Scheuermann Disease Clinical Presentation

Updated: Feb 01, 2017
  • Author: Jozef E Nowak, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Presentation

History

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  • Most patients with Scheuermann's disease present with a history of deformity. The parent brings the child to the physician because of poor posture or referral from a school screening program.
  • The incidence of pain is low, although 20% of patients may complain of discomfort in the region of the kyphosis. In patients with lumbar localization of kyphosis, the pain appears more pronounced—as many as 80% may report lower back pain. The pain is usually intermittent and is characterized as dull and aching; it is related generally to activity and is relieved by rest. [16]
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Physical

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  • Patients with upper thoracic Scheuermann's disease present with a kyphotic deformity best demonstrated in the forward flexed position.
  • Decreased flexibility of the spine is noted, indicating the structural nature of the kyphotic deformity, in contrast to patients with flexible postural kyphosis.
  • Patients may have tenderness to palpation above and below the apex of the kyphosis.
  • A high association exists between scoliosis and Scheuermann's disease. Patients also may have a hyperlordosis in the lumbar spine.
  • Lower thoracic kyphosis is localized at the thoracolumbar junction; in general, any kyphotic deformity present at this level must be considered abnormal.
  • Hamstring tightness may be present in these patients.
  • A careful neurologic examination is recommended, although neurologic deficits are extremely rare.
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Causes

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  • Osteochondritis of the upper and lower cartilaginous vertebral plates has been incriminated in the development of Scheuermann's disease.
  • Trauma sometimes seems to be a causative factor.
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