Does the scoliosis disappear when seated?
Procedure
- Allow the patient to sit on a stool with their back towards you.
- Inspect the spine and determine whether the scoliosis, which was present when standing upright, disappears [Figure 46].
Figure 46
Interpretation
If the scoliosis disappears then it concerns a functional (or non-structural) scoliosis
(as found with a difference in leg length).
Conduct, the other scoliosis test if the scoliosis remains present.
Does a gibbus become visible during the anteflexion?
Procedure
- The patient stands with his/her back towards you, and you check (again) whether the pelvis is straight. Any difference in leg length should, prior to this test, be corrected using planks until the pelvis is positioned straight (see Tests when suspecting a difference in leg length).
- Allow the patient to bend over slowly, with the arms hanging and both palms loosely against each other (stoop test). Observe, at eye level, whether both torso halves are moving symmetrically and at the same height [Figure 47].
Figure 47
Interpretation
If an asymmetric bulging to the back develops in the rib and/or waist region, then this is called a gibbus.
In such a case determine the localisation and how extensive it is. The presence of a gibbus indicates structural or non-functional scoliosis.
NB. With structural scoliosis, the spinous processes rotate in the direction of the concavity and thereby it seems upon inspection and palpation with the patient standing up, that the scoliosis appears less severe than it is.
Is there a case of ‘equilibration’?
Procedure
- The patient stands with their back towards you, during which the pelvis is straight.
- Localise the spinous process of C7 during light, active flexion of the neck and from this point drop the plumb line in a caudal direction, past the natal cleft [Figure 48]
- Observe whether C7 and the natal cleft are in vertebral alignment.
Figure 48
Interpretation
Disequilibrated scoliosis means that the plumb line from C7 falls to the right or left of the natal cleft; this is expressed to the nearest half cm.
In other words, the primary curve of the spine as a result of scoliosis is insufficiently compensated by a secondary curve. In an adult patient, strongly disequilibrated scoliosis can, in combination with other factors, be cause for surgery.