Protocol - Scoliosis - Physical Assessment
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.
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.
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: http://www.nlm.nih.gov/medlineplus/ency/imagepages/19465.htm
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.
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.
|Specialized requirements for biospecimen collection||No|
|Average time of greater than 15 minutes in an unaffected individual||Yes|
Mode of Administration
Infant, Toddler, Child, Adolescent, Adult, Senior, Pregnancy
Birth through adulthood
The Adam’s forward bend test and x-ray are standard procedures to screen individuals for scoliosis and determine the extent of scoliosis.
|caDSR Common Data Elements (CDE)||Scoliosis Physical Examination Assessment Text||4798284||CDE Browser|
|Human Phenotype Ontology||Scoliosis||HP:0002650||HPO|
Process and Review
Protocol Name from Source
Adam’s forward bend test:
A.D.A.M. Inc. website: http://www.adamimages.com/
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.
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.
|Variable Name||Variable ID||Variable Description||dbGaP Mapping|
|PX221601010000||This is a screening test to determine if an more||N/A|
|PX221601030000||Identify the superior and the inferior end more||N/A|
|PX221601020000||A straight spine has a curve of more||N/A|
Scoliosis - Physical Assessment
April 30, 2015
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.
This measure can be used to screen individuals for scoliosis and if positive, to determine the degree of scoliosis.
Scoliosis, growth, height, developmental delay, adolescent, pain, short stature, Adam's forward bend, Cobb technique, Scoliosis Research Society Questionnaire, SRS-30, x-ray, physical assessment