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==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].


==Overview==
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
Physical examination of patients with scoliosis is usually remarkable for shoulder asymmetry, waist-line asymmetry, thoracic wall or breast asymmetry, and truncal decompensation.
===Appearance of the Patient===
*Patients with scoliosis usually appear well.
===Vital Signs===
Patients with scoliosis and other complications may have:
**High blood pressure due to pulmonary hypertension and cor pulmonale
===Skin===
===Skin===
* [[Skin]] for [[Café au lait spot|café au lait]] spots indicative of [[neurofibromatosis]]
*[[Skin]] for [[Café au lait spot|café au lait]] spots indicative of [[neurofibromatosis]]
* [[Spina bifida]] as evidenced by a [[dimple]], hairy patch, [[lipoma]], or [[hemangioma]].
*[[Spina bifida]] as evidenced by a [[dimple]], hairy patch, [[lipoma]], or [[hemangioma]].
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
* HEENT examination of patients with Scoliosis is usually normal.
 
===Neck===
* Neck examination of patients with scoliosis is usually normal. But, patients may have lateral bending of their neck due primary or secondary curve.
* when scoliosis is complicated with pulmonary hypertension, it's physical findings may include0.0.0:
Prominent 'a' wave: due to forced atrial contraction
**Prominent 'v' wave: later if [[Tricuspid regurgitation|tricuspid regurgitation]] develops with [[right ventricular failure]]
**Elevated [[JVP]]: can be present if [[right ventricular failure]] develops
**Postive [[Kussmaul's sign]]: [[JVP]] elevation during inspiration (the opposite of what normally happens) because of [[right ventricular failure]]
 
===Lungs===
Patients with scoliosis and other complications may have:
*Chest wall or breast asymmetry is seen
*Decrease breast sounds upon auscultation of the lung
 
===Heart===
Patients with scoliosis and it's late complications such as pulmonary hypertension and cor pulmonale include physical findings:<ref name="isbn0-7295-3905-9">{{cite book |author=Simon O'Connor MBBS FRACP DDU; Nicholas P. Hirsch MBBS FRCA FRCP |title=Clinical Examination: A Systematic Guide to Physical Diagnosis |publisher=Churchill Livingstone |location=Edinburgh |year=2009 |pages= |isbn=0-7295-3905-9 |oclc= |doi= |accessdate=}}</ref><ref name="isbn0-07-055417-X">{{cite book |author=Alexander, R. McNeill; Hurst, J. Willis; Schlant, Robert C. |title=The Heart, arteries and veins |publisher=McGraw-Hill, Health Professions Division |location=New York |year=1994 |pages= |isbn=0-07-055417-X |oclc= |doi= |accessdate=}}</ref><ref name="isbn0-7020-2993-9">{{cite book |author=Clark, Michael; Kumar, Parveen J. |title=Kumar and Clark's clinical medicine |publisher=Elsevier Saunders |location=St. Louis, Mo |year=2009 |pages= |isbn=0-7020-2993-9 |oclc= |doi= |accessdate=}}</ref>
*Left parasternal heave: due to hyperdynamic right ventricle
*Palpable P2: correlates with severity of the disease
*Ausculation
**First and second heart sound (S1,S2)
***Loud P2 component of S2: this is due to the forceful closure of the valve because of increased pulmonary pressure. It can be heard mostly in the pulmonary area (upper right sternal border). If it is evident at the cardiac apex, this indicates more severe disease. It is best appreciated on inspiration.
Splitting of S2
***Narrowed splitting of S2: in chronic pulmonary hypertension, pulmonary artery compliance decreases leading to earlier pulmonary valve closure and narrowed splitting.
***Widened splitting of S2: widened splitting may occur later if right ventricular failure or bundle branch block develops.
**Extra Heart Sounds
***S4: due to right ventricular hypertrophy and therefore reduced compliance secondary to pulmonary hypertension. It is increased with inspiration.
***S3: if right ventricular failure develops. Increased with inspiration.
**Additional Sounds
Systolic pulmonary ejection click: increased with inspiration
**Murmurs
***Ejection midsystolic murmur: increased with inspiration
***Diastolic murmur (Graham-Steele murmur): indicates pulmonary regurgitation
***Pansystolic murmur: indicates tricuspid regurgitation and developing right ventricular failure[5]
 
 
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
 
===Back===
* Back examination of patients with scoliosis is vital. Physical findings may include:
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
*Genitourinary examination of patients with scoliosis is usually normal. But, in neuromuscular scoliosis, patient may present with bowel and bladder incontinence.
 
===Spine====
 
===Gait===
*Patients usually walk with bipedal unassisted gait.
*Some patients with neuromuscular scoliosis walk with a spastic gait.
 
===Palpation====
*No local rise in temperature
*Tenderness is usually not present.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
==References==
{{Reflist|2}}
 
 


===Extremities===
===Extremities===

Revision as of 20:06, 4 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; AE Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

Physical examination of patients with scoliosis is usually remarkable for shoulder asymmetry, waist-line asymmetry, thoracic wall or breast asymmetry, and truncal decompensation.

Appearance of the Patient

  • Patients with scoliosis usually appear well.

Vital Signs

Patients with scoliosis and other complications may have:

    • High blood pressure due to pulmonary hypertension and cor pulmonale

Skin

HEENT

  • HEENT examination of patients with Scoliosis is usually normal.

Neck

  • Neck examination of patients with scoliosis is usually normal. But, patients may have lateral bending of their neck due primary or secondary curve.
  • when scoliosis is complicated with pulmonary hypertension, it's physical findings may include0.0.0:

Prominent 'a' wave: due to forced atrial contraction

Lungs

Patients with scoliosis and other complications may have:

  • Chest wall or breast asymmetry is seen
  • Decrease breast sounds upon auscultation of the lung

Heart

Patients with scoliosis and it's late complications such as pulmonary hypertension and cor pulmonale include physical findings:[1][2][3]

  • Left parasternal heave: due to hyperdynamic right ventricle
  • Palpable P2: correlates with severity of the disease
  • Ausculation
    • First and second heart sound (S1,S2)
      • Loud P2 component of S2: this is due to the forceful closure of the valve because of increased pulmonary pressure. It can be heard mostly in the pulmonary area (upper right sternal border). If it is evident at the cardiac apex, this indicates more severe disease. It is best appreciated on inspiration.

Splitting of S2

      • Narrowed splitting of S2: in chronic pulmonary hypertension, pulmonary artery compliance decreases leading to earlier pulmonary valve closure and narrowed splitting.
      • Widened splitting of S2: widened splitting may occur later if right ventricular failure or bundle branch block develops.
    • Extra Heart Sounds
      • S4: due to right ventricular hypertrophy and therefore reduced compliance secondary to pulmonary hypertension. It is increased with inspiration.
      • S3: if right ventricular failure develops. Increased with inspiration.
    • Additional Sounds

Systolic pulmonary ejection click: increased with inspiration

    • Murmurs
      • Ejection midsystolic murmur: increased with inspiration
      • Diastolic murmur (Graham-Steele murmur): indicates pulmonary regurgitation
      • Pansystolic murmur: indicates tricuspid regurgitation and developing right ventricular failure[5]


Abdomen

  • Abdominal examination of patients with [disease name] is usually normal.

Back

  • Back examination of patients with scoliosis is vital. Physical findings may include:

OR

  • Point tenderness over __ vertebrae (e.g. L3-L4)
  • Sacral edema
  • Costovertebral angle tenderness bilaterally/unilaterally
  • Buffalo hump

Genitourinary

  • Genitourinary examination of patients with scoliosis is usually normal. But, in neuromuscular scoliosis, patient may present with bowel and bladder incontinence.

Spine=

Gait

  • Patients usually walk with bipedal unassisted gait.
  • Some patients with neuromuscular scoliosis walk with a spastic gait.

Palpation=

  • No local rise in temperature
  • Tenderness is usually not present.

OR

  • Patient is usually oriented to persons, place, and time
  • Altered mental status
  • Glasgow coma scale is ___ / 15
  • Clonus may be present
  • Hyperreflexia / hyporeflexia / areflexia
  • Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
  • Muscle rigidity
  • Proximal/distal muscle weakness unilaterally/bilaterally
  • ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
  • Unilateral/bilateral upper/lower extremity weakness
  • Unilateral/bilateral sensory loss in the upper/lower extremity
  • Positive straight leg raise test
  • Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
  • Positive/negative Trendelenburg sign
  • Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
  • Normal finger-to-nose test / Dysmetria
  • Absent/present dysdiadochokinesia (palm tapping test)

Extremities

  • Extremities examination of patients with [disease name] is usually normal.

OR

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity

References

  1. ↑ Simon O'Connor MBBS FRACP DDU; Nicholas P. Hirsch MBBS FRCA FRCP (2009). Clinical Examination: A Systematic Guide to Physical Diagnosis. Edinburgh: Churchill Livingstone. ISBN 0-7295-3905-9.
  2. ↑ Alexander, R. McNeill; Hurst, J. Willis; Schlant, Robert C. (1994). The Heart, arteries and veins. New York: McGraw-Hill, Health Professions Division. ISBN 0-07-055417-X.
  3. ↑ Clark, Michael; Kumar, Parveen J. (2009). Kumar and Clark's clinical medicine. St. Louis, Mo: Elsevier Saunders. ISBN 0-7020-2993-9.


Extremities

  • Uneven hip and shoulder levels
  • Unequal distance between arms and body
  • The feet for cavovarus deformity

Neurologic

Others

  • Asymmetric size or location of breast in females
  • Uneven musculature on one side of the spine
  • A rib "hump" and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis
  • During the exam, the patient is asked to bend forward (Adam's Bend Test). If a hump is noted, then scoliosis is a possibility and the patient should be sent for an x-ray to confirm the diagnosis.

References

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