Dowager's Hump

Dowager's Hump, also known as Postural Kyphosis or Hyperkyphosis, is an exaggerated curvature of the thoracic spine, which may result in back pain, neurologic impairment, and difficulty breathing.

Dowager's Hump is an exaggerated curvature of the thoracic spine, which causes a greater angle of curvature than what is normal in that part of the human spine. In the thoracic spine, a normal curvature is between 20 to 40 degrees, and it is concave anteriorly and convex posteriorly. In a person with this condition, the person has this curve in the normal direction, though the angle of curvature is greater than 40 degrees. Dowager's Hump is also known as roundback, Kelso's hunchback, Thoracic Kyphosis, or hyperkyphosis. This condition is usually caused by medical disorders such as osteopenia and osteoporosis which involve the loss of bone density. The loss of bone density in the weight bearing bones of the spine may make these bones vulnerable to compression fractures, in which the vertebral bodies collapse in on themselves. Other causes of Dowager's Hump are developmental problems such as Scheuermann's Disease, arthritis, and injury (i.e. accident or trauma).

Cause: The main cause of this condition are medical conditions that result in the loss of bone mineral density. Men and women both lose bone density as we get older, but menopausal women are the group of people most likely to suffer from bone density loss. In menopausal women, the production of the hormones estrogen and progesterone declines, resulting in changes in the rate in which bone tissues absorb and release bone minerals - such as calcium - to and from the bloodstream. Other factors that may lead to bone mineral density loss include smoking and diets that are low in Calcium and Vitamin D.

As a result of this condition, the person has a pronounced hunched forward posture in the area between the shoulders and the middle back. This abnormal spinal curvature may result in not only the obvious physical deformity, but it may also affect breathing and lung capacity. The thoracic spine is actually the posterior portion of the thoracic cavity and serves as the attachment for the ribs.

The degree of physical limitation that this condition cases may vary from person to person, though more severe angles of curvature are more likely to be associated with pain and other medical problems. Most cases of this condition are mild and don't require serious medical intervention as long as the patient doesn't suffer from symptoms. High degrees of thoracic kyphosis may result in problems with respiration and total lung capacity, cardiovascular irregularities, back pain, and compromise of the nerves. High degrees of kyphosis may be irreversible through means such as diet counseling and physical therapy, and may require spinal fusion surgery to restore this region of the spine closer to a normal curvature.

Dowager's Hump is one form of kyphosis. Mild cases of this condition may result from a combination of poor muscular conditioning in this part of the body, as well as persistently poor posture. Hyperkyphosis that results from consistently bad posture when sitting and standing may also be known as Postural Kyphosis. Over time, forward slouching of in the upper body may result in a stretching of the spinal ligaments, and muscular deconditioning of the back and upper body muscles that are responsible for holding the spinal curves in a normal alignment. Dowager's Hump associated with slouching may be reversed by correcting muscular imbalances. Postural kyphosis is the most common form of kyphosis. In about 33% of all cases of kyphosis, compression fractures or vertebral fractures is the cause of deformity.

Compression fractures and vertebral fractures: When bone density loss in the spine does occur, the vertebral bodies - being the weight bearing portions of the bones - become the most likely to collapse. When these vertebral bodies do collapse, they don't usually collapse evenly across the whole bean-shaped body. Usually, the collapse occurs in the anterior (front) portion of the vertebral body, causing it to take on more of a wedge shape than a block shape. This may cause the spine on a whole to become bowed forwards.