Scoliosis: The physical exam

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When assessing a child's scoliosis, several measurements may be taken. Learn about how Adam's test, balance, leg length and height are used in assessment.

Key points

  • Teens with a moderate or large curve will be referred to an orthopaedic surgeon.
  • Height, reflexes, senses, strength, legs, shoulder and hip and spinal balance may all be measured. Your teen will also be asked to bend and touch their toes in the Adam's test to show if there is rib prominence.
  • Your teen's surgeon may request before and after medical photographs to document changes in the back.

If your teen’s curve is moderate or large, they will be referred to an orthopaedic surgeon. In that case, your teen’s surgeon, or a member of the surgical team, may do some or all of these physical tests.


Your teen’s height will be carefully measured at each appointment. This helps to pinpoint when growth is accelerating, slowing down, or when it is finally complete.

Adam’s test

In the Adam’s test, your teen will be asked to bend forward as if to touch their toes. This position shows if there is a rib prominence. A rib prominence is when the ribs are more pronounced on one side of the spine.

The surgeon may do the Adam’s test with a tool called a scoliometer. This tool is similar to the balance carpenters use to check if something is level. It measures the severity of the rib prominence in degrees.

  • 0 to 10 degrees is a mild rib prominence
  • 11 to 20 degrees is a moderate rib prominence
  • 21 degrees or more is large rib prominence

Reflexes, sensory exam, and strength

This is a standard exam of nerve functions. It is generally done on all spinal patients.

Leg length

Your teen’s legs will be measured to see if one leg is longer than the other because this can cause scoliosis.

Spinal balance

The person doing this test will drop a plumb line from the top of your teen’s spine. This plumb line is similar to the ones carpenters use. The spinal balance test is done to see if your teen’s trunk (rib cage) is shifted off to one side.

Shoulder and hip balance

The person doing the test will check to see if your teen has one hip or shoulder higher than the other.

Medical photographs

If surgery is recommended, your teen’s surgeon may request before and after photos. These medical photographs help to document changes in how your teenager’s back looks.

Last updated: June 1st 2008