An In Depth Review of Scoliosis: Clinical

Clinical evaluation focuses on history and physical examination findings. Consideration is given to circumstances surrounding the patient's birth, delivery and development histories. Was the pregnancy full term? What was the child's birth weight? When did the child begin to walk?--are some of the important guide posts which are sought. Abnormalities in these areas may lead one to consider neuromuscular or congenital etiologies. With congenital anomalies, if one congenital anomaly is found, others are sought, e.g., kidney abnormalities are often associated with congenital scoliosis. Intermittent backache may occur with idiopathic scoliosis, but complaints of pain radiating into the legs, night pain, or systemic complaints (for example changes in bowel or bladder habits) are highly abnormal and are not common complaints in patients with idiopathic scoliosis and usually require further study. A family history of spinal deformity is looked for since certain types of spinal deformity are more prevalent within families.

Physical examination centers on assessment of trunk symmetry. The Adam's forward bend test is done with the patient bending forward with arms extended and knees straight. Asymmetry of the trunk when viewed from the front or the back as well as abnormal increases or decreases in lordosis or kyphosis when viewed from the side are assessed (Fig.3). This test is used during school screening for scoliosis. The test is sensitive to detect trunk asymmetry but it is not specific for spinal deformity. A common finding that is often misinterpreted as spinal deformity is truncal asymmetry from unequal trunk muscle development on the patient's dominant hand side.

Figure 3a Adam's Bend Test - clinical (Frontal view)

Further physical findings depend on the patient's deformity location and magnitude. Shoulder heights may be uneven and there may be an increased space between the elbow and trunk because of trunk deviation (Fig.4). Prominence of a "hip", pelvis or breast may be seen. Examination of the skin overlying the spine assesses the presence of dimples, sinuses, hairy patches and skin pigmentation changes. The effect of any limb length inequality is tested with the patient standing on blocks to level the pelvis or seated on a flat surface. Neurological examination includes evaluation of the function of the muscles and nerves of the upper and lower limbs.

Figure 4 Scoliosis - clinical (Posterior view)