Scheuermann's disease

       Scheuermann's disease (Structural Hyperkyphosis) – is a growth disorder characterized by inflammation and osteochondritis of the thoracic vertebrae.

This disease was identified by Holger Scheuermann in 1920. The aetiology of this symptom is unknown, an affects 0.4% of the population.

This degenerative condition wedges or narrows the anterior vertebral body at three or more levels secondary to axial and flexion overload.

An active condition may contraindicate sport participation and often increases pain with activity and forward flexion movements.

Wedging in Scheuermann’s involves the posterior part of vertebrae growing more quickly than the anterior part. This is knows as ventral wedging.

Diagnosis of Scheuermann’s is based on x-ray and physical criteria.  

Radiological criteria:

-          40 degrees of thoracic hyperkyphosis

-          At least 5 degrees of ventral wedging in at least 3 adjacent vertebrae

-          Irregular end-plates

-          Increases anterior-posterior diameter

-          Narrowness of the inter-vertebral discs

-          Schmorl nodes

Physical criteria:

-          Stiff hyperhyphosis

-          Flexible hyperlordosis ( usually)

-          Upper x syndrome- upper trapezius and pectoralis are shortened, chin is protracted, rhomboids and lower trapezius are over stretched.

-          Lower x syndrome – hip flexors are shortened and the pelvis is tilted anteriorly, lower back muscles are shortened and gluteals and abdominals are over stretched and weak.

Approximately 20-30% of patients with Scheuermann’s disease also have a scoliosis. This combination is known as kyphoscoliosis.