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Condition/Disorder Synonyms

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  • Scheuermann's disease

  • Juvenile disk disease

  • Roundback

  • Hunchback

  • Postural kyphosis

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ICD-9-CM Codes

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  • 737 Curvature of spine

  • 737.0 Adolescent postural kyphosis

  • 737.1 Kyphosis (acquired)

  • 737.10 Kyphosis (acquired) (postural)

  • 737.11 Kyphosis due to radiation

  • 737.12 Kyphosis postlaminectomy

  • 737.19 Other kyphosis acquired

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ICD-10-CM Codes

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  • M40.00 Postural kyphosis, site unspecified

  • M40.209 Unspecified kyphosis, site unspecified

  • M96.2 Postradiation kyphosis

  • M96.3 Postlaminectomy kyphosis

  • M40.299 Other kyphosis, site unspecified

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Preferred Practice Patterns1

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Key Features

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Description

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  • Excessive posterior curvature of the thoracic spine

  • Scheuermann's disease (juvenile disk disease) caused by wedging of several vertebrae

  • Postural kyphosis: from slouching or poor posture

  • Congenital kyphosis: under-development of the spinal column

  • Gibbus deformity: structural kyphosis from tuberculosis

  • Types of kyphotic deformities

    • Round back

      • Decreased pelvic inclination with thoracolumbar or thoracic kyphosis

      • Caused by tightness in soft tissues from prolonged postural change

      • Compensatory mechanism to maintain body's center of gravity

    • Hunchback (hump back)

      • Gibbus: localized, sharp, posterior angulation

      • Structural cause

        • Anterior wedging of 1 to 2 thoracic vertebrae bodies

        • Wedging may be caused by fracture, tumor, bone disease

      • Pelvic inclination usually normal

    • Flat-back

      • Decreased pelvic inclination

      • Thoracic spine remains mobile

      • Kyphosis present

      • Does not have appearance of excessive kyphotic curve

    • Dowager's hump

      • Secondary to postmenopausal osteoporosis

      • Anterior-wedge fractures of several upper or middle thoracic vertebras

      • Contributes to decrease in height

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Essentials of Diagnosis

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  • Diagnosis usually made by clinical examination

  • Can be an independent diagnosis, not associated with a disease process

  • Cobb angle measures degree of scoliosis

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General Considerations

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  • Respiratory problems secondary to changes in rib-cage space

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Demographics

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  • Women affected more frequently than men due to postmenopausal alteration

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Clinical Findings

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Signs and Symptoms

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  • Pain and stiffness at rest/sleep

  • Inability to sleep supine

  • Stiffness in the spine

  • Pain in the upper and middle thoracic spine

  • Tight pectoral, hamstring, hip flexor muscles

  • Fatigue

  • Overstretched and weak middle-/lower-trapezius and rhomboid muscles

  • Local tenderness with palpation seen in vertebral compression fractures

  • Scapular winging

  • Forward head positioning

  • Weak spinal extensors

  • Tight cervical extensors

  • Weak cervical flexors

  • Respiratory problems

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Functional Implications

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  • Pain while in supine position without head-of-bed elevation

  • Difficulty reaching overhead

  • Decreased endurance secondary to impaired pulmonary capacity

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Possible Contributing Causes

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  • Poor posture

  • Poor nutrition: rickets

  • Osteoporosis

  • Degeneration of intervertebral discs

  • Vertebral compression fractures

  • Endocrine disorders

  • Arthritis

  • Paget's disease

  • Metastatic tumor

  • Infection

  • Scheuermann's disease

  • Ankylosing spondylitis

  • Spina bifida

  • Polio

  • Neurofibromatosis

  • Tuberculosis

  • Spondylolisthesis

  • Cerebral ...

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