The pediatric physical examination: Back, extremities, nervous system, skin, and lymph nodes
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
Examination of the back, extremities, nervous system, skin, and lymph nodes in children will be reviewed here. Other aspects of the pediatric physical examination are discussed separately. (See "The pediatric physical examination: General principles and standard measurements" and "The pediatric physical examination: HEENT" and "The pediatric physical examination: The perineum" and "The pediatric physical examination: Chest and abdomen".)
The back examination is relatively standard for all ages. Spinal alignment, structural asymmetry, soft tissue masses, skin lesions, and points of tenderness should be noted. The vertebral column should be straight, with alignment along an imaginary vertical line from the midpoint of the occiput to the gluteal cleft. The level of the shoulders, scapulae, and pelvic rims should be symmetrical.
Any midline soft tissue lesion overlying the spine (eg, dimple, vascular anomaly, pigmented nevus, hairy patch) should raise suspicion of an underlying neurologic defect . Defects of the bony spine or of the overlying skin or soft tissue in an infant may indicate the presence of a meningocele, myelomeningocele, lipomeningocele, diastematomyelia, abscess, or tumor. With many of these lesions, the neurologic deficits may be sufficiently severe to lead to genitourinary tract, gastrointestinal tract, and/or lower-extremity impairment. (See "Closed spinal dysraphism: Clinical manifestations, diagnosis, and management", section on 'Cutaneous'.)
Midline dimples in the skin overlying the coccyx generally are of no significance. Dimples above the gluteal cleft and on or above the flat part of the sacrum (ie, lumbosacral dermal sinus tracts) usually require neuroimaging and/or neurosurgic evaluation. (See "Closed spinal dysraphism: Clinical manifestations, diagnosis, and management", section on 'Evaluation and diagnosis'.)
Scoliosis in the neonate has great significance because it produces cosmetic problems and potential visceral and/or neurologic dysfunction. Almost 33 percent of children with congenital scoliosis have associated urinary tract anomalies .
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