Describe the initial evaluation for a patient referred for assessment for adolescent idiopathic scoliosis

Patient history: Includes menstrual history, birth and developmental history, and inquiry regarding family history of scoliosis PHYSICAL EXAMINATION

• Height and weight assessment

• Observation (look for shoulder, thorax, or waist asymmetry)

• Adams forward bend test. The right and left sides of the trunk should be symmetrical. Presence of a thoracic or lumbar prominence suggests scoliosis. Use a scoliometer to quantitate asymmetry

• Neurologic assessment. Includes motor strength testing, deep tendon reflexes, abdominal reflexes (abnormalities may indicate intraspinal pathology such as syringomyelia), plantar reflexes, clonus testing

• Upper and lower extremity assessment. Include gait and leg length evaluation

RADIOGRAPHIC ASSESSMENT

• A standing posteroanterior (PA) long cassette radiograph is the initial view obtained

• Lateral radiographs are indicated when sagittal plane abnormalities are noted on physical examinations, for patients with back pain, when spondylolisthesis is suspected, and for presurgical planning prior to scoliosis correction

• Side-bending radiographs are indicated for defining curve type for presurgical planning prior to scoliosis surgery but are not required for a routine initial patient evaluation

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