Spinal Muscular Atrophy: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body temperature, body weight, body height; further:
    • Inspection
      • Skin (Normal: intact; abrasions/wounds, redness, hematomas, scars) and mucous membranes.
      • Posture [free sitting possible?, standing possible?, frog leg posture (bending of legs, angling of knees outward as well as angling of feet inward)]
      • Gait pattern (walking with walking aid possible?, no walking possible).
      • Malpositions (deformities, contractures, shortenings).
      • Muscle atrophies (side comparison!, if necessary circumference measurements).
      • Muscle contractures
    • Palpation of vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral musculature); soft tissue swelling; tenderness (localization! ; restricted mobility (spinal movement restrictions); “tapping signs” (testing painfulness of spinous processes, transverse processes, and costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain?; compression pain, anterior, lateral or saggital; hyper- or hypomobility?
    • Palpation of prominent bone points, tendons, ligaments; musculature; joint (joint effusion?); soft tissue swelling; tenderness (localization!).
    • Measurement of joint mobility and range of motion of the joint (according to the neutral zero method: the range of motion is given as the maximum deflection of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
    • If necessary, special functional tests depending on the affected joint.

Square brackets [ ] indicate possible pathological (pathological) physical findings.