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
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
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)
24. Posture
• Head centered over pelvis
• Ear, shoulder, GT, Ankle
• Hips and knees extended
• Pelvis is horizontal
• Shoulder are level
• Neck is neutral
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
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