Orthopedics Book

Thoracic Spine Disorders

  • Scoliosis Examination

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Scoliosis Examination

Aka: Scoliosis Examination, Forward Bending Test, Scoliometer, Adam's Test, Adam's Position, Adam's Forward Bend Test
  1. See Also
    1. Scoliosis
    2. Scoliosis XRay (Cobb Angle)
  2. Indications
    1. Scoliosis Screening
  3. Technique: Adam's Forward Bending Test
    1. Most accurate visual screening method
    2. Patient position
      1. Patient with shirt off and spine fully visible
      2. Forward bending with feet together and knees straight
      3. Allow arms to hang down freely (or palms opposed)
    3. Examiner position
      1. Observe patient from behind (preferred position)
      2. Some school screening programs observe the patient from the front (may be less accurate)
    4. Abnormal findings: Unilateral changes
      1. Rib Cage elevation on one side (rib hump)
      2. Prominent unilateral lumbar paravertebral muscle
  4. Technique: Scoliometer
    1. Scoliometer measures trunk rotation
    2. Patient positioned as in forward bending above
    3. Scoliometer position
      1. Place Scoliometer on midline, perpendicular to spine
      2. Position at Vertebral level of maximum rib prominence
    4. Interpretation
      1. Scoliometer inclination <5 degrees typically warrants no further evaluation
      2. Inclination of 5-9 degrees suggest Scoliosis and warrants Scoliosis XRay (or 6 month recheck at minimum)
      3. Scoliometer inclination >10 degrees suggests severe Scoliosis and requires work-up
    5. Scoliosis XRay Indications
      1. BMI <85%: Scoliometer measurement 7 degrees or more of trunk rotation (~20 degree Cobb Angle)
      2. BMI >85%: Scoliometer measurement 5 degrees or more of trunk rotation (~10 degree Cobb Angle)
  5. Technique: Moire Topography
    1. Imaging machine maps the thoracic back topography, identifying abnormal curvature
    2. Investigated in the 1970s as a tool for school screening, but rarely used in the U.S.
  6. References
    1. Greene (2001) Musculoskeletal Care, AAOS, p. 697
    2. Lonstein (July 1989) J Musculoskeletal Med 37-54
    3. Bunnell (2005) Clin Orthop Relat Res (434): 40-5 [PubMed]
    4. Kuznia (2020) Am Fam Physician 101(1):19-23 [PubMed]
    5. Skaggs (1996) Am Fam Physician 53(7):2327-34 [PubMed]

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