Spinal asymmetry

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Updated by: Allison Duey-Holtz
Updated on: August 2, 2017


Signs and symptoms

  • Asymmetric shoulder height
  • Asymmetric flank crease
  • Pelvic height asymmetry
  • Positive Adam's forward bend test


  • Idiopathic
  • Congenital
  • Neuromuscular
  • Thoracogenic

Referring provider's initial evaluation and management:

  • Spinal exam to include Adam's forward bend test
  • Neuromuscular exam
  • Evaluation of pain symptoms
  • If provider or family prefer images recommend PA/lateral scoliosis series
  • CHW has EOS low-dose radiation scanner.
  • CHW has physical therapists who specialize in spine and scoliosis conditions (Greenfield, Delafield, Mequon)

When to initiate referral/ consider refer to orthopedic clinic:

  • Positive physical exam or imaging finding
  • Ambulatory referral to orthopedics--may refer without images

What can referring provider send to orthopedic clinic?

1. Using Epic

  • Please complete the external referral order

In order to help triage our patients and maximize the visit, the following information would be helpful include with your referral order:

  • Urgency of the referral
  • What is the key question you would like answered?

Note: Our office will call to schedule the appointment with the patient.

2. Not using Epic external referral order:

  • In order to help triage our patients maximize the visit time, please fax the above information to (414) 607-5288
  • It would also be helpful to include:
  • Chief complaint, onset, frequency
  • Recent progress notes
  • Labs and imaging results
  • Other Diagnoses
  • Office notes with medications tried/failed in the past and any lab work that may have been obtained regarding this patient's problems.

Specialist's workup will likely include:

  • Comprehensive medical and surgical history
  • Family history
  • HPI including evaluation of symptoms
  • Height
  • Neuromuscular exam
  • Gait evaluation
  • Evaluate for spinal asymmetry and kyphosis
  • Review images and determine next steps in treatment plan


American Academy of Orthopaedic Surgeons. Position Statement: Screening for the Early Detection of Idiopathic Scoliosis in Adolescents. Published 1984. Updated September 2017 and December 2015. Accessed May 29, 2017

American Academy of Orthopaedic Surgeons. Idiopathic Scoliosis in Children and Adolescents http://orthoinfo.aaos.org/topic.cfm?topic=A00353. Accessed June 29, 2017

Scoliosis Research Society. Screening Procedure Guidelines for Guidelines for Spinal Deformity: Recommendations for Examiners. Published 2002. Accessed July 24, 2017.

Scoliosis Research Society. http://www.srs.org/professionals/online-education-and-resources/conditions-and-treatments/adolescent-idiopathic-scoliosis.

Accessed July 24, 2017.