Early And Late Childhood

In older children, abnormalities of the upper extremities are rare in the absence of injury.

The normal young child has increased lumbar concavity and decreased thoracic convexity compared with the adult, and often a protuberant abdomen.

Observe the child standing and walking barefoot. You can also ask the child to touch the toes, rise from a sitting position, run a short distance, and pick up objects. You will detect most abnormalities by watching carefully from

Toddlers may acquire nursemaid's elbow or subluxation of the radial head due to a tugging injury.

Adam Forward Bend Test For Scoliosis

both front and behind. To indirectly assess the gait pattern of the child, you can also note the soles of the shoes to see which side of the soles is worn down.

Inspect any child who can stand for scoliosis using techniques described below. Make sure to have the child bend forward with the knees straight (Adams bend test). Evaluate any asymmetry in positioning or gait. Scoliosis in a young child is unusual and abnormal; mild scoliosis in an older child is not uncommon.

If you detect scoliosis, you can use a scolio-meter to test for the degree of scoliosis. With the child standing, look for asymmetry of the shoulder blades or gluteal folds. Have the child bend forward as described.

Several types of scoliosis may present during childhood. Idiopathic scoliosis (75% of cases), seen mostly in girls, is usually detected in early adolescence.

Look for prominence of the posterior ribs. Place the scoliometer over the spine at a point of maximum prominence, making sure that the spine is parallel to the floor at that point, as shown on the previous page. Have the child bend fully forward to assess lumbar scoliosis, and less so to assess thoracic scoliosis.

In severe hip disease, the pelvis tilts toward the unaffected hip when weight is borne on the affected side (an abnormal positive Trendelenburg's sign).

You can also use a plumb line, a string with a weight attached, to assess symmetry of the back. Place the top of the plumb line at C-7 and have the child stand straight. The plumb line should extend to the gluteal crease (not shown here).

Test for severe hip disease, with its associated weakness of the gluteus medius muscle—observe the child from behind as the child shifts weight from one leg to the other. The pelvis should remain level when the weight is borne on the unaffected side, called a negative Tren-delenburg's sign.

Determine any leg shortening that may accompany hip disease by comparing the distance from the anterior superior spine of the ilium to the medial malle-olus on each side. First, straighten out the child by gently pulling on the legs and then compare the levels of the medial malleoli to each other. You can also put a small ink dot over the prominent malleoli and touch them together to give you a contact point to measure.

Also, have the child stand straight and place your hands horizontally over the iliac crests from behind, as shown in the photo on the next page. Small discrepancies in leg length can be appreciated. If such a discrepancy is noted, a clever trick is to place a book under the shorter leg; this should eliminate the discrepancy.

The musculoskeletal examination of the adolescent is similar to that of the adult. Pay particular attention to the possibility of scoliosis.

More than 25 million children and adolescents in the United States and a large number in other countries participate in organized sports and often

In severe hip disease, the pelvis tilts toward the unaffected hip when weight is borne on the affected side (an abnormal positive Trendelenburg's sign).

Important risk factors for sudden cardiovascular death during sports include episodes of dizziness or palpitations, prior syncope (particularly if associated with exercise), or family history of sudden death in young or middle-aged relatives.

require "medical clearance." Start the exam with a thorough medical history, focusing on cardiovascular risk factors, prior surgeries, prior injuries, other medical problems, and a family history. The preparticipation physical exam is often the only time a healthy adolescent will see a medical professional, so it is important to include some screening questions and anticipatory guidance (see the discussion on Health Promotion and Counseling). Finally, perform a general physical, with special attention to the cardiac and lung exams and a vision and hearing screen. The preparticipation exam should then include a focused, thorough musculoskeletal exam, looking for weakness, limited range of motion, and evidence of previous injury.

During the preparticipation sports physical, assess carefully for cardiac murmurs and wheezing in the lungs.

A 2-minute preparticipation screening musculoskeletal examination has been recommended.

Screening Musculoskeletal Examination for Children Participating in Sports

Specific Components of the Musculoskeletal Examination

Positioning

Instructions to Patients

Common Abnormalities Due to Prior Injury

1. Stand straight, facing you.

Asymmetry, swelling of joints

(continued)

Screening Musculoskeletal Examination for Children Participating in Sports (Continued)

Specific Components of the Musculoskeletal Examination

Positioning

Instructions to Patients

Common Abnormalities Due to Prior Injury

2. Move neck in all Loss of range of motion directions—look at the ceiling and floor, touch ears to shoulders.

3. Shrug shoulders while Weakness of shoulder, neck, you hold them down. or trapezius muscles

4. Hold arms out to side Loss of strength of deltoid and lift arms while you muscle press down.

(continued)

Screening Musculoskeletal Examination for Children Participating in Sports (Continued)

Specific Components of the Musculoskeletal Examination

Positioning

Instructions to Patients

Common Abnormalities Due to Prior Injury

Positioning

Instructions to Patients

Common Abnormalities Due to Prior Injury

Screening Musculoskeletal Examination for Children Participating in Sports (Continued)

Specific Components of the Musculoskeletal Examination

Positioning

Instructions to Patients

Common Abnormalities Due to Prior Injury

Positioning

Instructions to Patients

Common Abnormalities Due to Prior Injury

H The Nervous System_

The examination of the nervous system in infants and children has several special characteristics. The examination includes techniques that are highly specific to a particular age, especially for infants. Testing primitive reflexes is important in infants; they are only present at certain ages and then disappear. Absent reflexes or retention of these reflexes may signify abnormalities. In general, the examination of the nervous system of infants and young children is highly dependent on both internal and external factors listed here.

Eliminating Stress and Anxiety From Your Life

Eliminating Stress and Anxiety From Your Life

It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.

Get My Free Ebook


Post a comment