Scoliosis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Patients with scoliosis usually appear normal. Physical examination of patients with scoliosis is usually remarkable for shoulder asymmetry, waist-line asymmetry, thoracic wall or breast asymmetry, and truncal decompensation.

Physical Examination

Physical examination of patients with scoliosis is usually remarkable for shoulder asymmetry, waist-line asymmetry, thoracic wall or breast asymmetry, and truncal decompensation.[1][2][3]

Appearance of the Patient

  • Patients with scoliosis usually appear well.
  • Tanner staging done to predict magnitude of curve progression.

Vital Signs

Patients with scoliosis and other complications may have:

Skin

HEENT

  • HEENT examination of patients with scoliosis is usually normal.

Neck

Lungs

Patients with scoliosis and other complications may have:

Heart

Patients with scoliosis and it's late complications such as pulmonary hypertension and cor pulmonale include physical findings:[4][5][6]

Abdomen

  • Abdominal examination of patients with scoliosis is usually normal
  • Flank fullness may be seen

Genitourinary

  • Genitourinary examination of patients with scoliosis is usually normal. But, in neuromuscular scoliosis, patient may present with bowel and bladder incontinence.

Neuromuscular (Spine)

Scoliosis physical findings.Source: By https://wellcomeimages.org/indexplus/obf_images/8c/4f/9ae55eeb2f2735757102bb251795.jpg
  • Patient is usually oriented to persons, place, and time

Gait

  • Patients usually walk with bipedal unassisted gait.
  • Some patients with neuromuscular scoliosis walk with a spastic gait.

Palpation

  • No local rise in temperature
  • Tenderness is usually not present.
  • Head may be centered or tilted away from pelvis
  • Shoulders asymmetry
  • Scapular asymmetry with one scapula being farther away from the the mid-line
  • Spinous process are deviated away from mid-line
  • Lateral curvature of the spine, with curve described in terms of convexity directed to right or left
  • Paraspinal muscle spasm may be present
  • Rib razor hump is usually present
  • Posterior Superior Iliac spine (PSIS) asymmetry seen
  • Anterior Superior Iliac spine (ASIS) asymmetry seen
  • List and step are usually not present
  • Sagittal balance (Head in line with sacrum) may be disturbed
  • Sinuses and tuft of hair may be present
  • Flank fullness may be seen

Movement

  • Flexion and extension are usually affected
  • Lateral flexion and rotation helps to identify rigidity of the curve

Flexibility Test

  • Lateral bending test are usually affected
  • Traction test are usually abnormal
  • Prone position test are usually abnormal

Neurological

  • Motor
    • Motor weakness may be seen
    • Spasticity and rigidity may be seen depending on level of involvement
    • Sensory
      • Fine touch and crude touch may be lost
      • Hypoesthesia may be seen
      • Postion sense and vibration may be disturbed
      • Two point discrimination may be lost
    • Reflexes
      • Hypo or Hyper reflexia may be seen depending on level of involvement
      • Clonus may be seen
    • Coordination
      • Coordination may be affected when scoliosis is associated with CNS involvement such arnold-chiari malformation

Rib Hump

  • Adam's forward bending test makes the hump prominent

Measurement

  • Hump height
  • Chest expansion is usually decreased
  • Limb length discrepancy may be present
  • Truncal height is measured in standing and sitting position, which is usually abnormal
  • Scoliometer is used to measure the curve

Special Test

  • Straight leg raising (SLR) test may be positive
    • Test:
      • Patient in supine position with knee and hip in extension
      • Elevate the patient's leg in air, so the hip gets gradually flexed with knees in extension
      • Presence of radiating pain in the leg between 30-70 degrees of hip flexion indicates a positive test
  • Cross SLR is usually absent
    • Test:
      • Patient in supine position with knee and hip in extension
      • Elevate the patient's contralateral leg in air, so the hip gets gradually flexed with knees in extension
      • Presence of radiating pain in the ipsilateral leg indicates a positive test
  • Lassegue test may be positive
    • Test:
      • Patient in supine position with knee and hip in extension
      • Elevate the patient's leg in air, so the hip gets gradually flexed with knees in extension
      • If radiating pain present in the legs between 30-70 degrees of hip flexion, then slightly lower down the angle of flexion at the hip and dorsiflex the ankle
      • Presence of radiating pain in the leg again indicates a positive test
  • Bowstring test may be positive
    • Test:
      • Patient in supine position with knee and hip in extension
      • Elevate the patient's leg in air, so the hip gets gradually flexed with knees in extension
      • If radiating pain present in the legs between 30-70 degrees of hip flexion, then slightly bend the kneewhich will relieve the symptoms
      • Apply digital pressure in popliteal fossa over the posterior aspect of sciatic nerve
      • Reproduction of radiating pain indicates nerve compression
  • Femoral stretch test may be positive

Extremities

  • Feet may show cavovarus deformity

References

  1. Kapoor, Sudhir (2008). Orthopaedic clinics spine : with video demonstration. New Delhi: CBS Publishers & Distributors. ISBN 8123915993.
  2. Janicki JA, Alman B (2007). "Scoliosis: Review of diagnosis and treatment". Paediatr Child Health. 12 (9): 771–6. PMC 2532872. PMID 19030463.
  3. Azar, F., Canale, S., Beaty, J. & Campbell, W. (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. Page: 1898-2028.
  4. Simon O'Connor MBBS FRACP DDU; Nicholas P. Hirsch MBBS FRCA FRCP (2009). Clinical Examination: A Systematic Guide to Physical Diagnosis. Edinburgh: Churchill Livingstone. ISBN 0-7295-3905-9.
  5. Alexander, R. McNeill; Hurst, J. Willis; Schlant, Robert C. (1994). The Heart, arteries and veins. New York: McGraw-Hill, Health Professions Division. ISBN 0-07-055417-X.
  6. Clark, Michael; Kumar, Parveen J. (2009). Kumar and Clark's clinical medicine. St. Louis, Mo: Elsevier Saunders. ISBN 0-7020-2993-9.

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