Scheuermann's Disease

[drusso]

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Young female patient with chronic scapulothoracic pain and diagnosis of Scheuermann disease on a low dose time contingent opioid therapy. Highly functional and motivated. Any ideas, pearls, or successes in management of this disorder?

 

[lobelsteve]

Young female patient with chronic scapulothoracic pain and diagnosis of Scheuermann disease on a low dose time contingent opioid therapy. Highly functional and motivated. Any ideas, pearls, or successes in management of this disorder?

How much kyphosis and at what levels?

SMR's are a good choice for meds.

If lumbar (upto T12)- do MBB's. If higher- the big screw for her. No good fix outside of surgery for pain/deformity/neuro deficit with mediocre outcomes.

Hold her hand and provide PMR based conservative care with tempered enthusiasm.

 

[drusso]

How much kyphosis and at what levels?

SMR's are a good choice for meds.

If lumbar (upto T12)- do MBB's. If higher- the big screw for her. No good fix outside of surgery for pain/deformity/neuro deficit with mediocre outcomes.

Hold her hand and provide PMR based conservative care with tempered enthusiasm.

T5-T9, Mild = 35 degrees, that's what I thought...

 

[PMR 4 MSK]

If she's a teenager, we used to put them in Milwaukee braces, now we usually just use a TLSO. If adult, extension-based exercise program.

 

[Tenesma]

the big issue is progression of thoracic disease - and potential dyspnea.

for the most part treatment is conservative - including bracing...

interestingly every patient i have ever met with Scheuerman's remained active and always would fight with the pain --- so maybe genetically they are superior to workman's comp patients who are miserable with a hang-nail???