Scoliosis examination
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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.
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Scoliosis examination
- 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. Scoliosis is NOT a diagnosis
- 4. Skeletal Maturity Natural History Decision Etiology History Examination Imaging Specialist Referrals Clinical markers Skeletal markers Do nothing Observe Brace Surgery Severity of curve
- 8. 12 yr old girls 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 Appearance of Pubic Hair (Girls) Appearance of Pubic Hair (Boys)
- 12. History Deformity Pain Neurologic symptoms Cardiopulmonary issues Functional / psychological issues
- 13. Deformity Cosmesis / Psychological Concerns
- 14. 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
- 15. Pain Idiopathic Scoliosis does not cause pain
- 16. Neurologic Symptoms Especially when angular kyphosis Gait problems Loss of balance
- 18. 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)
- 19. History • Family History Parents and their families (AIS, NM, NF) Siblings Examine family if in room - Adam’s test
- 20. 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
- 21. Physical Examination Spine Head to Toe Neurological
- 22. Equipment
- 23. Look Gait Posture Spinal Alignment Skin Sexual maturity Feel Tenderness Step-offs Paraspinal muscles Move Range of Motion Flexibility Measure Height Weight
- 24. Posture • Head centered over pelvis • Ear, shoulder, GT, Ankle • Hips and knees extended • Pelvis is horizontal • Shoulder are level • Neck is neutral
- 25. Posture
- 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
- 34. Adam’s Forward Bending Rib Prominence Sharp Smooth
- 35. Adam’s Forward Bending Lumbar Prominence
- 36. Head tilt Neck line Chest asymmetry Rib impingement Pelvis ASIS Secondary sexual characters Skin Frontal view
- 37. Ear, Shoulder, GT, MM Thoracic Kyphosis Lumbar Lordosis Hip/knee flexion Side View
- 39. Spine is unloaded - see how it corrects Flexibility tests Hyperextension Push Prone Tender points palpated Prone
- 43. Head to Toe
- 44. Head to Toe
- 45. Physical Examination Head to Toe Exam
- 46. Head to Toe
- 47. Head to Toe
- 48. Head to Toe
- 50. 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
- 51. Thank You
Editor's Notes
- 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.
- 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.
- Upper row all boys are 14.75 years old. Lower row all girls are 12.75 years old.
- Go in detailed questioning about the nature of pain.
- Uncommon for scoliosis to have neurological symptoms Scoliosis associated with kyphosis are more likely to have neurological complications Presence may indicate spinal cord anomaly
- Curves more than 80 to 100. Ask for breathing difficulty Shortness of breath on running with friends Recurrent respiratory infections / hospitalizations