An important goal of the musculoskeletal examination of children aged 6 to 12 years is to detect scoliosis. Scoliosis is the most common spinal deformity, especially in pubertal girls. Have the patient stand stripped to the waist. Inspect the back. Are the shoulders, or scapulae, at the same height? Is the occiput aligned over the intergluteal cleft? Ask the child to bend down and try to touch the toes, allowing the arms to hang freely. A unilateral elevation of the lower ribs is seen in patients with scoliosis. This is shown in Figure 24-49. Another method for detecting scoliosis is for you to mark the spinous processes with a pen while the child is standing in front of you. Then ask the child to bend forward from the waist. A deviation of the marks to either side suggests scoliosis. Unfortunately, none of the methods for detecting scoliosis has adequate sensitivity or specificity.
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