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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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