A study of the diagnostic accuracy and reliability of the Scoliometer and Adam's forward bend test

STUDY DESIGN: Study of the diagnostic accuracy and interexaminer reliability of scoliosis diagnostic tests. OBJECTIVES: To estimate the sensitivity, specificity, and predictive value of the Scoliometer (National Scoliosis Foundation, Watertown, MA) and Adam's forward bend test in diagnosing scoliosis, and to determine the interexaminer reliability of the Scoliometer and Adam's forward bend test. SUMMARY OF BACKGROUND DATA: Exposure to diagnostic radiation in patients with adolescent idiopathic scoliosis may result in a small but significant increase in cancer rates. The full-spine radiographic examination remains the standard procedure for the assessment of scoliosis. There is a need for a valid and reliable noinvasive test to assess scoliosis. METHODS: Two examiners independently assessed 105 patients presenting to a scoliosis clinic for trunk asymmetry with Adam's forward bend test and axial trunk rotation with the Scoliometer. The Cobb method served as the gold standard. RESULTS: The interexaminer agreement for the Scoliometer is excellent in the thoracic spine and substantial in the lumbar spine. The interexaminer measurement error shows poor precision for thoracic and lumbar Scoliometer measurements. The interexaminer agreement for Adam's forward bend test is substantial in the thoracic spine and poor in the lumbar spine. Adam's forward bend test is more sensitive than the Scoliometer in detecting thoracic curves measuring 20 degrees or more by the Cobb method. Receiver operating characteristic curve analysis suggests that the use of the Scoliometer marginally improves the ability of diagnosing a scoliosis in the thoracic spine. CONCLUSIONS: The Scoliometer and Adam's forward bend tests have adequate interexaminer reliability for the assessment of thoracic curves. The Scoliometer has better interexaminer agreement in the lumbar spine. However, the Scoliometer has a high level of interexaminer measurement error that limits its use as an outcome instrument. Because Adam's forward bend test is more sensitive than the Scoliometer, the authors believe that it remains the best noninvasive clinical test to evaluate scoliosis.     

Hemifacial hypoplasia and hypomelanosis of Ito

Seventy patients with adolescent idiopathic right thoracic scoliosis had full assessment of their pulmonary function using a computerised pulmonary function system. Their mean age at evaluation was 13.8 years. The following measurements were obtained from anteroposterior and lateral standing and antero-posterior supine bending radiographs: lateral curvature, vertebral rotation, kyphosis, maximum sterno-vertebral distance and apical rib-vertebral angles. Using the above measurements, the flexibility of curve, vertebral rotation and rib-vertebral angle asymmetry were calculated. Patients were classified into three groups on the basis of their predicted vital capacity, to determine whether radiological features of deformity can help identify patients with compromised pulmonary function. The mean Cobb angle and vertebral rotation for the 70 patients were 50 degrees (range 35-100 degrees) and 22 degrees (range 1-44 degrees) respectively. The mean flexibility of curve and vertebral rotation were 52% and 49% respectively. Mean thoracic kyphosis was 25 degrees, ranging from -7 to 55 degrees. Of the patients with Cobb angle less than 90 degrees, 71% had vital capacity less than 80% of predicted values, and of these, 18% had marked compromise of vital capacity (less than 60% of predicted values). Mean values of Cobb angle, vertebral rotational flexibility, kyphosis, rib-vertebral angle asymmetry (in standing as well as supine bending radiographs) differed significantly between patients with more than 80% of predicted vital capacity and those with 60% or less of predicted values. Radiological features indicative of better pulmonary function were: rotational flexibility exceeding 55%, rib-vertebral angle asymmetry (standing) less than 25 degrees and kyphosis greater than 15 degrees. Two deformity parameters--that give a better prediction of pulmonary function than the widely used Cobb angle, vertebral rotational flexibility and rib-vertebral angle asymmetry--were identified in this study.     

The lordotic effect of the OSI frame on operative adolescent idiopathic scoliosis patients

STUDY DESIGN: A prospective evaluation of adolescent idiopathic scoliosis patients undergoing operative treatment on the Orthopedic Systems Incorporated (OSI; Jackson) frame. OBJECTIVES: To investigate prospectively thoracic, thoracolumbar, and lumbar sagittal alignments in patients with adolescent idiopathic scoliosis who undergo an instrumented posterior spinal fusion on the OSI frame. SUMMARY OF BACKGROUND DATA: In several studies, it has been shown that patient positioning on various operative frames is an important component of ultimate lumbar sagittal alignment. However, these studies have all concentrated on the lumbar spine, and no sagittal plane alignment data in adolescent idiopathic scoliosis patients have been reported in the thoracic and thoracolumbar junction as it relates to intraoperative positioning, correction maneuvers and correlative postoperative results. METHODS: Thirty-nine patients with operative adolescent idiopathic scoliosis treated with an instrumented posterior spinal fusion on the OSI frame were prospectively evaluated. Standing preoperative, intraoperative, and postoperative long-cassette lateral radiographs were reviewed with regional and segmental Cobb measurements of the thoracic, thoracolumbar junction, and lumbar spine obtained. RESULTS: Thoracic kyphosis (T1-T12) measured +34 degrees before surgery, +28 degrees during surgery, and +30 degrees after surgery, Thus, a statistically significant decrease was noted in thoracic kyphosis secondary to prone positioning on the OSI frame ( P < 0.05). Thoracolumbar spine measurements from T10 to L2 also showed a lordotic trend from +2 degrees before surgery, to -4 degrees during surgery, to -8 degrees after surgery, which was also statistically significant (P < 0.05). Total lumbar lordosis from T12 to S1 remained relatively unchanged from -60 degrees before surgery, to -59 degrees during surgery, to -60 degrees after surgery. However, segmental lumbar lordosis measured from T12 to the lowest instrumented vertebra showed a statistically significant increase in lordosis from -17 degrees before surgery, to -19 degrees during surgery, to -23 degrees after surgery (P < 0.05). Those patients in whom lumbar pedicle screws were used (vs. hooks alone) had the greatest increase in lumbar instrumented lordosis. CONCLUSIONS: Performing adolescent idiopathic scoliosis correction on the OSI frame tends to decrease thoracic kyphosis, increase thoracolumbar lordosis, and increase segmental instrumented lumbar lordosis, while it maintains total lumbar lordosis.     

Agreement between rectal and tympanic membrane temperatures in marathon runners

STUDY OBJECTIVE: To determine the agreement between rectal temperature and infrared tympanic membrane temperatures in marathon runners presenting to a field hospital at the finish line. METHODS: The subjects of this prospective, blinded, controlled study were runners 18 years or older who were triaged to the acute care medical area at the finish line for suspected hypothermia, hyperthermia, dehydration, or altered mental status. Rectal and tympanic temperatures were measured simultaneously in all subjects for whom rectal temperature measurement had been deemed necessary and recorded on separate data cards. RESULTS: Of the 239 runners treated in the acute care medical area, 37 required rectal temperature measurement and were enrolled in the study. The mean rectal temperature was 38.45 degrees +/- 1.20 degrees C (range, 35.9 degrees to 41.5 degrees C). The mean tympanic membrane temperature was 37.81 degrees +/- 95 degrees C (range, 36.3 degrees to 40.4 degrees C). Pearson's correlation coefficient revealed a moderate correlation (r = .6902, P = .00023). The mean temperature difference between the two thermometers, mean rectal minus mean tympanic membrane, was .64 degrees C (95% confidence interval, .35 degrees to .93 degrees C). Sixty-Two percent of the tympanic membrane readings were within 1 degree C of their rectal counterparts. Agreement ranged from 1.16 degrees (+2 SD) to -2.95 degrees (-2 SD). The 95% confidence interval was 1.67 degrees to -2.95 degrees C. CONCLUSION: We were able to demonstrate only a moderate correlation between the two thermometer readings, with a wide spread between the limits of agreement. This spread could be clinically significant and therefore limits the usefulness of tympanic temperature in the marathon race setting. Because of the potentially large and clinically significant differences in rectal and tympanic temperatures and the limitations inherent in our study, we cannot endorse the use of tympanic temperature in the setting of a marathon event.     

Severe rhabdomyolysis with renal failure after intranasal cocaine use

Torsion of a long bone is the twist along its longitudinal axis; torsion of the radius is defined by the angle between the proximal and distal metaphyses in the transverse plane. Measurement of the radial torsion angle provides a means of detection and quantification of malrotation after a fracture. The purpose of the current study was to develop and standardize a technique for the measurement of torsion of the radius. Axial computerized tomographic images of thirty-nine pairs of dry cadaver specimens of normal radii, and an additional four pairs of radii with a unilateral deformity of the distal metaphysis that was consistent with a previous fracture, were studied and a measurement protocol was established. The radial torsion angle was measured by three independent observers on two separate occasions. Reproducibility of the technique was determined with use of the intraclass correlation coefficient to express both interobserver and intraobserver reliability. Consistency of measurements between observers and by the same observer was high, with intraclass correlation coefficients ranging from 0.87 to 0.94. The mean torsion angle for the eighty-two normal radii in the study was 32.6 degrees (95 per cent confidence interval of the mean, 30.3 to 34.9 degrees; range, 1.4 to 58.8 degrees). There were small variations in torsion angle between the two radii of each normal pair (mean side-to-side difference, 4.9 degrees; 95 per cent confidence interval of the mean, 3.5 to 6.3 degrees). The mean torsion angle of the four radii with a malunited fracture was 10.4 degrees (95 per cent confidence interval of the mean, 5.7 to 15.1 degrees), and the mean side-to-side difference in the pairs containing these radii was 24.1 degrees (95 per cent confidence interval of the mean, 8.5 to 39.6 degrees; p < 0.0001 compared with the normal radii).     

Relation between adolescent idiopathic scoliosis and morphologic somatotypes

STUDY DESIGN: A prospective and controlled comparative study. OBJECTIVES: To verify the difference in morphologic appearance between a group of adolescents with progressive adolescent idiopathic scoliosis and a control group of normal adolescents. SUMMARY OF BACKGROUND DATA: In a previous retrospective study, the possibility of a relation between progressive adolescent idiopathic scoliosis and specific morphotypes was demonstrated. METHODS: Fifty-two adolescent girls with progressive adolescent idiopathic scoliosis were compared with an age-matched control group of 62 unaffected girls using a classification technique based on morphologic somatotypes. Morphotypes were evaluated with standardized pre-established criteria based on Sheldon's technique. RESULTS: Patients with progressive adolescent idiopathic scoliosis showed significantly less mesomorphism (mean value of 0.88 +/- 0.51) than control girls (mean value of 1.72 +/- 0.52). CONCLUSION: Adolescent girls with progressive adolescent idiopathic scoliosis have a morphologic somatotype that is different from the normal adolescent population. Subjects with progressive adolescent idiopathic scoliosis are significantly less mesomorphic than control girls. This observation may be of value as a predictive factor for early identification of subjects with adolescent idiopathic scoliosis at greater risk of progression.     

Agreement and repeatability of infrared pupillometry and the comparison method

OBJECTIVE: To evaluate the accuracy and repeatability of the widely used comparison method of measuring pupil size. DESIGN: Cross-sectional study. PARTICIPANTS: Fourteen eyes of seven healthy myopic subjects were examined. INTERVENTION: Two examiners made two repeated measures of pupil diameters of 14 eyes using Rosenbaum card comparison pupillometry and infrared pupillometry. Subjects fixated on a distant visual acuity chart, and pupils were measured under three luminance conditions. The agreement and inter-rater repeatability of both methods were determined. MAIN OUTCOME MEASURES: Outcomes were pupil diameters, limits of agreement, and coefficient of repeatability of two examiners. RESULTS: The mean difference between the two techniques ranged from 0.3 to 0.5 mm. The limits of agreement within two standard deviations ranged from 2.4 to 2.8 mm. Coefficient of repeatability ranged from 0.6 to 1.4 mm for infrared pupillometry and 1.0 to 1.2 mm for Rosenbaum pupillometry. Inter-rater repeatability of Rosenbaum pupillometry was consistently pupil diameter biased. Pupil diameters measured with the Rosenbaum method were consistently larger than diameters measured with the infrared technique for both examiners under all luminance conditions. CONCLUSIONS: Results indicate that although the mean difference in techniques was small, the range of the agreement between the Rosenbaum and the infrared techniques was large. The Rosenbaum method consistently overestimated pupil diameters and was subject to inter-rater repeatability bias. Rosenbaum pupillometry may not be appropriate when accurate pupil measurements are required. The results have implications for many clinical trials in ophthalmology, including those evaluating refractive surgery that use Rosenbaum comparison pupillometry.     

Adolescent idiopathic scoliosis: an update

Adolescent idiopathic scoliosis is defined as a lateral spinal curvature of greater than 10 degrees, for which no pathologic cause can be determined. The initial assessment of adolescents with scoliosis focuses on identification of any treatable underlying pathology. Adolescents with scoliosis typically are asymptomatic and have normal neurologic and physical examinations, with the exception of curvature of the spine. Treatment strategies are determined by the risk of progression. This risk depends on the extent of the curvature and anticipated future spinal growth. The extent of the curvature may be estimated by use of a scoliometer and verified by calculation of the Cobb angle on radiographic evaluation. Skeletal maturity may be estimated by several methods, including radiologic estimates of ossification by bone atlas or Risser sign. Treatment strategies include bracing and surgery.     

Interobserver reliability of digital and endovaginal ultrasonographic cervical length measurements

OBJECTIVE: Our purpose was to prospectively evaluate the interobserver reliability of digital and endovaginal ultrasonographic cervical length measurements. STUDY DESIGN: Forty-three women were recruited from our antepartum clinic to participate in this study. Two independent and blinded digital cervical examinations were performed by the first author and a second examiner. Instructions were given to estimate the cervical length in millimeters. After micturition endovaginal ultrasonographic cervical length measurements were performed by two independent, blinded registered diagnostic medical sonographers. Cervical lengths were compared with the Student t test and Pearson's correlation coefficient. A kappa statistic was calculated for interobserver reliability at three levels of agreement +/- 1 mm, +/- 4 mm, and +/- 10 mm. Data are expressed as means +/- SD. RESULTS: Digital cervical lengths were not different between the two examiners (18.7 +/- 4.8 mm, 20.5 +/- 6.2 mm) nor between the two ultrasonographic measurements (38.6 +/- 6.1 mm, 39.2 +/- 5.4 mm). The digital cervical lengths agreed (+/- 1 mm) 35% of the time (R2 0.10, p = 0.02). The endovaginal ultrasonographic measurements agreed (+/- 1 mm) 74% of the time with a stronger correlation (R2 0.53, p = 0.0001). The kappa statistic for interobserver variability was marginal for both digital and endovaginal cervical length measurements when agreement was defined as +/- 1 mm. Endovaginal ultrasonography was significantly more reliable than digital examination when agreement between examiners was defined as either +/- 4 mm or +/- 10 mm. CONCLUSION: Although both digital and endovaginal ultrasonographic cervical length measurements show correlation between examiners, endovaginal ultrasonography is significantly more reliable when agreement is defined as > or = +/- 4 mm. Serial cervical length measurements to predict preterm labor will be enhanced by the interobserver reliability of endovaginal ultrasonography.     

Interobserver reliability in quantitative MRI assessment of temporomandibular joint disk status

OBJECTIVE: The purpose of this study was to investigate interobserver reliability of a new technique for quantification of magnetic resonance images of temporomandibular joint disk status. STUDY DESIGN: Sixty magnetic resonance images of adolescent temporomandibular joints were randomly drawn for analysis. Four experienced observers traced the articular disk and osseous structures on sagittal magnetic resonance slice images. Quantitative measurements of disk length and disk displacement were recorded for each slice of 57 joints traced by each observer through use of a new quantification technique. Intraclass correlation coefficients were computed to assess interobserver agreement in the tracing of joint structures. RESULTS: The calculated intraclass correlation coefficient was 0.681 for disk length and 0.830 for disk displacement. In addition, the mean variability among observers was 1.041 mm for measurement of disk length and 0.972 mm for measurement of disk displacement. CONCLUSIONS: Interobserver agreement is high when the new quantification technique is used to interpret magnetic resonance images.     

Further analysis of the reliability of the posterior tangent lateral lumbar radiographic mensuration procedure: concurrent validity of computer-aided X-ray digitization

OBJECTIVE: To investigate the reliability of a specific method of radiographic analysis of the geometric configuration of the lumbopelvic spine in the sagittal plane, and to investigate the concurrent validity of a computer-aided digitization procedure designed to replace the more tedious and time-consuming manual measurement process. DESIGN: A blind, repeated-measures design was used. The results of radiographic measures derived through the traditional manual marking method were compared with measures derived by computer-aided digitization of lateral lumbopelvic radiographs. SETTING: Private chiropractic clinic. MAIN OUTCOME MEASURES: Pearson's product-moment correlation coefficients, paired sample t tests and intraclass correlation co-efficients (ICC) were used to examine intraexaminer reliability, and repeated measures of analysis of variance were used to examine interexaminer reliability for relative rotation angles for T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, L5-S1, overall lordosis measurement [absolute rotation angle (ARA)] from L1-L5 and Cobb angle of overall lordosis measured from the inferior surface of T12 to the superior surface of S1, Ferguson's sacral base angle to horizontal, angle of pelvic tilt (arcuate angle) to horizontal and anteroposterior thoracic translation (Sz) in millimeters. RESULTS: ICC estimates for intraexaminer reliability were in the range of 0.96-0.98 for the L1-L5 ARA, a range of 0.87-0.99 for the arcuate angle measurement, 0.83-0.94 for the Ferguson's angle measurement, 0.88-0.95 for the Cobb angle measurement from the inferior surface of T12 compared with the superior surface of S1 and 0.98-1.00 for the translation measurement of the lower thoracic spine to S1 (Sz). The intersegmental measurement's (T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, L5-S1) correlations ranged from a low of 0.55 to a high of 0.97. Examination of these findings suggests that the reliability for the three doctors is acceptable with only the T12-L1 intersegmental measure falling below 0.70 for the least experienced examiner. Average ICC of interexaminer reliability for manual and computer-aided digitizing examiners were the following: 0.96 for the L1-L5 ARA; 0.84 for the arcuate angle measurement; 0.82 for the Ferguson's angle measurement; 0.88 for the Cobb angle measurement; 1.00 for the Sz translation measurement; and values of 0.65, 0.73, 0.74, 0.75, 0.89 and 0.81 for relative rotation angle measurements T12-L1, L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1, respectively. CONCLUSION: The data tend to support the reliability of this method of radiographic analysis of the geometric configuration of the lumbopelvic spine as viewed on lateral lumbopelvic radiographs. The additional data presented here tend to support the concurrent validity of the computer-aided digitization method of analysis inasmuch as the measures determined by the digitizing examiners are essentially identical to those determined by the manual method plus or minus the average standard error of measure of each value.     

Natural history of scoliosis in spastic cerebral palsy

BACKGROUND: Although the frequent occurrence of scoliosis in patients who have spastic cerebral palsy is well known and surgical treatment has often been recommended for these patients, little is known about the natural history of scoliosis in this population. We aimed to clarify the natural history of scoliosis from childhood through to adulthood and provide objective data on proper surgical indications for such patients. METHODS: The participants were 37 institutionalised patients with severe spastic cerebral palsy and scoliosis. All the participants had a series of radiographs taken, starting at a mean age of 7.8 years; they were followed up for an average of 17.3 years. We retrospectively reviewed radiographs and assessed the effect of five factors on progression of scoliosis: sex, degree of spasticity, initial physical capability, pattern of spinal curve, and location of curve. FINDINGS: Scoliosis usually started before the age of 10 years and progressed rapidly during the growth period. In many cases, even after growth had ended, continuous progression was seen. The mean magnitude of the curves at final examination was 55 degrees (Cobb angle). In 11 (85%) of 13 patients who had a spinal curve of more than 40 degrees before age 15 years, the scoliosis progressed to more than 60 degrees by the time of the final examination. Meanwhile, in only three (13%) of 24 patients who had a curve of less than 40 degrees at age 15 years, did the scoliosis progress to more than 60 degrees. Severe scoliosis (> or = 60 degrees) developed predominantly in those who had total body involvement (67%), were bedridden (100%), or had throacolumbar curves (57%). INTERPRETATION: The risk factors for progression of scoliosis in spastic cerebral palsy are: having a spinal curve of 40 degrees before age 15 years; having total body involvement; being bedridden; and having a thoracolumbar curve. Patients with these risk factors might benefit from early surgical intervention to prevent progression to severe scoliosis.     

Cut-off point of the Scoliometer in school scoliosis screening

STUDY DESIGN: A large-scale study on school screening for scoliosis was conducted to assess the referral rate, prevalence rate, and positive predictive value using different angles of trunk rotation as criteria for referral. OBJECTIVE: To determine an ideal angle of trunk rotation cut-off point to be used for referral in school screening for scoliosis. SUMMARY OF BACKGROUND DATA: When using the Scoliometer (Orthopedic Systems, Inc., Hayward, CA) in school scoliosis screening, 5 degrees and 7 degrees angles of trunk rotation have been recommended as criteria for referral. Low positive predictive values and over-referral at these levels have been reported. METHODS: The Adams forward bend test and Scoliometer measurement were combined for school scoliosis screening in 33,596 girls from the fifth, sixth and seventh grades. Nurses were the primary screeners. Girls with trunk rotation angles of 5 degrees or more were referred for radiography. RESULTS: The referral rate was 5.2%. By selecting 6 degrees, 7 degrees, 8 degrees, 9 degrees or 10 degrees angles of trunk rotation as criteria for referral, the referral rate became 2.4%, 1.4%, 0.7%, 0.5%, or 0.3%, respectively. The prevalence rate for scoliosis equal to or larger than 10 degrees, 20 degrees, 30 degrees, or 40 degrees of the Cobb angle was 1.47%, 0.21%, 0.04% and 0.02%, respectively, by using a 5 degrees angle of trunk rotation as the criterion for radiography. The positive predictive value was 28.3% for scoliosis of 10 degrees or more, 4% for scoliosis of 20 degrees or more, 0.8% for scoliosis of 30 degrees or more, and 0.4% for scoliosis of 40 degrees or more with a 5 degrees angle of trunk rotation as the criterion for referral. By selecting angles of trunk rotation larger than 5 degrees as criteria for referral for radiography, the positive predictive value increased, but positive cases with larger Cobb angles also decreased markedly. CONCLUSION: The optimal cut-off point for referral when using the Scoliometer in school screening of scoliosis is still difficult to determine.     

Reliability of pain and stiffness assessments in clinical manual lumbar spine examination

BACKGROUND AND PURPOSE: The purpose of this study was to determine the intertherapist reliability of judgments of stiffness and pain at L-1 to L-5 made using posteroanterior (PA) central pressure testing. SUBJECTS: Three pairs of manipulative physical therapists with a minimum of 5 years of experience were asked to rate pain and stiffness in a total of 90 patients with low back pain. METHODS: Each pair of therapists assessed 30 patients within their own clinic, using their preferred technique to perform an examination using the PA central pressure test at the five lumbar levels. Each pair of therapists recorded their ratings of pain and stiffness. Reliability of judgments was evaluated by intraclass correlation coefficients (ICC) and percentage of exact agreement scores. RESULTS: The ICC values for pain judgments for the group as a whole ranged from .67 to .72, with agreement scores ranging from 31% to 43%. The ICC values for stiffness judgments ranged from .03 to .37, with agreement scores ranging from 21% to 29%. CONCLUSION AND DISCUSSION: Judgments of stiffness made by experienced manipulative physical therapists examining patients in their own clinics were found to have poor reliability, whereas pain judgments had good reliability. Further investigation of this test is required in order to develop a more reliable method of assessing PA stiffness.     

Test-retest reliability of three Dynavision tasks

The test-retest reliability of three Dynavision tasks of graded difficulty was estimated as high, with intraclass R correlation coefficients ranging from .88 to .97, and paired correlation coefficients ranging from .74 to .92. Recommendations are made for reliable testing procedures.     

Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons

BACKGROUND AND PURPOSE: The main purpose of this study was to determine the interrater and intrarater reliability of measurements obtained during palpation of the craniosacral rate at the head and feet. Palpated craniosacral rates of head and feet measured simultaneously were also compared. Subjects. Twenty-eight adult subjects and 2 craniosacral examiners participated in the study. METHODS: A within-subjects repeated-measures design was used. A standard cubicle privacy curtain, hung over the subject's waist, was used to prevent the examiners from seeing each other. RESULTS: Interrater intraclass correlation coefficients (ICCs) were .08 at the head and .19 at the feet. Intrarater ICCs ranged from .18 to .30. Craniosacral rates simultaneously palpated at the head and feet were different. CONCLUSION AND DISCUSSION: The results did not support the theories that underlie craniosacral therapy or claims that craniosacral motion can be palpated reliably.     

Scoliosis and trunk asymmetry in upper limb transverse dysmelia

The incidence of scoliosis and trunk asymmetry were studied in 60 patients with upper limb dysmelia of the transverse type. The evaluations were based on radiographic measurements of the spine and scoliometer readings of the angle of trunk rotation (ATR), which were correlated with the side and level of the limb deficiency and also with leg length-inequality (LLI). Nineteen patients (31%) had a scoliosis between 10 and 19 degrees, whereas the curves were between 5 and 10 degrees in another 30 patients and the remainder had no measurable curve. The scoliosis seemed at least partly to be of postural origin as LLI significantly correlated with the direction of the curves, but there was no correlation between the Cobb angles and the magnitude of LLI. The scoliometer readings did not correlate with the scoliosis or LLI. Our findings indicate that most patients with upper limb transverse amputations do not develop a significant scoliosis. A scoliometer screen has a low positive predictive rate for scoliosis and the diagnosis of scoliosis requires a radiograph of the spine.     

Morphologic discrimination among healthy subjects and patients with progressive and nonprogressive adolescent idiopathic scoliosis

STUDY DESIGN: A prospective and controlled comparative study. OBJECTIVES: To identify variables that would allow discrimination among patients with progressive adolescent idiopathic scoliosis, patients with nonprogressive adolescent idiopathic scoliosis, and control subjects. SUMMARY OF BACKGROUND DATA: In a previous study, the correlation was demonstrated between morphologic somatotypes and adolescent idiopathic scoliosis. METHODS: One hundred forty-six subjects were evaluated anthropometrically and were classified according to their morphologic somatotype. Of these subjects, 52 were adolescent girls with progressive idiopathic scoliosis, whereas 32 girls had nonprogressive idiopathic scoliosis. The control group was composed of 62 healthy adolescent girls. Somatotype values for ectomorphism, mesomorphism, and endomorphism were obtained according to a technique based on Sheldon's method, and 77 anthropometric measurements of segments of the thorax, head, and limbs were taken. RESULTS: The discriminant analysis realized on a subset of 18 variables allowed the correct identification of each subject's group in 84% of the cases. CONCLUSIONS: It is possible to differentiate healthy adolescent subjects, patients with nonprogressive adolescent idiopathic scoliosis, and patients with progressive idiopathic scoliosis by using anthropometric measurements and morphologic classification. These findings may be useful in the early detection of children at risk for progression of scoliosis and may allow earlier application of treatment methods without waiting for a significant increase in the curve.     

Intrasubject reliability of spinal range of motion and velocity determined by video motion analysis

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the repeatability of spinal range of motion (ROM) and movement velocity measurements of patients with chronic low back pain, using a two-dimensional motion analysis system. This apparatus uses reflective markers placed on anatomical landmarks and video digitization to derive ROM measurements from three segments of the spine and associated velocities through the respective ROMs. SUBJECTS: Forty-two patients with chronic LBP underwent ROM and movement velocity testing. METHODS: Each subject was tested twice without removal of the markers to minimize error contribution from differences in marker placement. RESULTS: Results indicated that both the ROM measures and the velocity measures were highly repeatable. Intraclass correlations for the ROM measures ranged from .77 to .96. Velocity measures were also reliable, with intraclass correlation coefficients ranging from .75 to .97. CONCLUSION AND DISCUSSION: Overall, the results seem to indicate that the video motion analysis system used in this study yields repeatable ROM and velocity measures on a clinical population. In practice, however, the measures may reflect greater errors due to the need of examiners to relocate markers at different testing sessions. These systems also offer distinct advantages over other means of obtaining ROM and velocity measures. The results of this study indicate that these measures may be obtained without undue concern for measurement artifact due to the instrumentation reliability.     

Interinnominate motion and symmetry: comparison between gymnasts and nongymnasts

Some clinical approaches to the treatment of low back pain evaluate and treat observed asymmetries of pelvic posture and motion. Scientific evidence suggests the motion available between the innominate bones is small and variable in nature. The purposes of this investigation were 1) to determine if interinnominate motion of subjects without low back pain was symmetrical in reciprocal test posture combinations, 2) to assess innominate bone symmetry in standing, and 3) to determine if a difference in the magnitude of interinnominate motion was present between a subject group which performs more frequent flexibility activities compared with a subject group representing the general population. Thirty-four subjects (eight male gymnasts, nine female gymnasts, eight male nongymnasts, and nine female nongymnasts) were evaluated in standing and three other reciprocal postures (modified standing, modified sitting, and half-kneeling). In each posture, the Metrecom Skeletal Analysis System was used to obtain coordinates for the anterior and posterior iliac spines. Projection angles were used to determine the relative positions of the right and left innominate bones. Results suggest that stand to right modified standing and stand to left modified standing oblique sagittal interinnominate composite motions were symmetrical, stand to right modified sitting and stand to left modified sitting oblique sagittal interinnominate composite motions were asymmetrical, and stand to right half-kneel and stand to left half-kneel oblique sagittal interinnominate composite motions' symmetrical properties were mixed depending on the group. Gymnasts as a group were found to have asymmetrically positioned innominate bones while nongymnasts as a group had symmetrically positioned innominate bones.