adolescent spine

Curve

Erect

From back

Scoliosis

· shoulder height

· scapular symmetry

· flank contour

· loin creases

· distance between medial epicondyle and lateral waist

Listhesis

· flattened heart-shaped buttocks

· step-off or depression

· fore-shortened trunk

· protruberant abdomen

· increased lumbar lordosis (with lumbosacral kyphosis)

General

· dimples of Venus

· PSIS height

· spinal dysraphism

· dimple

· hairy patch

· hyperpigmentation

· lipoma

· balance

· alignment of C7 over gluteal cleft

· ask for plumb bob

From side

· thoracic kyphosis

· present (normal)

· reduced

· exaggerated or focal

· lumbar lordosis

· present (normal)

· reduced

· exaggerated

Forward bending test

· Adam’s test

· hands together

· bend forwards to touch floor

From side

· comment on kyphosis

· localised kyphosis (Scheuermann’s)

· kyphos (congenital, trauma, infection, tumour, postsurgical)

· hypokyphosis (scoliosis)

· comment on lumbar spine

· satisfactory unroll

From back

· rib hump

· mild, moderate, severe

· well-rounded / angular

· lumbar fullness

Ryan typical curve

· the right shoulder is raised

· the right scapula is prominent

· the loin creases are asymmetrical

· the pelvis is level

· there is flattening of the normal thoracic kyphosis

· there is a normal lumbar lordosis

· on forward bending, there is a (mild / moderate / severe) (wellrounded / angular) rib hump and a mild left lumbar fullness

gait

Leg length

· if abnormal

· use blocks

· reassess curve

Trendelenburg

Walking

· look for

· Trendelenburg

· spastic

· short leg

prone

· palpation

· tenderness

· palpable step

· percussion

· tenderness

Cause

prone

Skin

· have you got any spots ?

supine

Maturity

· height

· breasts

· pubic hair

Skin

· cafe-au-lait spots

· axillary freckling

· neurofibromas

Eyes

· Liesch nodules in blue eye

· blue sclera

· cloudy cornea

· specialised

· Liesch nodule

· dislocated lens

· optic glioma

Mouth

· abnormal teeth

· high-arched palate

· large tongue

Trunk

· pectus carinatum or excavatum

· protruberant sternum with sharp manubriosternal angle

Limbs

General

· hemihypertrophy

· dolichostenomelia (long limbs)

· congenital anomalies

Upper

· arachnodactyly

· radial club hand

Lower limb

· club foot

· cavovarus foot

SLR

· hamstring tightness

Neurological

Reflexes

· upper limb

· abdominal

· lower limb

· Babinski

Sensation

· upper limb

· trunk (axillary)

· lower limb

Power

· upper limb

· lower limb

Other

collagen

· ligamentous laxity

concealed

· if forgotten

· natal cleft

· mouth

· eyes

· axillae

(cephalad) joints

· ROM if deformity

(circulation)