Uploaded byKshitij Chaudhary
Scoliosis examination
1) A thorough workup for scoliosis includes obtaining a detailed history, performing a physical examination, and ordering imaging studies. The history should include questions about deformity, pain, neurological symptoms, cardiopulmonary issues, and family history. 2) The physical examination evaluates posture, spinal alignment, and flexibility from multiple angles. It also evaluates the shoulders, ribs, pelvis, and for any neurological deficits. 3) Imaging studies like x-rays can further characterize the curve severity, skeletal maturity, and help determine a treatment plan. Together the history, exam, and imaging allow for an accurate diagnosis and clinical decision making.
More Related Content
Similar to Scoliosis examination
Scoliosis examination
- 1. How to doa 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. Scoliosis is NOTa diagnosis
- 4. Skeletal Maturity Natural History Decision Etiology History Examination Imaging Specialist Referrals Clinicalmarkers Skeletal markers Do nothing Observe Brace Surgery Severity of curve
- 5.
- 8. 12 yr oldgirls 14 yr old boys
- 9. 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)
- 10. Tanner 2 0.5 cm/month Standing height Risser 4 No change in serial height Closure of triradiate cartilage Menarche Axillary hair Risser 1
- 11. Tanner 2 Breast budding Appearanceof Pubic Hair (Girls) Appearance of Pubic Hair (Boys)
- 12. History Deformity Pain Neurologic symptoms Cardiopulmonary issues Functional/ psychological issues
- 13.
- 14. Deformity • When wasit 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
- 15. Pain Idiopathic Scoliosis doesnot cause pain
- 16. Neurologic Symptoms Especially whenangular kyphosis Gait problems Loss of balance
- 17.
- 18. History • Birth History Issuesin 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)
- 19. History • Family History Parentsand their families (AIS, NM, NF) Siblings Examine family if in room - Adam’s test
- 20. History • Past medicalor surgical history Hearing / visual problems Cleft lip/ palate Tracheo-esophageal fistula, Anorectal problems Cardiac murmurs / anomalies Genitourinary disorders Respiratory disorders Neurological disorders
- 21. Physical Examination Spine Head toToe Neurological
- 22.
- 23. Look Gait Posture Spinal Alignment Skin Sexual maturity Feel Tenderness Step-offs Paraspinalmuscles Move Range of Motion Flexibility Measure Height Weight
- 24. Posture • Head centeredover pelvis • Ear, shoulder, GT, Ankle • Hips and knees extended • Pelvis is horizontal • Shoulder are level • Neck is neutral
- 25.
- 26. 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
- 27. Physical Examination • Back •Front • Side • Supine • Prone • Sitting • Walking
- 28. Shoulder level Deformity (Apex,side, extent) Rib prominence Asymmetric flank crease Pelvic level Head Decompensation Trunk Decompensation Palpate tender points ROM Skin Back
- 29. Shoulder level Deformity (Apex,side, extent) Rib prominence Asymmetric flank crease Pelvic level Head Decompensation Trunk Decompensation Palpate tender points ROM Skin Back
- 30. Shoulder level Deformity (Apex,side, extent) Rib prominence Asymmetric flank crease Pelvic level Head Decompensation Trunk Decompensation Palpate tender points ROM Skin Back
- 31.
- 32.
- 33.
- 34. Adam’s Forward Bending RibProminence Sharp Smooth
- 35. Adam’s Forward Bending LumbarProminence
- 36. Head tilt Neck line Chestasymmetry Rib impingement Pelvis ASIS Secondary sexual characters Skin Frontal view
- 37. Ear, Shoulder, GT,MM Thoracic Kyphosis Lumbar Lordosis Hip/knee flexion Side View
- 38.
- 39. Spine is unloaded- see how it corrects Flexibility tests Hyperextension Push Prone Tender points palpated Prone
- 40.
- 41.
- 42.
- 43.
- 44.
- 45. Physical Examination Head toToe Exam
- 46.
- 47.
- 48.
- 49.
- 50. 14+6y old girlwho 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
- 51.
Editor's Notes
- #7 Decrease in growth rate from the massive intrauterine growth. Still the growth rate is very high. Decreases up to age 4-5 and then plateaus. Then pubertal growth spurt.
- #8 By Duval Beaupere Scoliosis progression in two phases. Mathematical relationship Greater the velocity during the first period sharper will be the rise in the second Earlier the age at which puberty starts longer will be the second phase. Concept of Point P. Slope P1 and Slope P2.
- #9 Upper row all boys are 14.75 years old. Lower row all girls are 12.75 years old.
- #16 Go in detailed questioning about the nature of pain.
- #17 Uncommon for scoliosis to have neurological symptoms Scoliosis associated with kyphosis are more likely to have neurological complications Presence may indicate spinal cord anomaly
- #18 Curves more than 80 to 100. Ask for breathing difficulty Shortness of breath on running with friends Recurrent respiratory infections / hospitalizations