Is it Scoliosis?

Adam's Forward Bend Test

Scoliosis can often be determined by a visual examination viewing the spine from behind because there is a lack of symmetry. Scoliosis is classified as mild, moderate or severe and depending on each unique case, may cause limited problems for the scoliosis sufferer, or many. The combination of lateral curvature and vertebral rotation often results in a “rip hump” in the thoracic spine. This occurs when spinal vertebrae rotate toward the concave side of the curve, pushing the ribs dorsally (backwards) producing a prominence on the convex side of the spine. This prominence can be viewed from the rear when a person bends forward from the waist with the spine parallel to the floor with feet together, knees straight, and arms hanging down. This is known as the Adam’s Forward Bend Test.Physicians should perform other tests, including x-rays, to determine if scoliosis is present.

With scoliosis, the spine must be considered from a lateral (side) view as well. From a lateral (sagittal) perspective a normal spine has four curves: cervical, thoracic, lumbar and sacral. Scoliosis frequently presents with deviations in the typical lateral curve patterns. For instance, it is normal for the thoracic spine to have a slight arcing ‘C’ pattern (kyphosis), but with scoliosis there may be a deviation from normal: if the arc is especially pronounced, it may be hyperkyphosis. If there is a flattening of the thoracic spine, the patient may have hypokyphosis. The lower back or lumbar spine should have a mildly inverse ‘C’ arc known as lordosis, but an above normal variation of the curve pattern in the low back is known as hyperlordosis. If there is a flattening in the lumbar spine this is known as hypolordosis. These variables in the way scoliosis presents contributes to making each scoliosis case unique and requires the expertise of a scoliosis specialist. A majority of scoliosis patients are hypokyphotic in the thoracic spine and hypolordotic in the lumbar spine.