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.
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.
