History

  • Age
  • Family History of scoliosis. If so, surgical intervention?
  • Age of onset
  • Acute or chronic pain (pain is not always associated with scoliosis.)
  • Duration/frequency/location
  • Neurologic symptoms
  • Sport/activities of interest
  • Treatment attempted if pain present
  • Cosmetic changes observed by family/patient

Physical Exam

Inspection

  • Forward Bend test
  • Look for lateral curvature and rotation of the spine
  • Observe posture: kyphotic curve, lordotic curve, shoulder asymmetry, excessive scapular winging, skin folds, rib prominence, truncal shift
  • Hairy patches, dimples, cafĂ©-au-lait spots, skin integrity
  • Check for leg length discrepancy

ROM

  • Extension/Flexion/Side Bending

Palpation

  • Spinous processes and paraspinous musculature

Motor Exam

  • Bilateral EHL, FHL, Tibialis Anterior, Gastrocnemius, Quadriceps, Hamstrings

Sensory Exam

  • L2 L3: Ant and inner thigh
  • L4: Lat thigh, ant knee, med leg
  • L5: Lat leg, dorsal foot
  • S1: Post leg
  • S2: Plantar foot

Reflexes

  • Umbilical
  • Achilles
  • Patellar Tendon

Imaging

Radiograph Indication

  • Scoliosis suspected or postural asymmetry noted during physical exam
  • AP Standing, Lateral

MRI Indications

  • Unusual curve pattern: left thoracic curve may indicate Chiari Malformation, tethered cord or syrinx
  • Neurologic symptoms
  • Rapid progression of curve
  • Pain failing conservative care

Management

  • Observation: Follow up appointments every six months with x-rays to monitor curve progression
  • Physical Therapy (core strengthening, peri-scapular strengthening)
  • Yoga/Pilates
  • Naprosyn or Ibuprofen for pain
  • Ice
  • Encourage patient to stay active in order to keep spine flexible
  • Bracing considered at 25 degrees if skeletally immature
  • Surgery indicated when curve approaches 50 degrees

When to Refer

  • Patient presents with spinal curvature > 10 degrees
  • Acute back pain with fever
  • Isolated back pain worse at night
  • Persistent back pain unresolved with NSAIDS or physical therapy
  • Neurologic changes
  • Diagnosis of Marfan Syndrome
  • Diagnosis of Ehlers Danlos