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
Skin
- cafe-au-lait spots / axillary freckling / neurofibromas
Eyes
- Lisch nodule (NF)
- blue sclera (OI)
- cloudy cornea (mucopolysaccharidases)
- dislocated lens (Marfan's)
- optic glioma
Mouth
- abnormal teeth (OI)
- high-arched palate (Marfan's)
Trunk
- pectus carinatum or excavatum (Marfan's)
Limbs
- hemihypertrophy
- dolichostenomelia (long limbs)
- arachnodactyly (thumb in palm)
- clubfoot - often first sign of dysraphism
- cavovarus foot
LLD
Side
Thoracic kyphosis - reduced / hypokyphotic
Lumbar lordosis - exaggerated, normal or reduced
Protruberant abdomen
Back
Curve
- right or left
Balanced / Unbalanced
- alignment of C7 over gluteal cleft (ask for plumb bob)
Shoulder height
Scapular symmetry
Loin creases / lumbar fullness
Pelvis
- level or not (pant line or PSIS)
Spinal dysraphism
- hyperpigmentation / hairy patch / dimple / lipoma / tail
Leg length
- if abnormal use blocks & reassess curve
Scoliosis can cause apparent LLD
- true curves rotate into their convexity
A long leg will elevate the hemipelvis / convexity will be to opposite side
- fixed left scoliosis will give apparent left leg shortening
True LLD -> Apparent scoliosis
True scoliosis -> apparent LLD
Adam's test
Hands together & bend forwards to touch floor
- mild / moderate / severe rib hump
- well rounded or angular
- satisfactory unroll
Meaure rib hump with scoliometer
Gait / STRAWS
Short
Trendelenburg
Rigid
Antalgic
Weak
Spastic
Supine
SLR
- hamstring tightness
Neurological
- reflexes UL / LL / Abdominal / Babinski
- sensation
- power UL / LL
Scoliosis + °Abdominal reflexes & °Axillary sensation
- syrinx till proven otherwise
Abdominal reflexes disappear during teens
Prone
Correctable
Collagen
Ligamentous laxity / Wynne Davies criteria
Concealed
- if forgotten
- natal cleft / mouth / eyes / axillae
Cephalad joints
- ROM if deformity
Circulation
Xray
"This is a PA spine radiograph of a __ old skeletally mature / 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