Scoliometer – have patient bend over and place on patient’s back to measure angle of incline. There are also scoliometer apps you can download on your smart phone.
Background
Definition: >10° lateral curve to spine with vertebral rotation
Types: classified as congenital, neuromuscular, or idiopathic. Idiopathic scoliosis is further classified by age: Infantile (0-2 yo), Juvenile (3-9 yo), Adolescent (>10 yo). Adolescent Idiopathic Scoliosis is the most common form.
Etiology unknown. Likely polygenic.
Risk factors for disease progression – initial Cobb angle (angle of curvature of spine) most important factor; Risser grade (more growth potential = more risk of scoliosis progression); sex (male and female have equal incidence, but female more likely to progress)
Screening
Screening is controversial!
USPSTF and AAFP do not recommend screening in asymptomatic adolescents. It causes low-risk adolescents to undergo expensive and unnecessary testing and treatments. Those who actually need treatment will be detected without screening.
AAP and AAOS both recommend screening.
Cobb Angle
Physical Exam
Adam’s Forward Bend Test – have patient bend forward at the waist. Stand behind patient and look for rib hump. Use a scoliometer (aka inclinometer) to measure the inclination angle. <5° is insignificant. 5-9° check again in 6 months. >10° is definition of scoliosis and requires XR evaluation to measure Cobb Angle and Risser Grade
Cobb angle – angle of deviation of the spine
Risser Grade –amount of ossification of the iliac apophysis, which reflects how much more growth potential a person has. Grade 1 = 25% ossification (lots more growth potential); Grade 2 = 50% ossification; Grade 3 = 75% ossification; Grade 4 = 100% ossification and no more growth potential.
My name is Benji Ho and I am a family physician and 2013 graduate of the American University of the Caribbean School of Medicine (AUC), located on the Dutch side of the beautiful island of St. Maarten. My time at AUC has been quite a worldwide adventure, studying two years of Basic Sciences on the island, then completing my clinical rotations in the US as well as the UK. I completed my family medicine residency at Mercer University School of Medicine / Navicent Health in Macon, Georgia. Today, I am a board-certified family physician practicing outpatient family medicine in Macon, Georgia. I hope you enjoy my site as I share with you my journey. Thanks for visiting Diary of a Caribbean Med Student!
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