1. POSITIVE: A “c” or “s” shaped scoliosis is observed to straighten.
  2. POSITIVE: A “c” or “s” shaped scoliosis does not straighten.

  1. INDICATES: Negative: evidence of a functional scoliosis, trauma or subluxation.
  2. INDICATES: Positive: evidence of a pathologic or structural scoliosis.

Patient Instructions: Patient standing, with examiner standing behind patient, examiner looks for evidence of scoliosis. Examiner instructs the patient to bend forward at the waist. Examiner observes for evidence of a change in the scoliosis.

Clinical Notes: Look for rib humping, muscular imbalance, and asymmetry in hand length as findings.

Do's and Don'ts: Do look and palpate if necessary at the spine before during and after. DO NOT let the patient bend forward if wearing a gown that is not tied up. Usually they have a male with no shirt on. DO NOT touch the patient in any way other than her spine. Explain you will be on her back looking for any deviation.


POSITIVE: Pain on the concave or convex side.

INDICATES: Pain on the concave side indicates intercostal neuritis. Pain on the convex side indicates fibrous inflammation of the pleura and or sprain.

Patient Instructions: Patient seated arms fully abducted and raised over head, examiner instructs patient to laterally flex thoracic spine to the left side and then to the right side.

Clinical Notes: Possible intercostal myofasciitis as ddx from pleuritis or neuritis.

Do's and Don'ts: Make sure the pelvis remains on the table if seated.


POSITIVE: Superior or inferior movement of the umbilicus.

INDICATES: Superior movement of the umbilicus is indicative of a spinal cord lesion at the level of T10 or lower abdominal weakness. Superior Inferior movement of the umbilicus is indicative of nerve root involvement T7 – T10.

Patient Instructions: Patient supine: examiner instructs patient cross their arms across the chest and perform a partial sit up.

Clinical Notes: Possible intercostal myofasciitis as ddx from pleuritis or neuritis.

Do's and Don'ts: Make sure the pelvis remains on the table if seated.

INSIDERS NOTE: Perform the exams in the same order they appear listed on the sheet, even if it takes more time. Skipping an exam or going out of order will confuse the examiner, the patient, and sometimes even you. If you forget an exam and want to skip it, let the examiner know that you are skipping an exam (and doing it later) and be clear as to what will be the next exam. Otherwise, you run the chance of confusing the patient and missing any positive complaints they have memorized that will help you answer questions on the PEP Room (following room).

If you ever skip and exam and never perform it... DO NOT ANNOUNCE IT OUT LOUD. Sometimes the examiner is distracted and will give you the point if you are doing everything correctly. Act professional, and act with confidence.

If the exam is positive, the patient might complain or the examiner might indicate a complaint. We advise you to use the rest of your time in the room to politely ask 1-2 questions related to this positive complaint. This will help you answer the PEP room as they might have a memorized script related to this complaint.  


  • Rib Compression


  1. Have you experienced sharp pain?
  2. Have you experienced shortness of breath?
  3. Does pain exacerbate with motion?

Complete and Continue