Case 10 Scoliosis


Case 10
Scoliosis

What happened ?                                                         Since when it occurred ?

Painful or not ?                                                                        Started menstruation ?

Progressing or not  ?                                                   

Any history of fever ,trauama ,night sweat , night cries , night pain , excess night sweat ?

On Examination

HEENT – Sclera color , Dentition ,
Chest  - Symmetric expansion
            Bilateral VBs


Alignment - 

 



                                            






Comment
            From front Head at centre , Rt shoulder higher than normal
Nipple at the same level , Rt ASIS higher than normal  , both patella at same level , alignment of leg and feet normal
From sides both the  elbows overlying greater trochanter , knees straight
Posteriorly – scoliosis , upper thoracic curve convex on left , lower thoracic convex on lt side ,lumbar curve convex on left
Curve prominent with Adam’s test
Upper thoracic curve less prominent with bending left
Overlying skin is normal on examination from all sides
Absence of any swelling , tuft of hair on back
Temperature – Normal
Palpation –       Superficially no any tenderness
                        Deep – no any defect palpable
                                    No any bony tenderness
Movement
            Flexion / extension
            Rotation




Meausrement
            Trunk Arm Distance
            LLD
            Schober’s Test
            Plumb Line
           
           
Investigations
X-rays –           AP Spine and Pelvis
                        Side Bending films
                        Measure deformity –
                                                Cobb’s Method
                                                …………. for Infantile Scoliosis
CT Scan-          to assess bony details

MRI     -           Status of Spinal Cord , associated lesions, diastomatomyelia , syrinx

Rotation – Nash and Moe
                       
Additional investigations if OT planned
USG –Abdomen and Pelvis
Pulmonary Function Test
Echo
Other investigations for fitness of surgery



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