A screen for the presence of scoliosis.

  • Adam’s Test/Adam’s Sign

  • Assess for the presence of a rigid scoliosis
  • Differentiate between rigid and supple scoliosis

Patient Position
  • Standing with feet together, hands hanging by sides with back exposed to examiner
Examiner Position
  • Behind the patient
Steps of Performance
  1. Patient bends forward, attempting to touch their toes, until their back is in the horizontal plane
    • Note: patient does not need to be capable of touching toes to complete this orthopedic exam
  2. Examiner observes for the presence of a rib hump or the resolve of a scoliotic curve
Alternative Methods
  • For patient comfort, the patient may stand facing the examiner before bending forward, though this will make it more difficult for the examiner to assess the lumbar and lower thoracic spine.
  • For a quantitative measure utilize a scoliometer with X-ray

Individuals with rigid scoliosis have a lateral deviation and a vertebral rotation that can be appreciated in the frontal plane by a rib hump on the convex side. The spinal rotation causes the rib on the convex side to be pushed posteriorly and the concave side to be pushed anteriorly during the forward bending test.

With secondary or supple scoliosis (eg. leg length inequality), the scoliosis will be visible while the patient is standing but will resolve (not show a rib hump) with lumbar flexion.

General

Positives

Rib Hump

  • Structural (rigid) scoliosis with the convexity towards the side of the deformation

Pertinent Negatives

Resolution of Visible Scoliosis with Lumbar Flexion

  • non-rigid (supple) scoliosis

DATA
TAGS
References
Vizniak N.A., & Buse, M. Evidence-Informed Orthopedic Assessment. Professional Health Systems Inc.; 2023.
Karachalios T, Sofianos J, Roidis N, Sapkas G, Korres D, Nikolopoulos K. Ten-year follow-up evaluation of a school screening program for scoliosis. Is the forward-bending test an accurate diagnostic criterion for the screening of scoliosis?. Spine (Phila Pa 1976). 1999;24(22):2318-2324. doi:10.1097/00007632-199911150-00006
Côté P, Kreitz BG, Cassidy JD, Dzus AK, Martel J. A study of the diagnostic accuracy and reliability of the Scoliometer and Adam's forward bend test. Spine (Phila Pa 1976). 1998;23(7):796-803. doi:10.1097/00007632-199804010-00011

A screen for the presence of scoliosis.

  • Assess for the presence of a rigid scoliosis
  • Differentiate between rigid and supple scoliosis

Patient Position
  • Standing with feet together, hands hanging by sides with back exposed to examiner
Examiner Position
  • Behind the patient
Steps of Performance
  1. Patient bends forward, attempting to touch their toes, until their back is in the horizontal plane
    • Note: patient does not need to be capable of touching toes to complete this orthopedic exam
  2. Examiner observes for the presence of a rib hump or the resolve of a scoliotic curve
Alternative Methods
  • For patient comfort, the patient may stand facing the examiner before bending forward, though this will make it more difficult for the examiner to assess the lumbar and lower thoracic spine.
  • For a quantitative measure utilize a scoliometer with X-ray

Individuals with rigid scoliosis have a lateral deviation and a vertebral rotation that can be appreciated in the frontal plane by a rib hump on the convex side. The spinal rotation causes the rib on the convex side to be pushed posteriorly and the concave side to be pushed anteriorly during the forward bending test.

With secondary or supple scoliosis (eg. leg length inequality), the scoliosis will be visible while the patient is standing but will resolve (not show a rib hump) with lumbar flexion.

General

Positives

Rib Hump

  • Structural (rigid) scoliosis with the convexity towards the side of the deformation

Pertinent Negatives

Resolution of Visible Scoliosis with Lumbar Flexion

  • non-rigid (supple) scoliosis