Approach to Spinal Deformity
– who picked it up? – family history
– when was it discovered? – functional disability
– any pain associated with it? ** automatic red flag!
– any weakness or sensory changes?
– any bowel or bladder disturbance?
– general physical exam
– inspection – shoulder asymmetry, head centered, plumb line
– hairy patches, cutaneous lesions, midline sinuses or clefts
– leg length, pelvic obliquity, foot deformities
– flexibility – forward bending (rotation?); lumbosacral increment
– side bending (correctability? Is this thing rigid???), extension
– neurology – gait, toe walking, heel walking, tandem gait, single leg stance and raise
– motor function
– sensory function: light touch, pin prick, vibration and proprioception
– deep tendon reflexes
– abdominal reflexes – stroke the skin towards the umbilicus; lack of umbilical deviation towards the tested
quadrant reflects an upper motor neuron lesion
– plantar response and Hoffman response