We discussed a 6 year old girl with concerns regarding her walking. Seen for FU. She had ‘Normal gait’, reduced muscle bulk in Left leg, some possible increase tone, reflexes defficult to elicit during the exam and almost equal power. There was a transverse scar, 8-10 cm in sacral area covered by her pants. This could be easily missed.
Points to examine: 4Ss, ask cahild to stand or hop on each leg, ALWAYS carefully examine spine.
Learning points:

• Do not regurge your clinical findings like an undergraduate
• Give your impression and why – supporting clinical findings
• Have a differential diagnosis
• In this case – likely Tumor, Meningomyelocle, Trauma – causing scar
• Examine fluent and structured. Repeat till you can do it in your sleep.
• Do the 4Ss before taking the child to couch.

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