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Scoliosis Adam's Forward Bend Test

The Adam's Forward Bend Test is an in-depth report on the causes, diagnosis, treatment, and prevention of scoliosis.

Your Dr will diagnose the following:

  • The severity of scoliosis and need for treatment is usually determined by two factors:
    • The extent of the spinal curvature. (Scoliosis is diagnosed when the curve measures 11 degrees or more.)
    • The angle of the trunk rotation (ATR).

    Both are measured in degrees. These two factors are usually related. For example, a person with a spinal curve of 20 degrees will usually have a trunk rotation (ATR) of 5 degrees. These two measurements, in fact, used to be the cutoff for recommending treatment. However, it is now well known that the great majority of 20-degree curves do not get worse. Patients do not usually need medical attention until the curve reaches 30 degrees and the ATR is seven degrees. Physical Examination

    Adams Forward Bend Test. The screening test used most often in schools and in the offices of pediatricians and primary care physicians is called the Adams forward bend test.

    The child bends forward dangling the arms, with the feet together and knees straight. The curve of structural scoliosis is more apparent when bending over. In a child with scoliosis, the examiner may observe an imbalanced rib cage, with one side being higher than the other, or other deformities.

    The forward bend test is a test used most often in schools and doctor's offices to screen for scoliosis. During the test, the child bends forward with the feet together and knees straight while dangling the arms. Any imbalances in the rib cage or other deformities along the back could be a sign of scoliosis.
    Adam's Forward Bend Test
    Scoliosis Adam's Forward Bend Test

    The forward bend test, however, is not sensitive to abnormalities in the lower back, a very common site for scoliosis. Because the test misses about 15% of scoliosis cases, many experts do not recommend it as the sole method for screening for scoliosis.

    Other Physical Tests

    • The patient is usually requested to walk on the toes, then the heels, and then is asked to jump up and down on one foot. Such activities indicate leg strength and balance.
    • The physician will also check leg length and look for tight tendons in the back of the leg, which may cause an uneven leg length or other back problems.
    • The physician will also check for neurologic impairment by testing reflexes, nerve sensation, and muscle function.

    Identifying the Curvature

    Proper diagnosis is important. A misjudgment can lead to unnecessary x-rays and stressful treatments in children not actually at risk for progression. Unfortunately, although measurements of curves and rotation are useful, no test exists yet to determine whether a curve will progress.

    After careful observation of the posterior and anterior trunk, the Adam's Forward Bend Test is useful for screening and diagnosis. This test often can identify both Scoliosis and Kyphosis. Lateral observation of the child in the forward bend position brings the apex of the kyphosis into plain view. This position will accentuate the paraspinal prominences in Scoliosis, and for some curve types, both a thoracic and thoracolumbar prominence will be identified. The trunk asymmetry will be most noticeable at the apex of the major curve. Usually the magnitude of the observed prominence for forward bend reflects the degree of segmental vertebral rotation at the apex. Although not always the case, increased vertebral rotation is often associated with larger stiffer curves.

    Right and left sided asymmetries on the Adams Forward Bend Test can be quantified using the Scoliometer does not correlate with the Cobb measurement obtained on the radiograph because trunk asymmetry may be present without Scoliosis, and Scoliosis may exist without any observable trunk asymmetry. The Scoliometer has a false-negative rate of 0.1% and a high degree of sensitivity. Bunnell sugegsted that patients with a high 5 scoliometer reading with have an 11 Scoliosis, and patients with a 7 scoliometer readfing are likely to have Cobb Angle of 20. Considering these associations and the fact that a 20 Scoliosis are approaching brace criteria, it is reasonable to send children who have greater than a 5 scoliometer reading for further evaluation.

    Ashworth and associates suggested that a scoliometer reading of 5 is 100% sensitive but only 47% specific for identification of Scoliosis. A scoliometer reading of 7 has a sensitivity of 83% but a specifity of 86%. Individuals with trunk rotation of greater than 7 by the scoliometer measurement should be referred to a spinal deformity specialist for further evaluation. Those with scoliometer readings of less 5 probably do not warrant radiographic investigation.

    Inclinometer (Scoliometer). An inclinometer, also known as a Scoliometer, measures distortions of the torso. The procedure is as follows:

    • The patient bends over, arms dangling and palms pressed together, until a curve can be observed in the upper back (thoracic area).
    • The Scoliometer is placed on the back and measures the apex (the highest point) of the upper back curve.
    • The patient continues bending until the curve can be seen in the lower back (lumbar area). The apex of this curve is also measured.
    • Measurements are repeated twice, with the patient returning to a standing position between repetitions.
    • If results show a deformity, x-rays probably need to be performed to determine the extent.

    Some experts believe the Scoliometer would make a useful device for widespread screening. Scoliometers, however, indicate rib cage distortions in more than half of children who turn out to have very minor or no sideways curves. They are therefore not accurate enough to guide treatment. Imaging Tests