Scoliosis - Diagnosis

Diagnosis

The severity of scoliosis and need for treatment is usually determined by two factors:

• The extent of the spinal curvature (scoliosis is diagnosed when the curve measures 11 degrees or more)
• The angle of the trunk rotation (ATR)

Both are measured in degrees. These two factors are usually related. For example, a person with a spinal curve of 20 degrees will usually have a trunk rotation (ATR) of 5 degrees. These two measurements, in fact, used to be the cutoff for recommending treatment. However, the great majority of 20-degree curves do not get worse. Patients do not usually need medical attention until the curve reaches 30 degrees, and the ATR is 7 degrees.

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Physical Examination

Adam's Forward Bend Test. The screening test used most often in schools and in the offices of pediatricians and primary care doctors is called the Adam's forward bend test.

The child bends forward dangling the arms, with the feet together and knees straight. The curve of structural scoliosis is more apparent when bending over. In a child with scoliosis, the examiner may observe an imbalanced rib cage, with one side being higher than the other, or other deformities.

The forward bend test, however, is not sensitive to abnormalities in the lower back, a very common site for scoliosis. Because the test misses about 15% of scoliosis cases, many experts do not recommend it as the sole method for screening for scoliosis.

Other Physical Tests.

• The patient walks on the toes, then the heels, and then jumps up and down on one foot. Such activities indicate leg strength and balance.
• The doctor will check leg length and look for tight tendons in the back of the leg, which may cause an uneven leg length or other back problems.
• The doctor will also check for neurological impairment by testing reflexes, nerve sensation, and muscle function.