Loading…

Protocol - Scoliosis - Physical Assessment

Add to Toolkit

Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Description:

The aggregate protocol includes the Adam’s forward bend test and an x-ray with Cobb technique to determine if an individual has scoliosis. Additionally, if scoliosis is present, the degree of curvature can be determined.

Note: this protocol applies to the three major types of scoliosis; however, only congenital and syndromic scoliosis apply to rare genetic conditions.

Protocol:

Adam’s forward bend test: This is a screening test to determine if an individual has scoliosis or signs of scoliosis. While bending forward the individual has their feet together, knees straight, and their arms dangling by their sides. If signs of scoliosis are observed, an x-ray with Cobb technique is recommended. Signs of scoliosis include imbalances in the rib cage (i.e., one side is higher than the other), and other deformities along the back.

Please note: The Adam’s forward bend test can also be used to differentiate postural scoliosis from structural scoliosis, since the curvature will disappear on forward bending in postural scoliosis. Additional information on the Adam’s forward bend test is available at: U.S. National Library of Medicine, National Institutes of Health MedlinePlus: [link[www.nlm.nih.gov/medlineplus/ency/imagepages/19465.htm|http://www.nlm.nih.gov/medlineplus/ency/imagepages/19465.htm]]

X-ray:

Full-length standing posteroanterior and lateral radiographs of the spine are required in order to assess the degree of curvature (i.e., deformity). These are taken with the patient in a standing position in order to assess the effect of gravity on the deformity. Patients are instructed to remove their shoes, and any lower limb discrepancy is compensated with a shoe lift before the radiograph is taken.

Radiographs are taken with the patient looking straight ahead, legs apart for stability and with their hands on clavicles.

A straight spine has a curve of 0º, any curve greater than 10º is considered scoliosis. Between 0º and 10º is considered a curvature which is not true scoliosis.

Cobb Technique:

Identify the superior and the inferior end vertebrae-the vertebrae with the greatest tilt at the proximal and distal ends of the curve. The angle between them is measured by drawing a line from the top of the superior end vertebra parallel to the upper endplate, and another line from the bottom of the inferior end vertebra parallel to the lower endplate. Perpendicular lines are then constructed at right angles to the lines along the endplates. The angle formed by the intersection of the perpendicular lines defines the Cobb angle. This angle is then compared to a standard scale in order to determine whether or not the curvature is potentially harmful. Individuals with a straight spine have zero degree curve. Individuals with a curve between 0o and 10o degrees are considered to have a curvature. Individuals with a spine that has a curve of greater than 10o degrees are considered to have scoliosis. Typically surgery is recommended in adolescents with a curve of a Cobb angle of more than 45o to 50o degrees.

Personnel and Training Required

X-ray technicians must be qualified to operate x-ray equipment. They must be capable of producing medical images. They must explain x-ray procedures to patients and adhere to regulations to protect themselves and others from harmful exposure to x‑rays.

A physician must determine if the individual has the signs of scoliosis and interpret the medical images.

Equipment Needs

X-ray machine

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualYes
Major equipmentYes
Specialized requirements for biospecimen collectionNo
Specialized trainingYes

Mode of Administration

Self-administered

Life Stage:

Infant, Toddler, Child, Adolescent, Adult, Senior, All Ages, Pregnancy

Specific Instructions:

The Rare Genetic Conditions Working Group (WG) recommends the Adam’s forward bend test be used as a screening tool for scoliosis. If an individual screens positive, then the WG recommends they have an x-ray with the Cobb technique to determine the angle between the superior and inferior end vertebrae.

Research Domain Information

Release Date:

April 30, 2015

Definition

Scoliosis is a spine deformity that can be categorized into three major types: congenital, syndromic, and idiopathic. Individuals can have various medical and/or quality-of-life implications, depending on the type and severity of their scoliosis.

Purpose

This measure can be used to screen individuals for scoliosis and if positive, to determine the degree of scoliosis.

Selection Rationale

The Adam’s forward bend test and x-ray are standard procedures to screen individuals for scoliosis and determine the extent of scoliosis.

Language

English

Standards

StandardNameIDSource
Common Data Elements (CDE)Scoliosis Physical Examination Assessment Text4798284CDE Browser

Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

Adam’s forward bend test:

A.D.A.M. Inc. website: http://www.adamimages.com/">http://www.adamimages.com/|http://www.adamimages.com/

X-ray:

Altaf, F., Gibson, A., Dannawi, Z., & Noordeen, H. (2013). Adolescent idiopathic scoliosis. BMJ (Clinical Research Ed.), 346, f2508. doi:10.1136/bmj.f2508

X-ray and Cobb technique:

The Scoliosis Research Society: www.srs.org with the selections: professionals, conditions and treatment, adolescent idiopathic scoliosis, imaging studies.

General References

Côté, P., Kreitz, B. G., Cassidy, J. D., Dzus, A. K., & Martel, J. (1998). A study of the diagnostic accuracy and reliability of the scoliometer and Adam’s forward bend test. Spine (Phila Pa 1976), 23(7), 796-802.

Protocol ID:

221601

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX221601_Scoliosis_BendTest_AdamsTest_DeformitiesPX221601010000This is a screening test to determine if an individual has scoliosis or signs of scoliosis. While bending forward the individual has their feet together, knees straight, and their arms dangling by their sides. If signs of scoliosis are observed, an x-ray with Cobb technique is recommended. Signs of scoliosis include imbalances in the rib cage (i.e., one side is higher than the other), and other deformities along the back.4N/A
PX221601_Scoliosis_BendTest_XrayPX221601020000A straight spine has a curve of 0¿¿, any curve greater than 10¿¿ is considered scoliosis. Between 0¿¿ and 10¿¿ is considered a curvature which is not true scoliosis.4N/A
PX221601_Scoliosis_BendTest_CobbTechniquePX221601030000Identify the superior and the inferior end vertebrae¿¿¿the vertebrae with the greatest tilt at the proximal and distal ends of the curve. The angle between them is measured by drawing a line from the top of the superior end vertebra parallel to the upper endplate, and another line from the bottom of the inferior end vertebra parallel to the lower endplate. Perpendicular lines are then constructed at right angles to the lines along the endplates. The angle formed by the intersection of the perpendicular lines defines the Cobb angle. This angle is then compared to a standard scale in order to determine whether or not the curvature is potentially harmful. Individuals with a straight spine have zero degree curve.4N/A