—– Original Message —–=20
From: David Gerecke=20
To: Orthotics and Prosthetics List=20
Sent: Tuesday, September 21, 2004 1:21 PM
Subject: Thoracic hyperextension brace recap
Original post:
Esteemed Colleagues,
A patient was recently referred to me with a prescription for a =
“Thoracic hyperextension brace”. Diagnosis given was “Shermans =
Epiphysitis”. No level was given. No X-rays. No obvious kyphotic =
deformity. No symptoms other than back pain. 14 y/o male active in =
multiple sports. MD on vacation until next week. I think he meant =
Scheuermann’s kyphosis. Advice?
Thank you,
David Gerecke, CPO, FAAOP
Seattle Prosthetic and Orthotic Associates
After speaking with the Physician, I found that the level was T5-8. The =
amount of deformity was not clinically significant. The only symptom is =
back pain. The Physician wanted a brace for “some support and a postural =
reminder”. The patient is also starting Physical Therapy. We discussed =
possible orthotic options, and he felt a dorsolumbar corset was the best =
solution at this time. The patient was fit with an appropriately sized =
D/L corset and with PT, is doing well.
Note the wide variety of recommendations in the responses. I think the =
key is to fill in the prescription and diagnosis blanks before =
proceeding. As usual, the names and email addresses have been removed to =
protect confidentiality. Thanks to all who responded.
David
a.. Sounds like this guy needs a Milwaukee brace, if he truly has =
Scheurman’s disease.=20
b.. I would put a Dosi-lumbar corset on the boy.=20
c.. Found this in a Merck Manual.
It is listed as Scheuermann’s epiphysitis and not Shermans.
Did not find anything under the MD’s term.
Have a good Labor Day Weekend=20
d.. Bivalved custom TLSO. Cast standing with thoracic region =
hyperextended.=20
e.. It is the same thing. Scheuermanns’s Disease is an disturbance the =
epiphyseal plates in the anterior portion of the thoracic spine, =
basically=20
deficient growth anteiorly, and normal growth posteriorly, resulting =
in a=20
khyphotic presentnation. It is also known as vetebral epiphysitis. =
Hope this=20
helps.=20
f.. You have to know really that your patient has schuermann or =
not.According to your e-mail you didn’t see any symptoms of schuermann, =
and it is very strange.any way hyper extension brace is not benefit for =
schuermann as you know. because usually kyphotic area is in level that =
Milwaukee brace can help.
I hope it is benefit for you.
g.. Your probably right as Scheuermann’s involves the epiphyseal =
plate. I have had a physician prescribe a Jewett for Scheuermann’s =
kyphosis (pt. was similar age). The disease process usually occurs at a =
vertebral level too high for this to be effective. I did try a Taylor =
on the patient with the physicans approval. She had very good long term =
results. The key here is to slow/prevent deformity during the stages of =
the disease process. I would give the Dr. a call. Knowing the =
vertebral level would be helpful.=20
h.. Not the greatest scenario but cast him supine, hips and knees =
flexed with a
doubled towel at the apex of T7-8 (inferior scapula). Try to get =
x-rays
from MD’s office in interim to help dial in posterior trimline. a =
cutout
over abdomen and lower ribs on the anterior section will provide more
comfort. I have seen this diagnosis before but we are use to the =
diagnosis
scheurmans kyphosis but your management of the pt. wont change.
i.. It sounds like the referring physician is leaving it up to you to =
select the most appropriate thoracic hyper. ext. brace for a 14 y/o =
male. I would play it safe and use a jewit hyper. ext. to control =
sternoclavicular to symphysis pubis.
j.. ADVICE??? Rx called for hyperextension brace…obvious??? DOesn’t =
have to be
Don’t second guess an orthopedic…whose office staf may have written =
in the
dx…fit him immediately…Jewitt..my first choice…mother’s hug my
second…cash third… this was covered in the first sememster at my
school…Edicate was covered the first week
