The viscera are distorted and displaced in accordance with the altered shape of the thoracic and abdominal cavities. The twisting of the spine causes the patient to lose in stature, and the limbs appear to be disproportionately long. In advanced cases the pelvis becomes obliquely contracted—a deformity known as the scoliotic pelvis.
Fig. 228.—Scoliosis with primary curve in Thoracic Region.
In spite of the marked deformity the spinal cord is never compressed.
Clinical features.—The development of scoliosis is always slow and insidious. As a rule, attention is first attracted to the deformity about the age of puberty, but in most cases it has existed for a considerable time before it is observed. The patient—usually a girl, although it also occurs in boys—is easily fatigued, has difficulty in keeping herself erect, and often complains of pain in the back and shoulders and along the intercostal spaces on the side of the convexity. To relieve the muscles of the back she is inclined to lounge in easy and ungainly attitudes.
The most common form of scoliosis met with in adolescents is a primary thoracic curvature with its convexity to the right ([Fig. 227]), and with more or less marked compensatory curves towards the left in the lumbar and cervical regions. The thoracic spines lie towards the right of the middle line. On account of the prominence of the ribs, the right scapula is projected backwards, and its inferior angle is on a higher level and farther from the middle line than that of the left scapula. The right shoulder seems higher than the left, and is popularly said to be “growing out”—a point which is often first observed by the dressmaker. The right side of the back is unduly prominent, while the left side is flattened. A deep sulcus forms in the left flank below the costal margin, and the space between the arm and the chest wall—the “brachio-thoracic triangle”—on the left side is much more marked than on the right; and the left iliac crest usually projects upwards and backwards. As seen from the front, the right side of the chest is flattened, while the left side is abnormally prominent, the breasts are asymmetrical, and the right nipple is on a higher level than the left.
Fig. 229.—Scoliosis showing rotation of bodies of vertebræ, and widening of intercostal spaces on side of convexity.