Important aspects of the examination in patients with suspected adolescent idiopathic scoliosis

Examination feature	Potential significance
Scoliosis examination
Lateral curvature of the spine	Scoliosis (any type)
Asymmetry of shoulders, scapulae, waistline, or distance that the arms hang from the trunk	Scoliosis (any type)
Thoracic or lumbar prominence during Adams forward bend test	Scoliosis (any type)
Angle of trunk rotation (as measured with a scoliometer) ≥7°	Approximately correlates with Cobb angle of >20°
General examination
Height and height velocity	Risk for progression is greatest during peak height velocity
Arm span to height ratio	Increased in Marfan syndrome
Sexual maturity rating (Tanner stage)	Risk for progression is increased if sexual maturity rating is ≤2
Skin examination
Café-au-lait spots and axillary freckling	Neurofibromatosis
Vascular or pigmentary changes over the spine	Spinal dysraphism
Lumbosacral dimpling	Occult spinal dysraphism
Skin laxity	Ehlers-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta
Musculoskeletal examination
Joint laxity	Ehlers-Danlos syndrome, Marfan syndrome
Intrinsic wasting of hands	Cervical syringomyelia
High-arched feet, hammer/claw toes	Neuromuscular disease (eg, Friedreich ataxia)
Asymmetric iliac crests	Leg length discrepancy
Neurologic examination
Abnormal reflexes, balance, strength, gait	Neuromuscular scoliosis
Absent abdominal reflex	Intraspinal pathology

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