Name: 小兒脊柱側彎誘發協議｜R.Shay Bess, M.D. (Pediatric Scoliosis Evaulation Protocol | R. Shay Bess, M.D.)
Uploaded: 2021-01-14T05:57:25.000Z
Duration: 8 min 2 s
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Hello I'm Dr. Shay Bess, I'm a board-certified orthopedic surgeon

as well as the spine surgeon with the Rocky Mountain Scoliosis and Spine Clinic

on the campus of Presbyterian/St. Luke's Medical Center

I'm here today to speak about physical examination procedures

physical therapists can use in determining whether

to refer a patient to the spine specialist these procedures can be

skin gait motor strength sensory conditions

reflexes and a range of motion of the extremities

in assessing posture we look for normal lordosis

C1 through C7 to be approximately 20 to 40 degrees

any condition of torticollis commonly known as wry neck

should be noted in the thoracolumbar region

normal kyphosis should be between T5 and T7

and again should be roughly between 20 and 40 degrees

and lordosis the lumbar spine should be approximately forty to sixty degrees

we also look for any real prominence including

as well as vertebral rotation  and also check the spine with a scoliometer

thoracic or lumbar prominences flat back deformity

or a loss of normal lordosis in the lumbar spine

is also a potential indicator of problems next we perform test

on the range of motion the spine in the extremities

from the cervical region we test for Spurling's

or creation of extremity pain by extending the neck

and rotating the chin toward the affected extremity this is an indicator of nerve

and we also ascertain any sternocleidomastiod or

trapizus pain including any soft tissue or bony anomalies

then turning to the thoracolumbar region  we check for flexion pain

which is an indicator disc with their problems as was extension pain

which may show us vacepulator problems  after checking for range in

we then turn to evaluation and the skin scars

can the notes problems including previous surgery as well as previous

hairy patches and skin dimpling may also  indicate

a simple gait analysis can also uncover a spinal condition namely

is their gait unsteady this may be due to pain

or a side to side lurch type gait is due to weakness

of the gluteus medius and gluteus minimus motor strength is a good indicator of

motor strength is graded I'm a scale of 0 to 5

with 0 being no evidence of contractivity of

normal strength in that muscle distribution

the cervical and lumbar dermatomes are useful

in assessing and locating a corresponding

and they are graded on a scale from 0 to 4 plus

indicates a normal reflex and four plus indicates hyperactivity

with associated clonus of the lower  extremities again the reflexes

follow a normal dermatome that corresponds

to that respective nerve root. In addition

to testing the reflexes of the lower extremeties

we also test the reflexes around the umbilicus region

we want to do a stroke all four quadrants

that's surround the abdomen and correspondingly

the umbilicus should move toward the stimulus

over a reflex or pull away from the region that is being stroked or

tested indicates an upper motor neuron lesion

is performed by striking either the volar or

and observing the reflex contraction of the thumb or

indicates presence of a upper motor neuron lesion

most likely emanating from spinal cord compression we next

test the planter aspects of the foot evaluating for a Babinski sign

normally when stroking the bottom or plantar aspect

however in the case of a positive Babinski sign

the toes splay upgoing rather than down going

rhythmic contraction causing the foot to alternate between

this most commonly indicates an upper motor neuron lesion

in performing a straight leg raise if raising away

and dorsiflexing the foot  causes pain that radiates from the back

which most commonly is caused by a herniated lumbar

disc in the event there is a contra lateral straight leg raise

causes left leg pain it's indicative of severe compression

cervical nerve tension is tested by the Spurling sign