HOW TO EXAMINE SPINE DEFORMITY

Here are the excerpts from Weinstein's book about examination od a spinal deformity.

SCREENING FOR SPINAL DEFORMITY:
Screening has been defined as the presumptive identification of unrecognized disease or a defect by the application of tests, examinations, or other procedures that can be applied rapidly to sort out apparently well people who have the disease from those who probably do not.

when should screening for spinal deformity start?
* prenatal -- spina bifida, myelodysplasia
* neonatal -- signs of spinal dysraphism,
* juvenile -- idiopathic, developmental, neuromuscular
* adolescent -- idiopathic

School Screening:

population - 10-14 yrs. of age

screening technique:
* train the primary sceeners like nurses, interested teachers, educated laity, physical therapists, and occasionally physicians
* integrate with preventive care programmes
*educate students and parents with slide shows and videos
* conduct screenig at school nurses' office or physiotherapists room
* boys can be exposed, girls should use bras or bathing suit

points to watch for:

*asymmetry of neck, shoulders, ribs, waist, hips
* posture of head over pelvis
*prominenet scapula
* truncal shift
*limb length inequality
*Adam's forward bending test
*Bunnel's inclinometer or scoliometer to measure angle of truncal rotation(ATR)

referral criteria- if ATR > 5 deg.
- painful scoliosis
- skin anomalies over spine s/o spinal dysraphism
- dwarfness
- secondary sexual characteristics

scoliometer:
*Bunell 1948, also called inclinometer, idea from sailing in a boat
*To measure deformity in rotational plane
* Measures ATR or angle of thoracic inclination; angle is the construct between the horizontal and a plane across the posterior rib cage at the greatest prominence of the rib
*how to measure- Patients are placed in the forward-bending position (Adams test), and the degree of hip flexion is adjusted to place either the thoracic or the lumbar spine in the horizontal position
*efficacy: The scoliometer has a false-negative result rate of 0.1% and a high degree of sensitivity. It has been reported as an effective screening tool in the identification of children at risk for significant scoliosis (more than 10 degrees) . Ashworth found that adding the scoliometer to the Adams test increased the specificity of that test from 56% to 86%. Bunnell found that the mean Cobb angle in patients with 5 degrees of truncal rotation was 11 degrees of scoliosis, and for a truncal rotation of 7 degrees, the mean Cobb angle was 20 degrees. The recommendation was made, therefore, to refer all patients with an ATR of 5 degrees or greater because they are in the at-risk population for spinal deformity. Some authors have recommended increasing this cutoff to 7 degrees, but at the same time, concern has been expressed that some patients with curves greater than 20 degrees will not be picked up on initial screening.


So far for today, will post detailed examination of spinal deformity tomorrow.