title: Neuro-orthopaedic evaluation of children and adolescents: a simplified algorithm.
abstract: Orthopaedic surgeons are often the first physicians to evaluate paediatric patients in the event of delayed walking, gait abnormalities, or parental concern about motor abilities. Therefore, orthopaedic surgeons must be thoroughly familiar with the normal neurodevelopmental stages. Neurological disorders are often first recognised during an orthopaedic evaluation. Minimal neurological abnormalities should be taken as warning signs that require additional investigations. Consequently, the evaluation must follow a strict protocol, even in children referred for apparently trivial functional disorders. We have developed an original physical examination protocol in which the largest possible number of signs is sought in each body position to ensure that the examination is both systematic and rapid. About ten minutes are required when all findings are normal. This protocol is extremely helpful for identifying the cause of the problem that motivated the evaluation or for reassuring the child and family. The main causes of paediatric orthopaedic disorders are cerebral palsy, spinal dysraphism, myopathies, peripheral neuropathies, motor neuron diseases, and intraspinal tumours. In some instances, no definitive diagnosis can be established clinically. In this situation, appropriate orthopaedic treatment can be initiated, although considerable caution is in order when establishing the indications. The cause may be detected only much later, when the clinical manifestations become more prominent.
authors.affiliation: Department of Pediatric Orthopaedics Surgery, University Hospital of Montpellier, Lapeyronie Hospital, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France. jerome.cottalorda@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Cottalorda
authors.forename: P
authors.initials: P
authors.lastname: Violas
authors.forename: R
authors.initials: R
authors.lastname: Seringe
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000465:Algorithms; D002547:Cerebral Palsy / Q000175:diagnosis* / Q000628:therapy; D002607:Charcot-Marie-Tooth Disease / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D016472:Motor Neuron Disease / Q000175:diagnosis* / Q000628:therapy; D009460:Neurologic Examination / Q000379:methods; D009468:Neuromuscular Diseases / Q000175:diagnosis / Q000628:therapy; D009985:Orthopedics / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D016135:Spinal Dysraphism / Q000175:diagnosis* / Q000628:therapy