Scoliosis Screening

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Scoliosis Screening
American Red Cross of Northeast Tennessee
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Scoliosis Update Quiz

• Name of spinal curvature forward at the waist
• ?Scoliosis ?Kyphosis ?Lordosis
• A spinal lateral curvature of 16-23 degrees would
  be considered
• ?Mild ?Moderate ?Severe
• This type of scoliosis represents 85 of cases
• ?Idiopathic ?Neuromuscular ?Congenital
  ?Idiopathic
• Percentage of adolescents will have some degree
  of spinal curvature
• ?2 ?10 ?22
• Primary age of onset for idiopathic scoliosis
• ?3-7 ?10-15 ?18-22 ?75-99

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True or False

• Most curvatures of the thorax are toward the left
• Scoliosis can be caused by carrying heavy book
  bags and poor posture.
• Lower back pain in adolescents is an early
  indicator of scoliosis.
• Race, ethnic background and socioeconomics are
  not factors for scoliosis.
• Treatment is not needed for the vast majority of
  adolescent scoliosis cases.
• Parents can give verbal permission for screening
  to a school official if the student forgets
  his/her form.
• Red Cross and School Health Nurses are the
  BEST!!!

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Normal Spinal Curvature
There are 4 natural curves in the vertebral
column
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Linear Spinal Curvatures

• Kyphosis

• Lordosis

Spine curves forward at the waist Swayback
Spine curves backward in the chest
area Roundback
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Scoliosis

• Sideways curvature of the spine
• Spine turns on its axis like a corkscrew
• Normal spine has a l appearance
• Scoliosis produces an S or C appearance

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Degrees of Curvature

• Scoliosis is a lateral deviation of the normal
• vertical line of the spine which, when measured
• by an X-ray, is greater than 10 degrees.

MILD
MODERATE
SEVERE
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Causes for Scoliosis

• Congenital
• Problem with the formation of vertebrae or
• fused ribs during prenatal development
• Present at birth
• Neuromuscular, Connective Tissue Chromosomal
  Abnormalities
• Caused by a neurological disorder of CNS or
  muscular weakness
• Cerebral palsy, Muscular dystrophy, Spina bifida,
  Paralysis
• Marfans Syndrome
• Downs syndrome
• Idiopathic
• Structural spinal curvature with no established
  cause
• Appears in a previously straight spine
• 80-85 of cases

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Most Common Forms
1. Right thoracic 90 of thoracic
curvatures are to the right 2. Right
thorocolumbar 3. Left lumbar 4. Double
major-S curve

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Diagnosis

• Physician Physical Exam
• Scoliometer measurements
• X Ray
• MRI

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Incidence

• 10 of population will have some degree of
  adolescent curvature
• Affects approx 1 million children in the US
• 3-5 out of every 1,000 cases are severe enough
  to require treatment
• 25 will require medical attention to monitor
  for progression
• YEARLY in the US (all forms)
• Affects 2-3 of the general population- 6
  million
• 600,000 physician office visits
• 30,000 children are treated with a brace
• 38,000 undergo spinal surgery

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Scoliosis Mythology

• Scoliosis can be caused by carrying heavy book
  bags, poor posture
• or sleeping on a bad mattress
• Sports favoring one side can cause scoliosis
• Lower back pain in adolescents is an indicator
  for scoliosis
• Scoliosis always progresses and requires some
  form of treatment
• Scoliosis is similar to osteoporosis in its
  destruction of the bone

• Scoliosis is usually painful
• Minor leg inequality will lead to scoliosis

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Weighing In on the Back Pack Issue
Children should carry no more than 10-15 of
their body weight in a backpack. Backpack should
be worn on BOTH shoulders to evenly distribute
the weight Heaviest books should be closest to
the back
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Scoliosis Facts

• Race, ethnic background socioeconomics
• do not appear to be factors
• Tends to occur in families
• Usually painless and without symptoms
• Child is generally unaware of curvature
• Untreated scoliosis of greater than 30 degrees
  can lead to back pain in adults
• 60 of curvatures in rapidly growing prepubertal
  children will progress
• Increased risk for osteoporosis gall bladder
  problems later in life
• Poor nutrition may play a role

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Girls Vs Boys

• Primary age of onset 10-15 years
• During the last major growth spurt of
  adolescence
• Time of greatest risk
• Girls 6 months before after onset of
  menstruation
• Boys Time when their voices deepen risk
• Mild scoliosis occurs equally between boys and
  girls(?)
• 1 in 10 girls vs 1 in 25 boys
• More serious curves (greater in girls than in boys.

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Scoliosis Treatment
Treatment is not needed for the vast majority
of cases

• Observation
• Minor curvatures (20 degrees)
• Skeleton is close to maturity
• Exercises may help with surrounding muscular
  strength
• Brace
• Around torso and hips
• Helps hold spine in place while it grows
• Can be removed for sports
• Surgery
• Major curvatures (
• Rapid deterioration/progression
• Generally spinal fusion

Generally physical therapy/exercises are not
effective
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Screening

• Purpose
• Identify physical characteristics that are
  suggestive
• of excessive or abnormal curvatures of the spine
• Screening is not meant to be a diagnostic exam
• or substitute for physician evaluations
• Target Population
• Adolescents during age of puberty and
  accelerated growth
• 7th graders
• Adolescents have a decreased frequency of
  routine physical exams

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Screening Program

• Cooperation between Red Cross, Sullivan County
  Schools Sullivan County Health Department
• Screening averages approx 1-2 min per student
• Screening for most schools can be completed in
  1-2 hrs
• Nurses must review scoliosis training either via
  classroom or self review module every 2 years.
  After training review each nurse will confirm
  update by signing a confirmation form and faxing
  to chapter office.

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Screening Process

• Introduction/ Overview with students
• Screen 2-3 days later allowing time for students
  to return signed parent permission form to school
• Students are segregated by sex and screened
• individually
• Follow up letters are sent to parent/legal
  guardian

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Parent Permission Form

• Permission form MUST have
• Parent signature
• YES permission given

Make sure student name, address are legible and
complete with City Zip
After screening be sure to mark Positive or
Negative and Initials BEFORE moving on to the
next student
Turn forms over so other students cannot see
their classmates form.
B
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Lets Get Started

• Observe school dress code wear Red Cross ID
• Wash hands prior to after screening
• Use hand sanitizer between students
• Sign in at school office as a visitor
• Arrive at least 15 min prior to scheduled time

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Student Considerations

• Modesty Insecurities
• Students should not be allowed to see
• each other during screening
• Face student toward wall before lifting shirt
• Pull arms out of shirt and leave around neck
• Students are told they WILL NOT have to remove
  their shirts.
• Call student by first name
• Thank student after screening

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Student position

• Be sure student holds head/chin up
• Looking forward- not down
• Lose relaxed, not tense or stiff
• Stand with feet slightly apart

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6 Step Screening Process

• Front standing position
• Back standing position
• Back bending away from you
• Side bending position
• Front bending toward you
• Side bends

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Step 1 Front View

• Shoulders should be level
• and at the same height
• Distance between arm and
• torso equal on both sides
• Crest of hips level on
• horizontal plane
• Head straight and centered

Normal
Abnormal
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Step 2 Back Standing View

• Shoulders should be level and
• the same height
• Distance between arm and
• torso equal on both sides
• Crest of hips level on
• horizontal plane
• Head straight and centered
• Scapula level on both sides

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Adams Bending Technique

• Feet slightly apart
• Palms together
• Arms outstretched with straight elbows
• Head out
• Bend forward at waist
• Place hands between legs at knee level

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Step 3 Back Bending Away

• Look For
• Rib prominence
• Lumbar Prominence
• Differences in height of hip
• crests

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Step 4 Side View

• Look for exaggerated rounding of the back
• Kyphosis

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Step 5 Bending Front View

• Shoulders level?
• Is one side of torso more
• rounded than the other?
• Look for lumbar prominence

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Step 6 Side Bends
Ask the student to bend at The waist to each
side Look for S curvatures
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Results

• Screening is subjective Trust your observations
• When in doubt ask for another opinion or mark YES
• Be sure to mark either YES or NO and sign
  initials
• Mark each students form before moving on to the
  next student

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Important Reminders

• Always double check for parent signature and
  yes box is checked
• Introduce yourself as a Red Cross Nurse
• Ask if the student has been screened previously
  or if they have a history of scoliosis
• Respect student modesty privacy during exam
• Do not ask student to completely remove top
• Maintain confidentiality

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Final Thoughts
No student can be screened unless there is a
signed permission form in hand. Parents cannot
give verbal or phone permission Students cannot
sign for parents Screen at your own
pace Screening is subjective. When in doubt ask
for a second opinion or mark Yes.
American Red Cross of Northeast Tennessee
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Scoliosis Quiz Answers

• TRUE OR FALSE
• False
• False
• False
• True
• True
• False
• Absolutely TRUE

• Lordosis
• Moderate
• Idiopathic
• 10
• 10-15