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Step 1
Observe the most common presenting symptom as poor posture. Only 20 percent of these patients complain of pain, usually when the kyphosis has spread to the lumbar spine.
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Step 2
Examine the patient in the forward flexed position. This position will make the kyphotic deformity most visible. The spine just above and below the apex of the kyphosis may be tender to the touch.
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Step 3
Measure the curvature of the thoracic spine with a radiograph. Scheuerman kyphosis is defined as an anterior wedging of at least 5 degrees in three consecutive vertebral bodies. It is also associated with a total curvature greater than 40 degrees and a loss of disk space height.
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Step 4
Determine the cause of the kyphosis. Kyphosis is a symptom and not a specific condition. It may be caused by overuse of the butterfly stroke but also may result from many other factors including poor posture, skeletal dysplasia, ankylosing spondylitis or a laminectomy that was performed before skeletal maturity.
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Step 5
Analyze the histology of the affected spine. Adolescent swimmer's back profoundly changes the enchondral ossification in these segments. The endplate cartilage should have a decreased collagen/proteoglycan ratio with an abnormal matrix.
