In terms of presentation, we say that
in children, adolescents and adults,
they're often asymptomatic.
And that's because the symptoms are mild, they're
hard to associate with a chronic condition
when the symptoms are transient.
In children, we check them for
scoliosis before their growth phase,
usually 10 to 12 in girls,
13 for boys.
In adolescents who are
they will notice complaints with clothes
not fitting and noticing the asymmetry.
That's a common thing that
drives them to the hospital or to a doctor.
It's the question of, "Is this normal
that there is an asymmetry in the body?"
With adults, we'll often hear complaints
of osteoarthritis and back pain
and just general aches and pains
in the back and neck region.
You will hear complaints of chest pain
as the next most common.
And you could potentially have
dysfunction of the heart and lungs.
The scoliosis presentation we
generally found on a screening exam,
once it presents to the doctor, once you see it,
you're gonna have to take it more seriously
and get a more objective assessment.
You're gonna need to solidify the diagnosis
with an x-ray and a spinal examination
preferrably before the growth
spurts you can monitor overtime.
But these are important points
in evaluating a child with a scoliosis.
The evaluation is to make sure
there is not a cancer, not trauma,
no fracture and assess for
more serious etiologies.
You wanna measure the magnitude
of the curve with a PA x-ray
and you may wanna use a Cobb, tool to
measure as well which is not the same
but it will give you a sense
of what the curvature is.
You also wanna note the age of onset,
any progression the family has noted
or changes the family has shared
with you overtime, any pain or discomfort.
What can't the patient do
or what they could do before,
what limitations do they have?
Are there issues with throwing, standing,
walking, getting upstairs, getting downstairs,
those are all questions you
want to address to the parents.
You also want to know when
to expect the growth spurt.
Has there been menarche in girls?
Has there been infection,
Has the patient been hospitalized?
Have they had bony infections?
These are all good things to know.
In the physical evaluation, make sure you
know any abnormal, physical findings,
any asymmetries and any areas that look like
there might be where the change is occuring.
During your exam make sure you note the
height because again, with scoliosis,
you will have a change in height and
you wanna note when that happens.
You wanna note the stage of puberty so you'll
understand when the growth phase is gonna occur
and when you need to be focusing on
changes in the curvature of the spine.
A solid neurological exam is necessary because
a lot of the conditions causing scoliosis
also have neurologic effects as well
So you wanna check the patient's ability to
walk, toe walk and heel walking is good.
Deep squatting or what we
call duck walking.
Are they able to hop on each leg and can
they do a 30 second stand on each leg?
What kind of balance issues do
they have and has that been affected?
You also wanna include notation of any
reflexes particularly the abdominal reflex.
You wanna examine the skin looking
for cafe-au-lait spots,
again, neurofibromatosis or any
vascular or hyperpigmented lesions
or patches that are overlying the spine
If you notice skin or joint laxity that can
lead you to worry about Ehler-Danlos syndrome
or other issues of joint laxity
that can lead to a scoliosis.
Are there any notes or signs of flat feet,
high arches or changes in the feet?
Any hammer toe or claw toe deformity?
those issues can give you a
sense of what the ideology is
and what you have to
worry about later on in life.
You also want to observe for symmetries
looking at the arms and the shoulders and
the neck and the occipital region.
You wanna check the level of the occiputs,
the shoulders, the iliac crest,
the PSIS, the PIIS and
the greater tronchanters.
And you wanna measure the leg lengths to make
sure there is no inequality of leg length,
not the short leg syndrome we talked about in the
other video, but a true change in the length of leg
which usually happens from a fracture
or other trauma related issues.
When you do the test,
the Adams forward bending,
you basically just wanna stand in front
of the patient and have them bend forward
and see if the curvature seems to go away and
what kind of functional deficit you may have.
You also wanna run the fingers
along the paraspinal musculature
and along the spinous processes.
We say if there's tenderness or
pain on the spinous processes,
you wanna look for malignancy or other
abnormalities like trauma or fracture
that would be more likely and
needs to be evaluated for.
If there's any problems with
walking or problems with balance,
those are important things that need
to be evaluated further as well.
A scoliometer is a carpenter's tool
that will measure the angle.
It's definitely PA x-ray, it will give you a
different score and it should be noted differently
than what you're noting on the x-ray.
You want to use the same tool each time when
you measure the curvature of the spine.
So with the scoliometer, it will
give you a sense of the curvature
but again, if you're gonna use that everytime,
use the same one and have consistency.
So it's important to remember when
you evaluate a person with scoliosis
that the scoliometer is not the equivalent to the
Cobb angle and their different measurements.
A general guideline is that the angle
of trunk rotation is of 7 degrees
is gonna have a Cobb angle
of 20 degrees.
So the Cobb angle is gonna be greater.
The operator-dependent measurements needs to
take into account things that cause error.
So if you don't forward bend them all the
way on the same degree or the same way,
you're gonna get inconsistent measurements.
If you're not measuring from
the top vertebrae,
you're gonna get
an inconsistent measurement.
So make sure you have a consistent,
standardized way of measuring the angle
so you get a good sense of what's going on.
When you measure scoliosis,
we're generally pretty good at it.
The inter-rater reliability is that
generally with the thoracic curves,
two different people measuring the curve
are gonna vary by about 2 degrees.
On the lumbar spine it's about 2.2 degrees
and when you have the intra-rater variability,
how much one person is gonna vary
in redoing their measurement?
it's about 1.2 degrees in the thorax
and 1.6 degree in the lumbar spine.
So we're pretty good at measuring it.