Introduction to Kyphosis

Kyphosis, also known as roundback, is an anteroposterior curving of the spine that causes a bowing of the back, commonly at the thoracic, but sometimes at the thoracolumbar or sacral, level.
Normally, the spine displays some convexity, but excessive thoracic kyphosis is pathologic. Kyphosis occurs in children and adults.

Causes

Congenital kyphosis is rare but usually severe, with resultant cosmetic deformity and reduced pulmonary function.

Adolescent kyphosis
Also called Scheuermann’s disease, juvenile kyphosis, and vertebral epiphysitis, adolescent kyphosis is the most common form of this disorder. It may result from growth retardation or a vascular disturbance in the vertebral epiphysis (usually at the thoracic level) during periods of rapid growth or from congenital deficiency in the thickness of the vertebral plates.

Other causes include infection, inflammation, aseptic necrosis, and disk degeneration. The subsequent stress of weight bearing on the compromised vertebrae may result in the thoracic hump commonly seen in adolescents with kyphosis. Symptomatic adolescent kyphosis is more prevalent in girls than in boys and usually occurs between ages 12 and 16.

Adult kyphosis
Also known as adult roundback, adult kyphosis may result from degeneration of intervertebral disks, atrophy, or osteoporotic collapse of the vertebrae that’s associated with aging; from an endocrine disorder, such as hyperparathyroidism or Cushing’s disease; or from prolonged steroid therapy.
Adult kyphosis may also result from conditions such as arthritis, Paget’s disease, polio, compression fracture of the thoracic vertebrae, metastatic tumor, plasma cell myeloma, or tuberculosis.

Shoulder Dislocation - A Brief DIscussion

Anterior shoulder dislocations are the most common and frequently caused by falling with the arm externally rotated and abducted.

Clinical Presentation: Patients present with the affected extremity held in adduction and internal rotation. Often, they complain of shoulder pain, refuse to move the affected arm, and may support the dislocated shoulder with the other arm. The acromion becomes prominent with loss of the rounded contour of the deltoid. A neurovascular examination of the upper extremity should be
performed to rule out associated injury, most commonly of the axillary nerve (sensation over the deltoid) and of the musculocutaneous nerve (sensation on the anterolateral forearm). Vascular injuries have rarely been reported to occur.

Diagnosis: Standard radiographic examination to evaluate for associated fracture should include AP and either axillary lateral or scapular views.

Anterior Shoulder Dislocation. Radiographic evaluation demonstrates that the humeral head is not in the glenoid fossa but is located anterior and inferior to it.


Posterior shoulder dislocations are commonly missed because of subtle radiographic findings.

Acromioclavicular Joint Seperation

Injury to the acromioclavicular (AC) joint usually results from an impact on the superior aspect of the acromion.

The classification system for AC joint injuries includes six types.

• A type I injury is equivalent to a stretching of the AC ligament. 
• A type II injury consists of tearing of the AC ligaments and stretching of the coracoclavicular ligaments. 
• Complete disruption of the AC and coracoclavicular ligaments is seen in types III to VI.

Clinical Features: Patients complain of pain at the AC joint and will actively splint the injured shoulder. Ecchymosis may be present; however, an obvious deformity is not always seen. There is significant tenderness upon palpation of the AC joint.

Diagnosis: Standard radiographs should include anteroposterior (AP) and axillary lateral views of the shoulder.

X ray Chest Showing Fracture Of The Left Clavicle.

A 56 years old female came to radiology department for X-ray chest with history of hypertension and pain in chest. She had a history of fall few days back but came to medical attention today.

Her X ray is shown below:

Description: X-ray chest shows normal lung fields. The examination of the film is not complete until the bones and soft tissues have also been surveyed. There is a fracture through the mid diaphysis of left clavicle with overlap of the bony fragments.

Clinical Discussion: Once the fractures of the clavicle is seen on X-ray chest,

Club Foot Deformity - A Brief Discussion

Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which the foot is twisted out of shape or position.
Also known as talipes equinovarus.
In patients with a club foot any of the following characteristics may be present, and each may vary from mild to severe:

• The foot (especially the heel) is usually smaller than normal.
• The foot may point downward.
• The front of the foot may be rotated toward the other foot.
• The foot may turn in, and in extreme cases, the bottom of the foot can point up.

Clubfoot can happen in one foot or in both feet. In almost half of affected infants, both feet are involved.
A club foot may occur as an isolated feature or, with multiple malformations else where but is usually an isolated problem for an otherwise healthy newborn.

Etiology: The cause of clubfoot is unknown (idiopathic), but it may be a combination of genetics and environment. Certain risk factors like family history, smoking in mother during pregnancy and decreased amniotic fluid may contribute to having club foot in the baby.

Clinical Features: Clubfoot typically doesn't cause any problems until the child starts to stand and walk. Although clubfoot is painless in a baby, treatment should begin immediately. Clubfoot can cause significant problems as the child grows. But with early treatment most children born with clubfoot are able to lead a normal life.

Complications: Untreated club foot can cause serious complications like: