Scoliosis Exam

Aims of Examination

 

1.  Identify cause

 

- Marfan's / Neurofibromatosis / Skeletal Dysplasia

 

2.  Balance & body asymmetry

 

3.  Exclude LLD as cause

- correct with blocks or sit patient

 

4.  Forward flexion / Adams forward bending

- look for rotation / rib hump

 

5.  Assess flexibility if considering surgery

 

Typical curve

 

The right shoulder is raised

The right scapula is prominent

The loin creases are asymmetrical

The pelvis is level

There is flattening of the normal thoracic kyphosis

There is a normal lumbar lordosis

On forward bending, there is a (mild/moderate/severe) (well rounded/angular) rib hump and a mild left lumbar fullness

 

Front

 

Maturity

- height / breasts / pubic hair

 

Skin

- cafe-au-lait spots

- axillary freckling (look in axilla)

- neurofibromas

 

Eyes

- Lisch nodule (NF)

- blue sclera (OI)

- cloudy cornea (mucopoly)

- dislocated lens (Marfan's)

- optic glioma

 

Mouth

- Abnormal teeth (OI)

- high-arched palate (Marfan's)

- large tongue (Achondroplastic)

 

Trunk

- pectus carinatum or excavatum

- protruberant sternum with sharp manubriosternal angle

 

Limbs

- hemihypertrophy

- dolichostenomelia (long limbs)

- arachnodactyly (thumb in palm)

- clubfoot - often first sign of dysraphism

- cavovarus foot

 

LLD

 

Side

 

Thoracic kyphosis

- exaggerated, normal or reduced / hypokyphotic

 

Lumbar lordosis

- exaggerated, normal or reduced

 

Protruberant abdomen

 

Back

 

Curve 

- right or left

 

Balanced or Unbalanced 

- alignment of C7 over gluteal cleft (ask for plumb bob)

 

Shoulder height

 

Scapular symmetry

 

Loin creases / lumbar fullness

 

Flattened heart-shaped buttocks

 

Pelvis 

- level or not (pant line or PSIS)

 

Spinal dysraphism

- hyperpigmentation / hairy patch / dimple / lipoma / tail

 

Leg length 

- if abnormal use blocks & reassess curve

 

Adam's test 

- hands together & bend forwards to touch floor

- mild/mod/severe rib hump

- well rounded or angular

- satisfactory unroll

 

Supine

 

SLR

- hamstring tightness

 

Neurological

- Reflexes UL / LL / Abdominal / Babinski

- Sensation

- Power UL/LL

 

Scoliosis + No Abdominal reflexes & No Axillary sensation 

 Syrinx till proven otherwise

 

Abdominal reflexes disappear during teens

 

Xray

 

"This is a PA spine radiograph of a __ old skeletally mat/immature Risser __ male/ female with Scoliosis"

 

"There is a R/L typical/atypical curve thoracic/lumbar curve ±  a R/L T/TL/L lower curve"

 

"The spine is/isn't balanced, the pelvis is/isn't level & the curve has a rotational component"

 

"The curve appears to be Idiopathic / Congenital / NF ? NM

 

Don't mention which is 1°/ 2° or postural or structural