Paediatric-History taking & Physical examination to scoliosis

Paediatric-History taking & Physical examination to scoliosisCreated OnMay 1, 2020Last Updated OnMay 1, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination to scoliosis < All Topics Table of Contents History taking: Ask about patient’s identification Name, age, gender – common in adolescent girls (>10 years old) Female – higher risk of curve progression Ask about chief complain May complain of deformity or incidental finding on examination or radiograph Ask about history of presenting illness When was deformity noted and who noted Deformity noted by family tend to be greater Progression of the deformity Rapid (suggest underlying cause) Presence of pain – SOCRATES Varies from absent to severe Significant pain suggests underlying cause Neurologic symptoms Muscle weakness, bowel or bladder problems, headache, neck pain – signify neuromuscular condition Absent in AIS Breathing difficulty or shortness of breath Indicate severe scoliosis (cobb angle >70’) Puberty – estimate risk of progression Tanner grade, growth trajectory, growth spurt – tanner stage 2 associated with maximum progression of scoliosis Onset of menarche (female) – girls continue to grow ~24 months after menarche Shaving history (male) – skeletal growth complete when they are shaving everyday History of fracture, joint pain or infection Cause leg length discrepancy – rule out compensatory scoliosis Red flags Markedly painful scoliosis Left thoracic curve Rapid progression after skeletal maturity Abnormal neurological examination Stigmata of other diseases Rapid progression in previously stable curve Back pain, fever, spasm on paraspinal muscle – rule out vertebral body infection Disturbance in daily activity – functionality Joint hypermobility, skin hyperextensibility, joint dislocation – EDS Ask about birth history Any congenital abnormality – failure of formation or segmentation of vertebrae Cerebral palsy – neuromuscular scoliosis Marfan or neurofibromatosis – associated with scoliosis DDH – leg length inequality Ask about developmental history Motor dysfunction (spasticity, ataxia, dyskinesia) – cerebral palsy Muscle weakness –myopathy Ask about immunization history – polio cause neuromuscular scoliosis Ask about past medical history Obstructive lung disease – assoc. with severe scoliosis (Cobb’s angle >40’) Neurological disease (e.g cerebral palsy, spinal cord tumor, poliomyelitis)-neuromuscular scoliosis Ask about family history of scoliosis Familial AIS may be linked to X chromosome with dominant inheritance pattern Physical examination: General examination Height, plot on growth curve Estimate remaining growth potential – linear growth is near completion when there is less than 1cm change of height over 6 months Built of patient – AIS more prone in overweight and obese patient Tanner staging – curve progression is the greatest during growth spurt, preceding Tanner stage 2 Stage 2 tanner Pubic hair: straight downy hair Breast – breast bud palpable under areola, first pubertal sign in female Male external genitalia – testicular volume 4-8ml, first pubertal sign in male Dysmorphic features Marfan – dolichocephaly, enophthlamos, downslanting palpebral fissure, malar hypoplasia, retronaghtia Marfan features – TRO syndromic scoliosis Arachnodactyly Long limbs Increased arm span to height ratio Skin Café au lait macules, axillary freckling – neurofibromatosis Skin hyperextensibility – EDS Hypo/hyperpigmented lesion, dimpling, patch of hair – spinal dysraphism Eye Lisch nodule – NF Dislocated lens, retinal detachment -Marfan Intrinsic wasting in hand (cervical syringomyelia) Excessive joint laxity – EDS, OI, Marfan syndrome Leg length discrepancy (<1cm is normal) – asymmetrical iliac crest Feet – high arch, hammer toes neuromuscular disease Inspection Proper exposure of the trunk Assess curvature of spine 90% of thoracic curves are to the right, left thoracic curve prompt extensive evaluation Shoulder asymmetry and protruding...

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