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