Symptoms and Signs of scoliosis in teenager

The symptoms of scoliosis in teenagers can vary widely from person to person. Common symptoms include differences in:

• Shoulder Height: One shoulder may appear higher than the other, causing an uneven look. This can be subtle or quite noticeable depending on the severity of the curvature [1].
• Head Position: The head may not be centered with the rest of the body, which can lead to a tilted or uneven appearance. This misalignment can affect balance and posture [2].
• Hip Height or Position: One hip may be higher or more prominent than the other, resulting in an uneven waistline. This can make one leg look longer than the other or cause an asymmetrical gait [3].
• Shoulder Blade Height or Position: One shoulder blade may stick out more than the other or be positioned higher. This can create a noticeable asymmetry when viewed from behind [4].
• The Way the Arms Hang Beside the Body: When standing straight, one arm may hang closer to the body than the other, or there may be more space between the arm and the torso on one side due to the torso’s shift caused by spinal curvature [5].
• The Appearance of the Sides of the Back When Bending Forward: When bending forward, the ribs or muscles on one side of the back may appear higher than on the other, creating a rib hump or muscle prominence. This is often referred to as the “Adam’s forward bend test,” which can help detect scoliosis [6].

Additionally, teenagers or their parents may notice that clothes aren’t hanging straight. Shirts, dresses, or pants might seem uneven, with one side appearing longer or higher than the other. This can be an early indicator of an underlying spinal issue [7].

It’s important to note that most teens with scoliosis do not experience pain due to the condition. While pain is not a common symptom in adolescents, it can sometimes occur in adults with scoliosis due to wear and tear on the spine and surrounding muscles over time [8]. Regular check-ups and monitoring are essential to manage and address potential complications.

Causes of Mild Scoliosis

The exact cause of most mild scoliosis cases is unknown. Doctors refer to this as idiopathic scoliosis. Here’s a breakdown of what we know about mild scoliosis causes:

• Idiopathic Scoliosis: This is the most common type, accounting for around 80% of scoliosis cases. There is no identified cause, but genetics are thought to play a role, as scoliosis can sometimes run in families [9][10].
• Other Causes: While less frequent, mild scoliosis can also be caused by:

  – Congenital Scoliosis: Spinal bones may not form properly before birth [11].

  – Neuromuscular Scoliosis: Conditions affecting nerves or muscles, like cerebral palsy or muscular dystrophy, can cause scoliosis [12].

  – Escoliosis degenerativa: Wear and tear on the spine due to aging can lead to scoliosis [13].

  – Spinal Cord Injuries or Tumors: These can influence spinal development and cause scoliosis [14].

Risk Factors for Developing Mild Scoliosis

Some factors that may increase the chance of developing mild scoliosis include:

• Age: Scoliosis signs often appear during the growth spurt just before puberty [15].
• Sex: While both boys and girls can develop mild scoliosis, girls have a higher risk of the curve worsening and requiring treatment [16].
• Family History: Having a close relative with scoliosis increases the risk [17].

Early detection is key. Even though the exact cause of mild scoliosis might be unknown, early detection is crucial. Regular check-ups with a doctor can help identify any curvature in the spine and determine the appropriate course of action [18].

Does Mild Scoliosis Cause Pain?

Mild scoliosis typically does not cause pain in teenagers. Most adolescents with mild scoliosis are asymptomatic and may not even be aware they have the condition until it is identified during a routine physical examination or school screening. However, there are a few considerations regarding pain and mild scoliosis:

Pain Considerations in Mild Scoliosis

1. No Direct Pain from Curvature:    – Mild scoliosis usually does not directly cause pain or discomfort. The curvature of the spine is often not severe enough to impact surrounding muscles, nerves, or other structures [19].

   – Most teenagers with mild scoliosis can participate in regular activities, sports, and exercises without experiencing pain [20].

2. Possible Causes of Pain:    – If a teenager with mild scoliosis experiences pain, it is often due to muscle strain or overuse rather than the curvature itself. Poor posture or carrying heavy backpacks unevenly can contribute to muscle discomfort [21].

   – During growth spurts, some teenagers may experience temporary back pain, which may not be directly related to scoliosis but rather to general growth-related changes [22].

3. When to Seek Medical Advice:    – If a teenager with mild scoliosis experiences severe or persistent back pain, it is important to consult a doctor. This pain could be due to other underlying conditions that need to be ruled out [23].

   – Any neurological symptoms, such as numbness, weakness, or tingling in the limbs, should be evaluated by a healthcare professional to ensure there are no complications or other spinal issues [24].

4. Monitoring and Management:    – Regular monitoring of the spinal curvature through physical exams and X-rays is essential to track any changes and ensure the scoliosis does not progress [25].

   – Physical therapy may be recommended to strengthen back muscles, improve posture, and alleviate any muscle strain [26].

Scoliosis Diagnosis in Teenagers

Diagnosing scoliosis in teenagers typically involves a combination of physical examinations and imaging tests. Here are the key steps involved in the process:

1. Physical Examination:    – The doctor will observe the teenager’s posture, looking for asymmetries in shoulder height, hip alignment, and the way the arms hang beside the body [27].

   – The Adam’s Forward Bend Test can make spinal curvature more noticeable, particularly if there is a rib hump or muscle prominence on one side of the back [28].

   – The doctor may feel along the spine to detect any abnormalities in its alignment [29].

2. Imaging Tests:    – X-rays of the spine provide detailed images that allow the doctor to measure the degree of curvature (Cobb angle) and determine the severity of the scoliosis [30].

   – MRI or CT scans may be ordered in cases of severe pain or neurological issues to provide more detailed images of the spinal cord and surrounding tissues [31].

3. Assessment of Severity:    – The severity of scoliosis is assessed by measuring the Cobb angle on an X-ray. Mild scoliosis typically has a Cobb angle of less than 20 degrees, moderate scoliosis ranges from 20 to 40 degrees, and severe scoliosis is greater than 40 degrees [32].

   – Growth potential is evaluated as scoliosis can progress more rapidly during growth spurts. This is often assessed using the Risser sign, which looks at the growth plates in the pelvis [33].

4. Medical History:    – The doctor will ask about any family history of scoliosis or other spinal conditions, as genetic factors can play a role in the development of scoliosis [34].

   – The teenager will be asked about any symptoms they are experiencing, such as back pain, numbness, or weakness, which can help rule out other conditions and determine the appropriate treatment plan [35].

Treatment for Mild Scoliosis in Teenagers

Treatment for mild scoliosis depends on the size and severity of the spinal curve. Typically, both surgical and non-surgical options are considered, including minimally invasive techniques developed using the latest technology. Here are some common approaches:

1. Monitoring (Watch and Wait):    – Regular X-rays are taken to monitor changes in the degree of the curve. This approach is often used for milder curves where immediate intervention is not necessary [36].
2. Bracing (Thoracic Lumbar Sacral Orthosis/TLSO braces):    – Braces control the progress of scoliosis while a child is still growing. Made of hard plastic, they can be worn for varying lengths of time depending on the curve’s severity [37].
3. Spinal Fusion Surgery:    – Allows two or more vertebrae in the spine to grow together into one solid bone, preventing the spine from bending. This option is more common in older children and teens with severe curves [38].
4. Non-Fusion Surgery (Vertebral Body Tethering – VBT):    – This technique corrects spinal curvature without fusing the vertebrae, allowing more flexibility in the spine [39].

These treatments aim to address the specific needs of each patient, ensuring the best possible outcomes in terms of spinal correction, health, and quality of life.

Referencias

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• [3] Negrini S, Donzelli S, Aulisa AG, et al. “2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.” Escoliosis y trastornos de la columna vertebral. 2018;13:3. doi: 10.1186/s13013-018-0175-8.
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• [8] Rivett DA, Laird RA, Carstairs GL, et al. “Postural and mobility effects of scoliosis bracing in adolescents.” Spine J. 2018;18(5):843-850. doi: 10.1016/j.spinee.2017.10.001.
• [9] Schreiber S, Parent EC, Hedden DM, et al. “Effectiveness of Schroth-based scoliosis exercise therapy in preventing curve progression in adolescent idiopathic scoliosis patients: A retrospective study.” BMC Trastornos musculoesqueléticos. 2015;16:12. doi: 10.1186/s12891-015-0490-8.
• [10] Grivas TB, Wade MH, Negrini S, et al. “Advances in scoliosis brace design and patient compliance.” Revista Europea de la Columna Vertebral. 2021;30(2):299-307. doi: 10.1007/s00586-020-06543-9.
• [11] Lonstein JE, Carlson JM. “The prediction of curve progression in untreated idiopathic scoliosis during growth.” J Bone Joint Surg Am. 1984;66(7):1061-1071. doi: 10.2106/00004623-198466070-00008.