PRACTICAL CASE 1 -Torticollis


Case 1
Torticollis

Introduction , Permission to ask questions and examine. Tell patient to remind him if the patient is not comfortable during the examination.

Two Relevant Questions
   Age of Patient                                                 
  Occurred since birth ?

On examination
Inspection
Front
Head               –                     Bent to left side ,
both shoulders at the same level
Chin on rt side ,
Decrease head shoulder distance ,
Facial assymmetry,
Left sternoclediomastoid muscle is taut
Chest               –                      No muscle wasting
Upper Limbs   -                       Bilateral

Side –
 Ear almost touching shoulder
                                                            Deltoid countour Normal
                                                            Elbow fully extended

Back                            -                       Both shoulders symmetrical ,
                                                            Hairline low lying or not ,
                                                            Scapula at same level,
                                                            Thoracic/lumbar vertebrae maitained

Gait                             - Normal or not
Squating                      -symmetrical

Feel
Back –
Neck –             Sternocleidomastoid taut and thinned out , prominent on rotation towards opposite side and bending same side

Thyroid cartialge ,thyroid , trachea central , Carotid Pulsation
                                    Lymph nodes
Feel along Sternoclavicular joint , clavicle , Acromion , Spinous Process, Scapula Medial ,,inferior angle , lateral borders ,humeral head first superfical palplation to find out tenderness anywhere then deep palpation
                                    (comment on level of scapula height )
                                               
Movement from front – (move yourself )
Flexion /Extension /Rotation / Lateral Flexion
Also check movement of shoulder

Quick Neurovascular assessment of upper Extremity
C5 – T1 Dermatome – Sensation
Myotome – muscle power ,  reflexes



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