What is Adam's test (Adams forward bend test)?

Adams Forward Bend Test

The Adams forward bend test is a clinical screening tool used to detect scoliosis by observing trunk asymmetry when a patient bends forward at the waist with arms hanging freely and palms together. This test reveals the rotational component of scoliosis by making the rib hump or lumbar prominence more visible.

Technique and Execution

The Adams forward bend test is performed as follows:

• The patient stands with feet together and is asked to bend forward at the waist to approximately 90 degrees
• Arms hang freely with palms together or touching the floor
• The examiner observes the patient's back from behind and from the side
• The examiner looks for asymmetry in the thoracic and lumbar regions, including:
  • Rib humps in the thoracic spine
  • Paraspinal muscle prominence in the lumbar spine
  • Uneven shoulder heights
  • Asymmetry of the waistline

Diagnostic Accuracy

The Adams forward bend test has limitations as a standalone screening tool:

• Sensitivity of 84.37% and specificity of 93.44% for detecting scoliosis 1
• Studies show it can miss cases of scoliosis (false negatives), making it unreliable when used alone 1
• When compared to other screening methods like the Scoliometer, Moiré topography, and humpometer, the Adams test has inferior negative predictive value 1

Historical Context

The test was first described by William Adams in 1865 2. His understanding of the rotational component of scoliosis was informed by a postmortem examination he performed on Dr. Gideon Mantell, an eminent surgeon and geologist 2.

Clinical Applications and Limitations

The Adams forward bend test is commonly used in school scoliosis screening programs but has important limitations:

• Should not be used as the sole screening method due to unacceptable false-negative findings 1
• Some studies suggest that selecting children for further examination based solely on the Adams test is not supported by data 3
• When combined with other assessment tools like the Scoliometer, diagnostic accuracy improves 4

Best Practice Recommendations

For optimal screening and diagnosis:

1. Combine the Adams forward bend test with objective measurement tools like the Scoliometer
2. Consider using cutoff limits for referral (such as asymmetry of two Moiré fringes, humpogram deformity of 10 mm, or 8 degrees of Scoliometer angle) to reduce unnecessary radiologic examinations 1
3. Be aware that the test has better reliability for thoracic curves than for lumbar curves 4
4. Remember that the interexaminer agreement for the Adams test is substantial in the thoracic spine but poor in the lumbar spine 4

Common Pitfalls

• Misinterpreting normal variants in thin individuals as pathological findings 5
• Overlooking subtle abnormalities that may indicate early signs of spinal disorders 5
• Relying solely on the Adams test without complementary objective measurements
• Using inconsistent technique when performing the test, which can affect reliability

By understanding both the utility and limitations of the Adams forward bend test, clinicians can use it appropriately as part of a comprehensive approach to scoliosis screening and diagnosis.