My first post...we visit orthopedist at 2pm today

[cello_mom]

Hello!

I am glad to have found a place like this.

My DD is just 12, and at her annual check up the ped noticed a hump during her scoliosis screening. She referred us for an x ray, and then called and told us to make an appointment with the orthopedic surgeon (he specializes in pediatrics. He set a broken wrist for DD many years ago).

I received a copy of the radiologist report and x rays on disk. It says:

"INDICATION: iliopsoas

FINDINGS: There is S shaped thoracolumbar scoliosis. The superior apex is right-sided at the level of T8, measured at 21 degrees. The inferior apex is left-sided at the level of L2-L3, measured at 22 degrees. Neither curve complete corrects with lateral bending. No segmentation or other congenital abnormalities are identified."

DD12 has not gone through puberty yet. Am wondering as I approach this first meeting anything I should be prepared for? I've spent the weekend researching online. Do you think such degrees will require bracing or monitoring?

[LindaRacine]

Hi...

It depends on the orthopaedist. I wouldn't do anything until your daughter can be seen by a scoliosis specialist. You can find a list of specialists here:

http://www.srs.org/find/

Does your daughter play the cello? I ask because there has been some conjecture that playing cello is a risk factor for scoliosis. As far as I know, there is no research to prove a correlation, but I've heard this mentioned several times.

Regards,
Linda

[Pooka1]

Does your daughter play the cello? I ask because there has been some conjecture that playing cello is a risk factor for scoliosis. As far as I know, there is no research to prove a correlation, but I've heard this mentioned several times.


Structural or functional?

[cello_mom]

We saw him today and he measured her spine and said he thought she was more like 20 than 21 or 22. He recommended we come back in 6 months for an xray and a re check.

Yes, she does play the cello and I can't imagine how that would have anything to do with scoliosis.

[LindaRacine]

Structural or functional?
I don't know, but YoYo Ma had to have surgery, so I would assume his was structural. Maybe it starts out as functional and becomes structural over time.

--Linda

[LindaRacine]

We saw him today and he measured her spine and said he thought she was more like 20 than 21 or 22. He recommended we come back in 6 months for an xray and a re check.

Yes, she does play the cello and I can't imagine how that would have anything to do with scoliosis.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2802%2911992-1/fulltext

Ergonomic pathology of Luigi Boccherini
Rosalba Ciranni, Gino Fornaciari

Paleopathological study of the famous Italian musician Luigi Boccherini (figure) allowed elaboration of an ergonomic model peculiar to Baroque cellists.1, 2 The model was based on acquired lesions diagnosed on his skeleton, which has been exhumed in Lucca, Tuscany, and on assessment of a present-day cellist, during a performance of one of Boccherini's adagios, with a Baroque cello.

The bow is strenuously pushed and pulled on the keyboard, leading to stretching and flexion of the right thumb. Boccherini, spent his life playing the cello and therefore his thumb joint was subjected to this repeated movement, which evolved into rhizoarthritis of the right thumb.

The left hand holds the neck of the cello and, simultaneously, the fingers are moved on the keyboard; during these actions the elbow, arm, and shoulder are constantly moved, causing severe left epicondylitis in Boccherini.

The Baroque cello is smaller than a normal cello, without the point. The absence of this point means the musician must hold the instrument with a tonic contraction of the knees and legs, causing Boccherini to have varism of the tibiae.

The sitting position, with knees and hip bent close to 90° and thighs and torso at 90° too, causes loss of cervical and lumbar lordosis.3, 4 The position of the body on the instrument, bent at the front and on the right, leads to left- convex scoliosis, at a maximum on T3 and T4.

Even if the left forearm and left scapular truss showed muscle insertions stronger than those on the right, Boccherini was not a left-handed individual: the greater upper-left muscular development was attributable to the natural conformation of the cello.

Acquisition of the cello's point and its raised height have reduced the possibility of valgism and scoliosis, but the cello player is still forced to maintain an unnatural position, making the described ergonomic model partly superimposable to that of contemporary cello performers.

[Pooka1]

I don't know, but YoYo Ma had to have surgery, so I would assume his was structural. Maybe it starts out as functional and becomes structural over time.

--Linda

Wow. Good to know.

[cello_mom]

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2802%2911992-1/fulltext

Acquisition of the cello's point and its raised height have reduced the possibility of valgism and scoliosis, but the cello player is still forced to maintain an unnatural position, making the described ergonomic model partly superimposable to that of contemporary cello performers.

This article discusses the malformed spine of a long dead cellist who played an obsolete instrument. It's more likely the fact he lived in the Baroque period than he played the cello that had anything to do with it. I think you over estimate how much my daughter practices! ;-)

[leahdragonfly]

Hi Cello Mom,

I'm glad you've found us, although of course sorry to hear of your daughter's mild scoliosis. Her curves are under the cusp for bracing for AIS, which is great news. She will definitely need regular monitoring and periodic x-rays until she is done growing at around age 14-16.

I would encourage you to find a pediatric scoliosis specialist to follow her. A general pediatric ortho who also sets broken bones etc may not really see enough pediatric scoliosis cases to give your daughter the most up-to-date care. You can search at www.srs.org and search by geographic location, then "adolescent".

BTW, while the above posts about cellists and scoliosis may be interesting, your daughter's curves are very typical in location of garden-variety AIS, and not the same direction or levels that are mentioned above. You could of course always ask your daughter's ortho if there was any question about the cello playing!

Good luck, and please do ask any questions you may have here.

[cello_mom]

Thanks Gayle!

I was relieved to hear bracing was not called for immediately and hope she will be one of the 80% of 20-degree curves that doesn't progress. I surely hope so!

I did check the list and may refer to it if/when they decided to do treatment. Our doctor seems very good to our eyes:


Dr. (name removed for privacy reasons) received his M.D. from the University of Illinois in 1985 and completed his Orthopedic Surgery Residency at Northwestern University in 1990. He continued his program at Shriner's Hospital in Los Angeles, California where he achieved a Fellowship in Pediatric Orthopedics in 1991.

Dr. (name) joined (this office) in 1991 and remains an Assistant Professor of Clinical Orthopaedic Surgery at Northwestern University. In addition to his relationship as a member of the staff of (local big hospital), Dr. (name) is also an attending physician at Children's Memorial Hospital and a consulting physician at the Rehabilitation Institute of Chicago.

Dr. (name) practices General Orthopedic Surgery with an emphasis in Pediatric Orthopedic illness and injury.

[leahdragonfly]

Hi there,

I hope your daughter will be in the lucky group, too!

Your orthopedist sounds good, may be fine for monitoring for now if you like him, however he is not a SPINE specialist and that would be very important to me in selecting a physician to treat my child's scoliosis.

Good luck, keep us posted!

Gayle

[Resilience]

Best wishes for your family and your daughter as you begin this journey.

I agree that while your General Pediatric Ortho may be great, I would also recommend an opinion from a Pediatric Scoliosis Specialist.

Very interesting reading re the Cello. When my daughter was first diagnosed and I was talking to everyone about it the first thing that two friends said to me, one a Sports Medicine Physician and the other a Physical Therapist was to have my daughter do symmetrical activities not one hand dominant sports like tennis or golf. Neither were her thing, but she has been an avid hulla hooper and now she still occasionally does it but she knows to change directions. I have looked for research about this and have never found it but it seems like with a Scoli patient that you'd want to have symmetrical paraspinal and core muscle development. Just my two cents.

All the best to you.

[mariaf]

I also want to extend my best wishes to you and your daughter as you begin this journey. I agree with Resilience and Gayle that I would want my child under the care of a pediatric orthopedic surgeon who specializes in scoliosis.

Best of luck and please keep us posted.

[Lkershner]

I went to an arts High School and have played violin for 20+ years.
Although I don't play as intensively as I used to I used to play 3+ hours a day. The posture required is not natural. Lean to the left... left arm elbow down... right arm out and elbow out. Why not a correlation with violin, then?

I've know many cellists since grade 2 (over 20 years) and not a single one of them I know has been diagnosed with scoliosis.

I do know, however, that the vertebra in the top portion of my neck are rotated although the remainder of my posture is normal. This is most likely from my 3+ hours of daily practicing and playing throughout the growth period of my life. You would never know unless you saw one of my x-rays, though, and I have 0 pain (from that, alyways! We won't talk about the herniated disk from a fall.... that's belongs to a different forum, I believe.)


Just food for thought-
:)

Madisyn's mom

DD Madisyn
58 degrees upper
48 degrees lower
Waiting for surgeon opinion #2 at Shriners Tampa tomorrow