Thoracic hyperextension brace recap
David Gerecke
Description
Collection
Title:
Thoracic hyperextension brace recap
Creator:
David Gerecke
Date:
9/21/2004
Text:
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.
b.. I would put a Dosi-lumbar corset on the boy.
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
d.. Bivalved custom TLSO. Cast standing with thoracic region hyperextended.
e.. It is the same thing. Scheuermanns's Disease is an disturbance the
epiphyseal plates in the anterior portion of the thoracic spine, basically
deficient growth anteiorly, and normal growth posteriorly, resulting in a
khyphotic presentnation. It is also known as vetebral epiphysitis. Hope this
helps.
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.
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
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.
b.. I would put a Dosi-lumbar corset on the boy.
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
d.. Bivalved custom TLSO. Cast standing with thoracic region hyperextended.
e.. It is the same thing. Scheuermanns's Disease is an disturbance the
epiphyseal plates in the anterior portion of the thoracic spine, basically
deficient growth anteiorly, and normal growth posteriorly, resulting in a
khyphotic presentnation. It is also known as vetebral epiphysitis. Hope this
helps.
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.
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
Citation
David Gerecke, “Thoracic hyperextension brace recap,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/223712.
