Question of the week # 304

304)

A 16-year-old male who presents to your office for his regular health checkup and for clearance before participation in then high school basketball team. During the physical examination, you note a mild convexity in the thoracic region of his spine with forward flexion at the hips. You ask him to lean forward with his feet together and bend 90 degrees at the waist. Based on your clinical examination, you estimate a lateral spinal curvature of about 5 degrees. You discuss these findings with the patient and his mother. Which of the following is the most appropriate action?

A. Recommend back-strengthening exercises.

B. Refuse medical clearance for participation in sports.

C. Order a radiograph of the back to quantify the curvature

D. Observation alone.

E. Refer for orthopedic consultation.

8 Responses

  1. observation

  2. d

  3. c

  4. D………The majority of cases of scoliosis do not require treatment.

    •If the curve is less than 25°, no treatment is required, and the child can be reexamined every four to six months.

    •If the curve is more then 25° but less than 30°, a back brace may be used for treatment.

    •Curves more than 45° will need to be evaluated for the possibility of surgical correction. Surgical correction involves fusing vertebrae together to correct the curvature and may require inserting rods next to the spine to reinforce the surgery.

    •Treatment options depend more on how likely it is that the curve will worsen than on the angle of the curve itself. A child with a 20° curve and four more years of growth may require treatment while a child with 29° of curvature who has stopped growing may not require treatment.

    • No you’re missing it. The 5 degree in the question refers to measurement using a scoliometer on clinical exam.You still have to take an PA xray of the spine to measure the Cobb’s angle and then determine treatment based on the severity.

  5. ddd

  6. E

  7. Answer is. C.we must have accurate quantitation of scoliosis before deciding what to do.depending on clinical sense only is not right.

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