A young adolescent female has mild unequal scapula prominences that disappear in the Adams forward bending position. What should the clinician do?

A young adolescent female has mild unequal scapula prominences that disappear in the Adams forward bending position. What should the clinician do?

• A. Reassure the parent's functional scoliosis will self-resolve.
• B. Obtain radiographic studies of the entire spine and neck.
• C. Discuss posture and exercise and backpacks/books.
• D. Refer to an orthopedic specialist for evaluation and possible bracing.

Answer: (C)

The key idea is distinguishing functional (postural) scoliosis from a structural one using the Adams forward bend test. If mild scapular asymmetry is present when standing but the prominence disappears when the patient bends forward, the spinal rotation is not fixed, indicating a postural issue rather than a true structural curve. Management is conservative: talk about posture, and introduce back and core strengthening exercises along with guidance on carrying backpacks and distributing weight properly. Radiographs, bracing, or specialist referral aren’t indicated here unless the asymmetry persists in forward bend, progresses, or red flags appear (such as pain, neurological symptoms, or rapid progression).

The key idea is distinguishing functional (postural) scoliosis from a structural one using the Adams forward bend test. If mild scapular asymmetry is present when standing but the prominence disappears when the patient bends forward, the spinal rotation is not fixed, indicating a postural issue rather than a true structural curve. Management is conservative: talk about posture, and introduce back and core strengthening exercises along with guidance on carrying backpacks and distributing weight properly. Radiographs, bracing, or specialist referral aren’t indicated here unless the asymmetry persists in forward bend, progresses, or red flags appear (such as pain, neurological symptoms, or rapid progression).