VIDEO 13. Scoliosis Definition and Assessment II

In scoliosis, postural changes in the body result from rotation and deviation in the spine. Abdominal muscles, lumbar, and back extensors are primarily affected, and musculoskeletal deformities may also occur.

The musculoskeletal system undergoes changes associated with scoliosis. Some muscles experience contraction and atrophy, while others undergo elongation and loading. The abdominal muscles, quadratus lumborum (QL), iliocostalis, iliopsoas, erector spinae, and latissimus dorsi muscles, are the most affected muscles in a scoliotic posture.

The impact on the sagittal plane alignment results in loss of dorsal kyphosis and pelvic tilt.

Scoliosis is identified in the coronal plane of the spine using the Cobb angle, often accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane. These abnormalities in the costovertebral joints, spinal rotation, and chest cage create a ‘convex’ and ‘concave’ hemithorax. When scoliosis becomes more pronounced, the rotational component begins, leading to torsion-scoliosis, also known as gibbosity.

Various symptoms may indicate the possibility of scoliosis:

• Lateral curvature of the spine
• Lateral body posture
• Variation in shoulder heights
• Discrepancy in pelvis heights
• Leg length inequalities
• Muscle pain
• Ligament pain
• Reduced respiratory function is a significant concern in progressive severe scoliosis.

Clinical photography and radiographic methodology are employed in the assessment of spinal deformities.

Scoliosis is typically confirmed through physical examination, X-rays, spinal radiography, CT scans, or MRI.

The curve is measured using the Cobb Method, and severity is determined by the degree of the angle.

In the assessment of scoliosis, a functional examination helps differentiate between incorrect posture and the presence of true idiopathic scoliosis.

1. Evaluating active movements of the cervical, thoracic, and lumbar segments of the spine (flexion, extension, and lateral flexion).

2. The Adams Forward Bending Test can be used to differentiate between structural scoliosis and non-structural scoliosis. The individual is asked to bend forward without bending the knees, with feet together and arms hanging down, to assess the presence of curvature.

3. The Cobb Angle is a standard measurement used to determine and monitor the progression of scoliosis.

4. The scoliometer, a tilt meter designed to measure body asymmetry or axial trunk rotation, evaluates the presence of asymmetry by measuring in the upper thoracic (T3-T4), middle thoracic (T5-T12), and thoracolumbar region (T12-L1 or L2-L3).

5. Respiratory Function Test assesses lung volume and functional capacity in scoliosis patients.

Adam’s forward bend Test (will be given in e manual)

Scoliosis is a three-dimensional abnormality of the spine that causes an observable deformity. Scoliosis is defined by the Cobb’s angle of spine curvature in the coronal plane, and is often accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane. The purpose of Adam’s forward bend test is to detect structural or functional scoliosis. This test is most often used during school screening for scoliosis. Symptoms (e.g. lateral bending) decrease with forward banding in functional scoliosis. With structural scoliosis, the scoliotic deformity will remain the same as in the standing position. If there is an increased kyphosis when bending forward, Scheuermann’s disease or congenital kyphosis is also possible.

1. The patient takes off his/her t-shirt so that the spine is visible.
2. The patient needs to bend forward, starting at the waist until the back comes in the horizontal plane, with the feet together, arms hanging and the knees in extension. The palms are held together.
3. The examiner stands at the back of the patient and looks along the horizontal plane of the spine, searching for abnormalities of the spinal curve, like increased or decreased lordosis/ kyphosis, and an asymmetry of the trunk.