<prompt> Answer this question truthfullyWhat does the physical examination for scoliosis involve?  <response>: <reason> Physical examination of patients with scoliosis is usually remarkable for shoulde r asymmetry, waist-line asymmetry, thoracic wall or breast asymmetry, and truncal decompensation. Patients with scoliosis usually appear well. Tanner staging done to predict magnitude of curve progression.Patients with scoliosis and other complications may have:High blood pressure due to pulmonary hypertension and cor pulmonaleSkin for café au lait spots indicative of neurofibromatosis Spina bifida as evidenced by a dimple, hairy patch, lipoma, or hemangiomaHEENT examination of patients with scoliosis is usually normal.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, its physical findings may include: Prominenta wave: due to forced atrial contraction Prominentv wave: later if tricuspid regurgitation develops with right ventricular failure Elevated JVP: can be present if right ventricular failure develops Postive Kussmauls sign: JVP elevation during inspiration the opposite of what normally happens because of right ventricular failurePatients with scoliosis and other complications may have:Chest wall or breast asymmetry is seen Decreased breast sounds upon auscultation of the lungPatients with scoliosis and its late complications such as pulmonary hypertension and cor pulmonale include physical findings: 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 failureAbdominal examination of patients with scoliosis is usually normal Flank fullness may be seenGenitourinary examination of patients with scoliosis is usually normal. But, in neuromuscular scoliosis, patient may present with bowel and bladder incontinence.Patient is usually oriented to persons, place, and timePatients usually walk with bipedal unassisted gait. Some patients with neuromuscular scoliosis walk with a spastic gait.No local rise in temperature Tenderness is usually not present. Head may be centered or tilted away from pelvis Shoulders asymmetry Scapular asymmetry with one scapula being farther away from the the mid-line Spinous process are deviated away from mid-line Lateral curvature of the spine, with curve described in terms of convexity directed to right or left Paraspinal muscle spasm may be present Rib razor hump is usually present Posterior Superior Iliac spine PSIS asymmetry seen Anterior Superior Iliac spine ASIS asymmetry seen List and step are usually not present Sagittal balance Head in line with sacrum may be disturbed Sinuses and tuft of hair may be present Flank fullness may be seenFlexion and extension are usually affected Lateral flexion and rotation helps to identify rigidity of the curveLateral bending test are usually affected Traction test are usually abnormal Prone position test are usually abnormalMotor Motor weakness may be seen Spasticity and rigidity may be seen depending on level of involvement Sensory Fine touch and crude touch may be lost Hypoesthesia may be seen Postion sense and vibration may be disturbed Two point discrimination may be lost Reflexes Hypo or Hyper reflexia may be seen depending on level of involvement Clonus may be seen Coordination Coordination may be affected when scoliosis is associated with CNS involvement such arnold-chiari malformationAdams forward bending test makes the hump prominentHump height Chest expansion is usually decreased Limb length discrepancy may be present Truncal height is measured in standing and sitting position, which is usually abnormal Scoliometer is used to measure the curveStraight leg raising SLR test may be positive Test: Patient in supine position with knee and hip in extension Elevate the patients leg in air, so the hip gets gradually flexed with knees in extension Presence of radiating pain in the leg between 30-70 degrees of hip flexion indicates a positive testCross SLR is usually absent Test: Patient in supine position with knee and hip in extension Elevate the patients contralateral leg in air, so the hip gets gradually flexed with knees in extension Presence of radiating pain in the ipsilateral leg indicates a positive testLassegue test may be positive Test: Patient in supine position with knee and hip in extension Elevate the patients leg in air, so the hip gets gradually flexed with knees in extension If radiating pain present in the legs between 30-70 degrees of hip flexion, then slightly lower down the angle of flexion at the hip and dorsiflex the ankle Presence of radiating pain in the leg again indicates a positive testBowstring test may be positive Test: Patient in supine position with knee and hip in extension Elevate the patients leg in air, so the hip gets gradually flexed with knees in extension If radiating pain present in the legs between 30-70 degrees of hip flexion, then slightly bend the kneewhich will relieve the symptoms Apply digital pressure in popliteal fossa over the posterior aspect of sciatic nerve Reproduction of radiating pain indicates nerve compressionFemoral stretch test may be positive Test: Patient in prone position with knee bend to 90 degrees and hip in extension Grasp the lower end of the femur and extend the hip Presence of pain on the anterior aspect suggests compression of the femoral nerveFeet may show cavovarus deformity 