- [STAND AND LOOK]
- “Can you please take off your shoes and shirt”
- [look at foot for abnormalities (myelodysplasia)]
- From Sides - “head over pelvis”, no obvious sagittal mal-alignment
- From front - Neutral, no cafe Au Lait Spots, lift up to look for freckling
- "I will now evaluate the scoliosis further"
- Adam forward bend test, right rib hump exaggerated,
- Use scoliometer = scoliometer gives assessment of rotation in thoracic spine
- Feel for spinous process for tenderness
- Plumb line from C7, measure deviation from gluteal cleft
- Report as “listing to the side”
- Lateral bending and note correction in the lumbar curve
- [SIT]
- comment that scoliosis does not correct = structural curve and not from LLD
- [LIE] - offer 3 things and see if need to do
- 1. Full neurological exam of the lower limbs
- 2. Evaluate limb length to confirm no LLD
- 3. Abdominal reflexes
- Complete my exam by
- Beighton score (>6)
- History to look for stage of puberty - menses and voice break
- History looking for pathological curves - pain, syndromes, neurology
- Look for VP shunt in neuromuscular scoliosis - should be palpable in neck, and should see a abdominal wound
- Looking for features of Marfan's [Avoid as you may forget not to do for females]
- Mouth for high arched palate
- Arm Span - offer to measure (arm to height > 1.05)
- Thumb sign (steinberg)
- Entire thumb protrudes beyond ulnar border of hand
- Hand wrist (Walker Murdoch) sign
- Thumb and little finger can overlap around wrist to DIPJ
- Chest wall deformities - pectus excavatum
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