01/12/2022
Scoliosis

What is the clinical examination of scoliosis? – 2022

scoliosis

What is the clinical examination of scoliosis?

The physical examination will analyze the scoliotic deformity, look for an imbalance and damage to the nerves. Scoliosis

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What is the clinical examination of scoliosis?

The physical examination will analyze the scoliotic deformity, look for an imbalance and damage to the nerves.

In a standing position, back to the doctor, the latter will look for a deviation of the head from the sacrum, a difference in height of the shoulders, an asymmetry of the folds of the waist.

In profile, the examiner looks for a fall of the trunk forward (hunted patient), a hyperextension of the neck and a bending of the knees to keep the gaze straight. These symptoms reflect an imbalance.

The humpback is the typical sign of scoliosis, it is a “bump” in the back, it is clearly visible when the standing patient leans forward to try to touch his feet with his hands. Thoracic scoliosis causes a deformation of the rib cage, one scapula is higher than the other. The height difference is measured. At the lumbar level, the rotation of the vertebrae is responsible for a less spectacular lumbar hump.

The neurological examination looks for:

A motor deficit

Each root is assessed through the muscles it innervates. The leg muscles are successively tested by resistance movements against the examiner. A score of 0 to 5 is assigned based on the resistance provided.

A rating less than or equal to 3 reveals a significant deficit and requires urgent treatment. Pain makes exercise difficult, and may suggest a deficit that does not exist. If in doubt, the patient is re-examined after pain relief with medication.

Neurological testing remains imperfect for detecting a beginning deficit. Walking on tiptoes and heels remains the most difficult exercise for the nerve roots. The success of this exercise testifies to the absence of a deficit.

A sensory deficit

A sensation of cardboard skin, the existence of tingling or even cutaneous insensitivity testify to the compression of the sensitive fibers of a nerve root. The affected root can be diagnosed based on the path of sensory symptoms. Thus, an attack of S1 borrows the following way: buttock, posterior face of the thigh and the leg, side toes, plantar face.

Compression of a root can be sought by stretching maneuvers that reproduce pain. The appearance of sciatica or cruralgia in the lying position when the leg is raised passively by the examiner reflects compression (Lasègue or Léri sign)

The faster the pain appears during the elevation of the leg, the more the root is compressed.

WHAT IS THE IMAGING ASSESSMENT TO BE PERFORMED?

X-rays
Different types of X-rays are performed:

  • The standing telerachis: entire spine standing from the front and in profile, used to assess the deformity by measuring the angulation from the front (Cobb). The evolution of imaging techniques has made this type of radiography obsolete for follow-up. X-rays centered on the lumbar or thoracic spine have often made it possible to make the diagnosis but are no longer used thereafter because they are unreliable and very irradiating.
  • Dynamic X-rays: the patient adopts a posture (lean forward, straighten up) are performed to detect vertebral instability (spondylolisthesis = sliding of the vertebrae in profile)
  • Bendings: these are x-rays where the patient tilts to the right and left. These images allow the stiffness of the curvature to be assessed. Pure degenerative or advanced idiopathic scoliosis is stiffer due to osteoarthritis. These pictures partially predict the operative result and allow the surgeon to adapt his technique if necessary.

 

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