Pediatric Orthopedic Physical Examination of the Infant: A 5-Minute Assessment

Abraham Ganel, MD, Israel Dudkiewicz, MD, Dennis P. Grogan, MD

Disclosures

J Pediatr Health Care. 2003;17(1) 

In This Article

Scapulae and Spine

Scapulae

The scapulae should be palpated, checking size, location, and symmetry. In Sprengel deformity, the scapula fails to descend during development and remains abnormally high and smaller than the contralateral side (Leibovic et al., 1990). There may be an abnormal connection between the scapulae and the cervical spine known as the omovertebral bone. A limited range of shoulder motion is common. Winging of the scapula should be noted.

Spine

The spine should be palpated noting congenital abnormalities, or signs of spinal dysraphism. Ahairy patch at the lumbar region, a sacral sinus, or hemangioma could represent an occult spinal abnormality, such as diastematomyelia or sacral agenesis (Jamil & Bannister, 1992; Miller et al., 1993). A dimple on the buttocks could also indicate a congenital anomaly of the femur. The Shochat test, in which the soles of the two feet are brought together, should be performed while the child is prone and the hips in abduction. Normally the gluteal cleft should be in alignment with the line of the contact between the two feet. Failure to realign indicates limited abduction on one side, and could be another sign of developmental dislocation of the hip. Bending the knee to 90° will enable measurement of the thigh-foot angle, as well as assist in detecting foot anomalies, such as forefoot adduction. Detection of multiple joint dislocations may indicate Larsen's syndrome (Laville et al., 1994).

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