Scheuermann’s Disease

• Scheuermann’s Disease - Pathology/Anatomy:

  • Growth disorder that is caused through osteochondrosis with degenerative changes to the disc and cartilage endplates (Singer & Fazey., 2012)
  • Results in a low thoracic kyphosis, usually involving multiple levels T7 - T9 or T10 - T12
  • May predispose to later degenerative changes in the lumbar region.
  • Normal thoracic kyphosis: 20 - 40 degrees
  • Scheuermann’s Disease Kyphosis: 45 - 75 degrees
  • Aetiology unknown

  
• Scheuermann’s Disease - Clinical Presentation:

  • History:
  • Most common cause of thoracic spine pain in adolescents (starts 13 - 16 years)
  • More common in males
  • Objective:
  • Smooth rounded kyphosis, exaggerated on flexion
  • a third will also have a scoliosis
  • Reduced spinal mobility, especially in Extension
  • Reduced hamstring length
  • Reduced iliopsoas length
  • Investigations:
  • xray - will see irregular fragmented vertebral endplates with translucent areas surrounded by sclerosis
  • MRI - irregular narrowing as well as presence of scheuermanns nodes towards endplates

  
• Scheuermann’s Disease - Conservative Management:

  • Advice and education:
  • Explain what is wrong: explain diagnosis and encourage compliance with a home exercise programme (HEP)
  • Modification particularly those that aggravate/exacerbate symptoms
  • Address fears and unhelpful beliefs
  • Symptom Control:
  • Modify postures and positions that aggravate their symptoms
  • Postural correction as able
  • In some extreme cases bracing maybe indicated
• Scheuermann’s Disease - Conservative Management:

  Build Capacity:

  • Maintain/improve mobility
  • Thoracic ROM exercises and stretches – rotation and extension
  • Strengthen/maintain strength within the thoracic spine
  • Exercises to improve/maintain muscle strength and endurance in the thoracic spine
  • Increase muscle length of hamstrings (attaches to pelvis) and iliopsoas (attaches to lumbar spine) via stretches
• Scheuermann’s Disease - Conservative Management:

  • Return to Function:
  • Advanced rehabilitation to build strength and conditioning in order for sufficiently strength, mobility and control towards specific goal/function/sporting activity
  • Continue to maintain thoracic mobility and strength to ensure necessary capacity for desired function is there
  • Graded return to activity
• DO THE CASE STUDY FOR THIS LECTURE WHEN REVISING!!