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