Orthopedic examinations in children - Not only just orthopedic -- AAH

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Date Posted: 10:46:15 11/10/14 Mon
Author: Knut Holt
Subject: Orthopedic examinations in children - Not only just orthopedic

Orthopedic Examinations in Children - Often Done With Hidden Motives

By Knut Holt
http://www.mydeltapi.com

An orthopedic examination is an integral part of a well-child periodic assessment, and it is also performed both on children and on adults upon special concerns. The extent of the examination varies however much from setting to setting. The part which is nearly always present is the back and spine check, with the specific purpose of cacting a developing scoliosis as early as possible. The scoliosis check is usually done like this:

One first checks if one shoulder is higher than the other. Then one checks if one hip crest is higher than the other. One looks and feels along the spine while the patient is standig upright to see and feel the curvature. Often abnormal twistings and bendings can be seen right away. To be more sure one also lets the patient bend foreward. Where the spine is curved towards one side, one will see a bump on that side of the back, because the bent part of the spine will be pressed outward on that side. By letting the patient do other bends and twistes with the torso, arms and legs, a more complete picture can be made.

During this test the patient must be naked on the back and also on the upper parts of the buttocks. The very best for the diagnosis is a totally naked patient, so that on can also see misalignment of the buttocks that are assosiated with scoliosis, but one usually lets the patient wear underpants and pulls these down more or less at some point in the test. It is generally recommended that children and teens are examined by such a simple test each year.

If scoliosis is detected with such simple tests, and it looks severe enough, one will often do more thorrough examinations, especially with x-ray imaging.

In addition to the back and scoliosis check, the checking of limbs, joints and their function is a main topic by the orthopedic examination, and especially at the legs and the pelvic zone. Usually the patient will wear short briefs only during this examination. In certain settings one prefere to examine children totally naked.

By this orthopedic examination one usually begins by checking the gait. One lets the patiant go from and to the examinator while watching himher walking in both directions.

Later on one usually checks the hip joints and the legs. The patient will usually be laying on the back on an examination table. One will then do several handlings and bendings of the legs to check range of movement:

- One feels along each legs to test consitancy and tone of the muscles and the temperature in the leg.

- With both leg streight out, one swings the foot outwards and inwards, up and down.

- The patient lays with straight legs and the examinator spreads the legs as far as possible out to each side.

- One flexes the knees of the patient up in a frog fashion and let hisher soles touch each other. Then the legs are spread down to each side.

- One lets the legs lay straight out on the examination table. With one leg still laying straight, one swings the other straight leg up as far as possible and then down again, and the foot is held so that the calves are maximally stretched.

- While one legs lays straight, one flexes the other leg up and tries to press the knee of that leg as far down towards the chest area as possible, while also trying to press the foot as far as possible down towards the thigh, and the foot is held so that the toes point upwards.

- Whith one leg laying straight, one flexes the other leg up so that the thigh and calve make a 90 degree angle, and then one swings the calve as far as possible inwards and outwards.

- With one leg laying straight, one holds under the foot and over the knee, lets the knee joint be flexed and rotate the leg around.

The same tests are then done with the other leg while the first leg is held straight. Many of these tests are often done in one continuous movement.

As said one will often prefere to have the child completely naked during these tests. This has the advantage that one can see if the cleft between the buttocks, the natal cleft, and the vulvar cleft in girls, are alligned normally. But the child might, depending much upon its cultural heritage, feel it to be embarressing being totally naked during these hip and leg tests.

Even though these tests are necessary for a thorrough test of the joints of the lower extremities, the very nature of the movements will also give a mechanical stimulation upon the genital organs and upon the area around the anus. The examinator possibly also looks for the nature of the reactions caused by this stimulation, but will never mention that heshe so does.

Even though it is never said openly, one possibly also prefere the child to be naked to test hisher psychological reactions upon being inspected rather intimately this way, or to see if the movements cause leackage from the urinary tract, the vagina or anus.

The pediatric services in most countries have a standing order form the authorities of being on constant allert for signs of sexual abuse of children or for signs that the children themselves have unwanted sexual habits, and suspect every parent of being abusers. Even though it is never said openly, it seems that the reactions of the child during these tests are used to assess the possibility of the child being a victim of abuse or of "self-abuse".

The shoulder and elbow joints will be tested in much the same way. This will occur before or after the hip and knee test. There is however a tendency to keep much less attention upon the joints in the upper extremities than those in the lower.

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