Diagnosis & Screening of Scoliosis
What are symptoms and signs of scoliosis?
- One shoulder may be higher than the other.
- One scapula (shoulder blade) may be higher or more prominent than the other.
- With the arms hanging loosely at the side, there may be more space between the arm and the body on one side.
- One hip may appear to be higher or more prominent than the other.
- The head may not be exactly centered over the pelvis.
- The waist may be flattened on one side; skin creases may be present on one side of the waist.
How is scoliosis diagnosed?
When the patient is examined from the rear and asked to bend forward until the spine is horizontal, one side of the back may appear higher than the other. This test, called the Adams test, is a very sensitive test for scoliosis; it is therefore the most frequent screening test for scoliosis. Determining whether or not you have scoliosis is best done by a physician who performs a physical examination of your back. The examination is done with you standing in a relaxed position with your arms at your sides. The physician will view you from behind looking for curvature of the spine, shoulder blade asymmetry, waistline asymmetry and any trunk shift. You will then bend forward at the waist and the physician will view your back once again to look for the rotational aspect of the scoliosis in the upper part of the back (rib prominence) or in the lower part of your back (flank or waist prominence). Following this simple examination, the physician will usually obtain initial radiographs of the spine viewed from the back and the side to see the entire spine from the neck to the pelvis. If scoliosis is present, the physician will measure the radiographs and provide you with a numerical value, in degrees, to help describe the scoliosis.
What is the difference between a functional or structure curve?
A scoliotic curve may be functional or structural in nature. Functional curves may be positional. For example, if a person stands asymmetrically, with one knee bent, and the pelvis tilted downward, a curve will be present, but this will go away as soon as the knee is straightened and the pelvis is held parallel to the floor. Structural curves are those that have stiffness within them, such that they do not go away with changes of position. These therefore have much more significance than functional curves.
How early should children be screened for scoliosis?
Children can be screened at any age, although idiopathic scoliosis is more commonly discovered during a child's growth spurt (10 to 15 years old). The Scoliosis Research Society recommends that girls be screened twice, at 10 and 12 years of age (grades 5 and 7), and boys once at 12 or 13 years of age (grades 8 or 9). A great deal of controversy exists as to the benefits of school screening.
Does scoliosis run in families?
Yes, approximately 30 percent of Adolescent Idiopathic Scoliosis patients have a family history of scoliosis. About 1 in 3 children whose parents have scoliosis will develop scoliosis. It’s considered a partially genetic condition. Doctors do not yet know exactly what gene can cause it.
Is genetic testing available?
Yes. A genetic screening test, called the ScoliScore™ is available as an adjunct to clinical and x-ray information to determine risk of progression in Adolescent Idiopathic Scoliosis. It is currently used in Caucasian (North American, European, Eastern European, Middle Eastern) patients between ages 9 - 13 with a mild scoliotic curve (less than 25 degrees). The stated goal of the test is to determine the risk that the curve will increase to 40 degrees or more. Thus far independent verification of the test has not been done. Doctors do not yet know if the test can be used to predict the likelihood of passing on scoliosis to one’s children.
Do siblings of children with scoliosis need to be checked?
Because scoliosis tends to run in families, it is good to have siblings checked at their yearly physical examinations, especially during their growth spurts (10 to 15 years old). Early detection is important and parents can help. Look at your child's back with a bathing suit on. If you see one shoulder appearing higher than the other, or one side of the ribcage sticking out more than the other side, call your pediatrician.