| Examination feature | Potential significance |
| Spine examination |
| Observation: |
- Lateral curvature of the spine with thoracic or lumbar asymmetry
- Head not centered over the sacrum and/or torso not centered over the pelvis in either coronal or sagittal plane
- Asymmetry of shoulders, scapulae, waistline, or distance that the arms hang from the trunk
| |
- Increased thoracic kyphosis when viewed from the side
| - May be seen with osteoporosis/compression fractures and degenerative disc disease
- May be associated with underlying deformity (eg, Scheuermann kyphosis)
|
- Decreased thoracic kyphosis when viewed from the side
| - May be seen with scoliosis and/or previous back surgery
|
- Decreased lumbar lordosis ("flatback syndrome")
| - Associated with progression of degenerative scoliosis
|
| Adam's forward bend test* | - Thoracic or lumbar hump suggests scoliosis (any type)
|
| Angle of trunk rotation (as measured with a scoliometer) | - Angle of trunk rotation of 7° approximately correlates with Cobb angle of 20°
|
| Tenderness to palpation of the spine | - Localized tenderness may indicate facet arthritis or fracture
|
| Tenderness to palpation of the sacroiliac joints | - Sacroiliac joint arthritis
|
| Tenderness to palpation of the pelvis | - Sacral insufficiency fracture(s) in older patients with osteoporosis
|
| General examination |
| Height | - For patients ≥40 years, loss of height ≥0.5 inches (1.3 cm) per decade may indicate osteoporotic compression fracture or buckling progression of deformity
|
| Standing posture and trunk balance | - Scoliosis and kyphosis are defined by characteristic changes in posture
|
| Gait | - Clumsiness or spasticity may indicate cervical or thoracic myelopathy or neuromuscular disease
- Antalgic gait may indicate nerve root compression
- Imbalance may indicate spinal deformity or lower extremity arthritis
- Need for walker or cane indicates unsteadiness
|
| Strength, sensation, and reflexes in the upper and lower extremities | - Hyperreflexia, pathologic reflexes, and clonus may indicate myelopathy
- Absent or diminished reflexes may indicate radiculopathy
|
Check for leg length discrepancy: - Leg length is measured from the anterior superior iliac spine to the caudal edge of the medial malleolus
| - Most patients with scoliosis have normal leg lengths but apparent leg length discrepancy because the pelvis tilts to compensate for the lumbar portion of the curve
- Leg length discrepancy may contribute to the pathogenesis of scoliosis through unbalanced loading
|
| Clinical features of syndromes associated with spinal deformity (eg, connective tissue disorders [eg, Marfan syndrome, Ehlers-Danlos syndrome], neurofibromatosis, spinal dysraphism) | - Suggests scoliosis secondary to another pathologic condition
|
