal dystonia (ie, dystonic movements in a single body
part)
Diagnosis
• Plain cervical
radiograph
• MRI
• CT scan
• Clinical examination
Provide opportunities to
baby to turn head to the Immobilization after
affected side trauma
Stretching and Analgesics, muscle
lengthening exercises by relaxants, anxiolytics
Botulinum toxoid
physiotherapist
Full recovery in 85%
injection
cases by 1 year of age Chiropractic care,
Remaining will need
massage, orthotic
orthopedic consultation collar, alternative
and possibly surgery medicine
SCOLIOSIS
Scoliosis
Lateral curvature of spine
Generally, a sideways curvature greater than 10 degrees is considered
scoliosis
As the spine curves, the vertebrae rotate, pulling the ribs along
Types
Etiological types are
Congenital
Juvenile
Neuromuscular
Idiopathic
Congenital Scoliosis
Embryologic malformation of spine
Localized or generalized deformity
Hemivertebra
Rib fusion
Neuromuscular Scoliosis
Secondary to neuropathic disorders (Poliomyelitis, Cerebral
palsy, Myelomeningocele)
Initially flexible, gragually becomes rigid
Long generalized C-curvature with severe muscle weakness
Infantile Idiopathic Scoliosis Juvenile Idiopathic
Occurs in first 3 years of life
Associated with intrauterine malposition
Scoliosis
Boys are affected more Uncommon
Usually left thoracic curve is seen Between ages 4 and 10years
Associated with mental deficiency or other congenital Right thoracic curve
skeletal deformities
Self limiting, spontaneously resolves in majority Both sexes equally affected
Worse prognosis
Surgical correction before puberty
Adolescent Idiopathic Scoliosis
Between ages 10 and 16years
Seven times more common in girls
Fairly common
Majority with left lumbar curved
Curves under 20 degrees either resolve spontaneously or remain unchanged
Clinical features Diagnosis
Mild lower back pain Spinal X rays
Neck pain, Headache MRI
Premature disc and joint Curve measurements
degeneration Pulmonary function tests
Decreased pulmonary functions
Psychological effects
Treatment
Observation
Orthotics (Braces)
Traction and Casting
Exercises
Surgery (Fusion or Implants)
For curves greater than 40 degrees
KYPHOSIS
Kyphosis
Curving of spine that causes a bowing or rounding of the back, which leads to a
hunchback or slouching posture
Three main types
1. Postural kyphosis
2. Scheuermann’s kyphosis
3. Congenital kyphosis
4. Other Causes:
◼ Certain endocrine disorders
◼ Connective tissue disorders
◼ Infection
◼ Muscular dystrophies
◼ Poliomyelitis
◼ Spina bifida
◼ Tumors
Postural Kyphosis Congenital
Most common type
Noticed in adolescents, Girls Scheuermann’s Kyphosis
more than boys Least common type
Caused by poor posture and
Kyphosis
Caused by abnormal
weakening of paraspinous Noticed in adolescents development of vertebra
muscles, ligaments in the back Result of structural deformity prior to birth
Progressively gets worse with Commonly develops with
time
Occurs due to fusion of
scoliosis many vertebra
Symptoms: Pain and muscle
fatigue
Clinical Features Diagnosis
Difficulty in breathing (only in Clinical assesment
severe cases X-ray spine
Fatigue MRI
Back pain Pulmonary function
Tenderness and stiffness tests
Round back appearance
(Cosmetic concerns)
Management Complications
Postural kyphosis Decreased lung capacity
Lifestyle modification, Exercises Disabling pain
Congenital kyphosis Neurological symptoms (weakness
and paralysis of lower limbs)
Surgery at early age
Round back deformity
Scheuermann’s kyphosis
Braces and physical therapy
Tumors
Surgical resection
LORDOSIS
Lordosis
Natural curve of spine in the
cervical and lumbar regions
Exaggeration of this curve
is called lordosis
Pain and discomfort, limited
mobility
Common Causes
In Adults In children
Spondylolisthesis Hip dislocation
Osteoporosis Cerebral palsy
Muscular dystrophies
Osteosarcoma
Spinal muscular atrophy
Obesity
Pregnancy
Types Symptoms
Postural lordosis (In Pain
obese individuals) Muscle spasm
Congenital/Traumatic
Limited movement
lordosis
Involvement of limbs
Post-surgical
Numbness
Neuromuscular lordosis Tingling
Electric shock like pain
Weak bladder control
Muscle weakness
Diagnosis
History and examination
Plain radiographs of Cervical/Lumbar spine
Treatment
Most people don’t need
treatment
Analgesics
Physiotherapy
Weight loss
Braces
Nutritional supplement
Surgery
FLATBACK
The natural curve of human is like a soft
‘S’. The spine has an inward-outward-
inward curve at the upper, middle and
lower back, when viewed from the side.
These natural curves help in the even
distribution of weight and impart
flexibility to movements.
Flatback Syndrome is an abnormal
spine condition where spine in the
lower back loses its natural curves and
becomes flat over time. It creates spinal
imbalances causing the patient to lean
forward, over time making it difficult to
stand upright causing back or even leg
Causes of Flatback Syndrome:
• Degenerative Disc Disease
• Ankylosing Spondylitis
• Post-Laminectomy Syndrome
• Vertebral Compression Fractures
Flatback SyndromeSymptoms
Some of the other common symptoms one must look out for are:
1. Head leaned forward and feeling of falling forward.
2. Prolonged pain in the back muscles, shoulder or neck.
3. Fatigue & posture issues
4. Muscle weakness and inability to stand or walk for a longer duration.
Diagnosis
• Medical history – incidence of back surgery and spinal deformities
• Musculoskeletal examination
• Neurological examination
• Gait exam to assess walking
• X-ray to analyse the changes and visualize the sagittal alignment respectively.
Treatment
• Conservative treatment for Flatback Syndrome starts with
Physical therapy and exercises which include strengthening
and stretching exercises for better mobility, movement,
improved posture and muscular imbalance correction.
In rare cases, spine surgeries like Wedge osteotomy
THANK YOU
Dr.Tehreem Nasir
MBBS, RMP
