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24.04.2015 | Original Article | Ausgabe 11/2016

European Spine Journal 11/2016

Does patient perception of shoulder balance correlate with clinical balance?

European Spine Journal > Ausgabe 11/2016
Antonia Matamalas, Juan Bagó, Elisabetta D’Agata, Ferran Pellisé



To evaluate the relationship between radiological, clinical and perceived shoulder balance (ShB) in a sample of non-operated, moderate, idiopathic scoliosis (IS) patients.


80 patients (85 % women) with a mean age of 20.3 years (SD 8.6, 12–40 years) were included. Mean Cobb angle was 45.9° (SD 12.9, 25.1°–77.2°). All patients had full spine X-ray and a digital photography from the front. To determine clinical ShB, shoulder height angle (SHA) and axilla height angle (AHA) were measured on clinical photographs. Radiological ShB was assessed with the clavicle–rib intersection angle and T1-tilt. Patients also completed different patient-reported outcomes (PRO) instruments: SRS-22, TAPS and Spinal Appearance Questionnaire (SAQ). SAQ included two questions concerning the shoulder area (SAQ-6 = perception and SAQ-13 = expectation) which were used to assess perceived ShB. Patients were divided into two groups: balanced (SHA <3.0°), and imbalanced (SHA ≥3.0°) according to minimal detectable change of SHA. The correlations between variables and mean differences between the two groups were analyzed.


No statistically significant correlations were found between clinical (SHA and AHA) and perceived ShB (SAQ-6), or with PRO scores. 62.5 % of patients were in the “Balanced” group. 46.6 % (14/30) of patients in the clinically imbalanced group (≥3.0°) perceive themselves as totally balanced (score 1 and 2 in SAQ-6), while 10 % (5/50) of patients in the balanced group (SHA <3.0°) perceive themselves as totally imbalanced (score 4 and 5 in SAQ-13). No differences were found between both groups in terms of radiological and perceived ShB, or in PRO scores.


We have not found a significant correlation between clinical/radiological ShB and perceived ShB in non-operated IS patients. It seems that ShB is not a key factor in patient trunk deformity perception. In addition, patient expectations regarding improvement with treatment are not directly related to actual clinical imbalance.

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