Adolescent idiopathic scoliosis

Case history

A 12-year-old white girl is referred by her paediatrician for evaluation of truncal asymmetry identified by screening during a routine physical examination. She and her parents have never noticed an abnormality in her appearance and she is asymptomatic. She describes herself as very active in school and in her recreational activities, and has recently noticed a growth spurt. On physical examination, she is thin and her right shoulder appears to be slightly elevated compared with the left. On forward bending she is very flexible, easily reaching the floor with her legs straight. A right-sided mid-thoracic prominence is noted, as well as a smaller left-sided paraspinal prominence at the thoracolumbar junction. These prominences significantly decrease in size with side bending in the forward flexed position. She has full and symmetric strength, normal sensation, and symmetric deep tendon reflexes throughout her upper and lower extremities. She has a normal gag reflex and symmetric abdominal reflexes. Her gait is normal, including toe and heel walking. The patient is suspected to have adolescent idiopathic scoliosis.