Movement and postural disturbances in adolescence

Chapter 9 Movement and postural disturbances in adolescence



Case 9.1


A 14-year-old girl has presented with weakness of one hand. Observe the photograph in Figure 9.1, in which she has been asked to hold her arms out directly in front of her.


image

Figure 9.1


(Source: Mir, MA. Atlas of Clinical Diagnosis [2nd edn]. Edinburgh: Saunders; 2003: 61, Fig 9.136)




Questions



1. Which of her movements are affected? Which of her muscles are weakened?

2. What is the name of the deformity shown in the photograph?

3. The patient has no problem in opposing her thumb and little finger. Is her condition more likely to be a peripheral nerve lesion, or spinal cord/nerve root pathology? Why?

4. At what site would you expect to demonstrate sensory changes?

5. Although she was unable to extend at her metacarpophalangeal joints, she was able to partly extend at her interphalangeal joints. Why?

6. What may have caused her problem?


Case 9.2


A mother brings in her 12-year-old daughter, Sally. Sally has uneven shoulders and an asymmetrical thoracic cage, which has been concerning her mother. She does not complain of shoulder or back pain although she states sometimes her low back aches a little bit.




Questions



1. What pertinent questions do you wish to ask?

2. What are the possible causes of her asymmetry?

3. What physical examination techniques and investigations can you do in order to narrow your differential diagnosis?

4. Considering the age and gender of the patient, what is the most likely diagnosis?

5. Who is most susceptible to this condition?

6. What two methods are commonly used to measure a scoliotic curve on a plain film radiograph?

7. Describe the age-based classification categories for idiopathic scoliosis.

8. Are there any complications associated with this patient’s presenting condition?


Case 9.3


Sheamus, a 14-year-old boy, is brought to your office by his mother, after a teacher noticed his posture to be somewhat ‘hunched’ in class. Sheamus had also recently been complaining of a minor dull ache localised to the middle of his back, which is aggravated when playing soccer. While appearing generally healthy, Sheamus seems very tall for his age. His gait is normal. He takes no medication.




Questions



1. What is your differential diagnosis, based solely on the history?

2. An X-ray is subsequently taken, and shown in Figure 9.2. What does it demonstrate? What features denoted here are of significance? What is now your most likely diagnosis?

3. What is the major cause(s) of this condition?

4. What other symptoms and signs can occur with this disorder?

image

Figure 9.2



Case 9.4



History


A 13-year-old girl presents with concern that she can no longer perform handstands in gymnastics without falling immediately. Weakness in both hips was first noted a year ago, and progressed insidiously over this time. A few weeks ago she also noticed weakness of both shoulders, and hence became unable to perform the handstands. The weakness does not improve with rest. There is no history of trauma or other injuries. She is otherwise well.



Questions



1. What is your differential diagnosis, based solely on the history?

2. What additional questions do you wish to ask?


Physical examination


On examination, there is marked bilateral atrophy and weakness of pelvic, shoulder and abdominal musculature. Bilateral scapular winging is evident. Facial muscles are unaffected. Gait is wide-based and lordotic. Calves appear normal, feel muscular and are equal in size. Respiration is normal. There are no signs of cardiac abnormalities.



Questions



3. How does this information help narrow your differential diagnosis? What is now the most likely diagnosis?

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Dec 26, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Movement and postural disturbances in adolescence

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