Deformity

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A 16-year-old female patient with progressively worsening back pain and deformity

Orthopedics Today, November 2017
Philip K. Louie, MD; Sravisht Iyer, MD; Brandon M. Hirsch, MD; Christopher J. Dewald, MD; Howard S. An, MD

A 16-year-old female high school soccer player with no known medical comorbidities (2 years post-menarche) presented to the clinic for evaluation of diffuse back pain. She reported being diagnosed with adolescent idiopathic scoliosis at age 14 and placed in a brace. For the two years prior to presentation, she was largely non-compliant with the bracing regimen. She noted wearing the brace for “several hours a day” over the past few months.

On physical examination, the patient was 5 feet 8 inches tall and weighed 123 pounds. She had mild shoulder asymmetry with the left shoulder sitting slightly lower than the right. Her pelvis was level and symmetric. She had a normal gait pattern. There was no tenderness to palpation about the spinous processes. There were no limitations with lumbar flexion, extension or lateral bending to either side. An Adam’s forward bend test was positive for a right-sided rotational thoracolumbar prominence. She exhibited 5/5 strength throughout the bilateral upper and lower extremities with 2+ symmetric patellar and Achilles reflexes. There was a down-going Babinski and negative Hoffman’s sign bilaterally. A negative straight leg raise was observed bilaterally.

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