Kyphosis is an excessive forward curve of the upper back that gives a rounded or hunched look. It can be postural, structural as in Scheuermann disease in teens, or caused by osteoporotic fractures in older adults.
Key symptoms
- Rounded upper back or hunched posture
- Back pain and fatigue
- Loss of height
- Breathing problems in severe curves
What you find on exam
- Forward bend test: a rigid curve suggests structural kyphosis
- In postural kyphosis the curve corrects when lying flat or standing tall
- Height and spinal tenderness
- Neurologic exam of the legs
Tests
- Standing spine X-ray to measure the curve (Cobb angle)
- Wedged vertebrae: 3 in a row of 5 degrees or more in Scheuermann disease
- Bone density test in older adults
- MRI if there are neurologic signs
Treatment basics
- Posture training and physical therapy for postural kyphosis
- Brace for growing teens with Scheuermann disease
- Treat osteoporosis and pain from compression fractures
- Surgery for severe or progressive curves or neurologic problems
Red flags
- Weakness, numbness or bladder changes
- Rapidly worsening curve
- Sudden back pain in an older adult (new fracture)
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.