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





- height / breasts / pubic hair



- cafe-au-lait spots

- axillary freckling (look in axilla)

- neurofibromas



- Lisch nodule (NF)

- blue sclera (OI)

- cloudy cornea (mucopoly)

- dislocated lens (Marfan's)

- optic glioma



- Abnormal teeth (OI)

- high-arched palate (Marfan's)

- large tongue (Achondroplastic)



- pectus carinatum or excavatum

- protruberant sternum with sharp manubriosternal angle



- hemihypertrophy

- dolichostenomelia (long limbs)

- arachnodactyly (thumb in palm)

- clubfoot - often first sign of dysraphism

- cavovarus foot






Thoracic kyphosis

- exaggerated, normal or reduced / hypokyphotic


Lumbar lordosis

- exaggerated, normal or reduced


Protruberant abdomen





- 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



- 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





- hamstring tightness



- 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




"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