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Scoliosis examination

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Examination of a scoliosis patient. Presented at Bombay Orthopaedic Society's Postgraduate preparatory course for the MS Orthopaedic Exams

Published in: Health & Medicine

Scoliosis examination

  1. 1. How to do a clinical and radiological workup? SCOLIOSIS Dr Kshitij Chaudhary MS, DNB, Fellowship in Spine Surgery (USA). Consultant Spine Surgeon Sir HN Reliance Foundation Hospital Mumbai
  2. 2. Scoliosis is NOT a diagnosis
  3. 3. Skeletal Maturity Natural History Decision Etiology History Examination Imaging Specialist Referrals Clinical markers Skeletal markers Do nothing Observe Brace Surgery Severity of curve
  4. 4. Growth and Maturity
  5. 5. 12 yr old girls 14 yr old boys
  6. 6. Maturity Markers • Menarche • Secondary Sexual Characters Breast Pubic and axillary hair Genitals Voice change Facial hair • Radiographic signs Risser’s sign Triradiate Cartilage • Serial Height measurements (PHV)
  7. 7. Tanner 2 0.5 cm /month Standing height Risser 4 No change in serial height Closure of triradiate cartilage Menarche Axillary hair Risser 1
  8. 8. Tanner 2 Breast budding Appearance of Pubic Hair (Girls) Appearance of Pubic Hair (Boys)
  9. 9. History Deformity Pain Neurologic symptoms Cardiopulmonary issues Functional / psychological issues
  10. 10. Deformity Cosmesis / Psychological Concerns
  11. 11. Deformity • When was it first noticed? • How was it first noted? • Is it progressive? • What treatment has been taken so far? How long? Details about old records / X-rays Bracing? Prior procedures
  12. 12. Pain Idiopathic Scoliosis does not cause pain
  13. 13. Neurologic Symptoms Especially when angular kyphosis Gait problems Loss of balance
  14. 14. Cardiopulmonary Problems
  15. 15. History • Birth History Issues in pregnancy? Health of mother? Diabetic? Antenatal care appropriate? Previous pregnancies ending in miscarriages? Issues during perinatal and postnatal period Term delivery? C-section or vaginal ICU / ventilatory care • Developmental History Motor milestones Learning disabilities Grade in School? Keeping up with peers Menarche (record in yr+mo)
  16. 16. History • Family History Parents and their families (AIS, NM, NF) Siblings Examine family if in room - Adam’s test
  17. 17. History • Past medical or surgical history Hearing / visual problems Cleft lip/ palate Tracheo-esophageal fistula, Anorectal problems Cardiac murmurs / anomalies Genitourinary disorders Respiratory disorders Neurological disorders
  18. 18. Physical Examination Spine Head to Toe Neurological
  19. 19. Equipment
  20. 20. Look Gait Posture Spinal Alignment Skin Sexual maturity Feel Tenderness Step-offs Paraspinal muscles Move Range of Motion Flexibility Measure Height Weight
  21. 21. Posture • Head centered over pelvis • Ear, shoulder, GT, Ankle • Hips and knees extended • Pelvis is horizontal • Shoulder are level • Neck is neutral
  22. 22. Posture
  23. 23. Spinal Alignment • Location (apex) • Side (Right or left) - convexity • Largest curve (Major curve) • Symmetry • Shoulder • Ribs prominence / Lumbar prominence • Waist asymmetry • Pelvic obliquity - LLD, Hip exam • Decompensation - Head/Trunk • Flexibility
  24. 24. Physical Examination • Back • Front • Side • Supine • Prone • Sitting • Walking
  25. 25. Shoulder level Deformity (Apex, side, extent) Rib prominence Asymmetric flank crease Pelvic level Head Decompensation Trunk Decompensation Palpate tender points ROM Skin Back
  26. 26. Shoulder level Deformity (Apex, side, extent) Rib prominence Asymmetric flank crease Pelvic level Head Decompensation Trunk Decompensation Palpate tender points ROM Skin Back
  27. 27. Shoulder level Deformity (Apex, side, extent) Rib prominence Asymmetric flank crease Pelvic level Head Decompensation Trunk Decompensation Palpate tender points ROM Skin Back
  28. 28. Trunk Decompensation Head Decompensation
  29. 29. Adam’s Forward Bending
  30. 30. Adam’s Forward Bending
  31. 31. Adam’s Forward Bending Rib Prominence Sharp Smooth
  32. 32. Adam’s Forward Bending Lumbar Prominence
  33. 33. Head tilt Neck line Chest asymmetry Rib impingement Pelvis ASIS Secondary sexual characters Skin Frontal view
  34. 34. Ear, Shoulder, GT, MM Thoracic Kyphosis Lumbar Lordosis Hip/knee flexion Side View
  35. 35. Breast development LLD Neurological Exam Supine
  36. 36. Spine is unloaded - see how it corrects Flexibility tests Hyperextension Push Prone Tender points palpated Prone
  37. 37. Flexibility Aided Bending
  38. 38. Flexibility Traction
  39. 39. Flexibility Push Prone Test
  40. 40. Head to Toe
  41. 41. Head to Toe
  42. 42. Physical Examination Head to Toe Exam
  43. 43. Head to Toe
  44. 44. Head to Toe
  45. 45. Head to Toe
  46. 46. Hyper flexibility Beighton Score
  47. 47. 14+6y old girl who is 18 months postmenarchal with right sided thoracic scoliosis, probably adolescent onset idiopathic, with trunk decompensation but without head decompensation, partially flexible normal neurology Clinical Diagnosis Keep it simple Curve (side, location) Probably etiology Decompensation Flexibility Sexual maturity Neurology
  48. 48. Thank You

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