A site for medical students - Practical,Theory,Osce Notes

Significance of posture of the patient

The position or attitude that is constantly assumed by a patient at rest or in motion is referred to as posture. The posture of a patient, when viewed from the side, may be characteristic enough to suggest an underlying diagnosis.

The various postures seen in clinical practice are the following :
1. Postures seen when the patient is standing / sitting.
  • Vertical line seen in standing posture, when the patient is viewed from the side, is a good posture.
  • Standing posture, when it assumes a S-shaped curve, when viewed from the side of the patient , is a poor posture.
  • Asthenic posture : The normal curves of the spine are exaggerated in asthenic posture. Seen in debility, wasting and insenility.
  • Parkinsonian posture : Universally flexed posture.
  • Lordotic posture : There is an exaggerated lumbar lordosis.This is seen in muscular dystrophy, due to proximal muscle weakness.Lordotic posture is also seen in bilateral hip problems.
  • Cerebellar posture : In lesions of the cerebellum or its connections, the patient stands with his feet wide apart, and is unable to maintain a upright steady posture when standing with both his or her feet placed close together. Patient is ataxic on standing (truncal ataxia) when the cerebellar vermis of is involved.
  • Posture in ankylosing spondylitis : There is loss of the lumbar lordosis, and an exaggeration of the upper thoracic kyphosis.
  • Catatonic posture : It is seen in schizophrenia. In this the patient maintains particular posture of the body and limb for hours together. 
2. Postures seen when the patient is lying down:
  • Decerebrate posture : There is extension of elbows and wrists, with pronation of the arms is seen. This posture suggests that the lesion is at the brainstem level, disconnecting the cerebral hemispheres from the brainstem.
  • Decorticate posture : There is flexion of elbows and wrists, with supination of the arms is seen. It suggests severe bilateral hemispherical damage above the midbrain.
  • Hemiplegic posture : The patient lies on his back,with the cheek on the affected side blowing out with each time the patient expires. The affected upper limb lies flaccidly by his side, and the affected lower limb is externally rotated. This picture is seen immediately after the onset of hemiplegia. In long standing hemiplegia, there may be loss of naso labial fold of the face on the side of the paresis, with the affected upper limb in a flexed posture and the affected lower limb in an extended posture.
  • Opisthotonus : In this posture the patient is arched up like a bow, with his or her heel and occiput in contact with the bed. This posture is seen in patients affected with tetanus and strychnine poisoning.
  • The lateral decubitus posture with curled up limbs to minimise the stretching of the meninges, is seen patients with meningitis or meningism.
  • Patient lying up with a back rest or cardiac rest (propped up posture )suggests a possibility of the patient having CCF or COPD.
  • Patient sitting up and holding on to a support before him, in order to fix his shoulders, and the patient is dypneic suggests a diagnosis of bronchial asthma.
3. Patient lying down still and
  • Clutching his chest-suggest anginal chest pain
  • Shallow breathing, with minimal or no movement of the anterior abdominal wall is seen in peritonitis.
4. Patient rolling about in the bed from side to side and
  • Clutching his chest is observed in Myocardial infarction.
  • Holding his upper abdomen is seen in Biliary colic.
5. Patient sitting up and bending forwards, may be seen in
  • Pericarditis
  • Pancreatitis
The patient assumes this posture because the pain caused by both these conditions is relieved by assuming this posture.
Prone posture : Patient preferring to lie in the prone position than in the supine position may be due to the presence of an abdominal aortic aneurysm which may erode on the vertebra in the supine posture and this may cause back pain. On lying prone as the  the aorta falls forward from the vertebra and the back pain subsides.
Pleuritic pain and pleural effusion patient may be seen lying on the affected side for relief of pain and dyspnea.