Pain is uncommon in adolescents with idiopathic scoliosis and therefore requires further evaluation. The spinal curve is more pronounced when the adolescent bends forward. Most curves are convex to the right in the thoracic area and to the left in the lumbar area, so that the right shoulder is higher than the left. One hip may be more prominent than the other. X-ray examination should include anteroposterior and lateral views of the spine with the patient standing.
Prognosis depends on the site and severity of the curve and the age of onset of symptoms.
The primary care physician's role for adolescents with scoliosis, in collaboration with an orthopedist, includes diagnosis and counseling about treatment options and adjustment. This disorder often occurs in overweight adolescents, usually boys. The cause is unknown but may be related to the effects of growth hormone and estrogen on the thickness of the epiphyseal plate. Onset is usually insidious, and symptoms are associated with the stage of slippage. Initially, there may be hip stiffness that improves with rest, followed by a limp and then hip pain that radiates down the anteromedial thigh to the knee.