. Lateral curvature of the spine and round shoulders . h.) spine. The thorax and shoulders will be twisted backward onthe right, and when the patient bends forward, this twisted posi-tion of the shoulders may be carried over into the position offorward bending if the case has been of long standing, and theright side of the back will be higher in this position. This reverserotation, concave torsion, retrotorsion, as it has been called,has been much discussed- and is an accompaniment of total scoli- ^ Srhulthess: Zeitsch. f. orth. Chir., vi, 399-566, 1902.^ Schulthess: Zeitsch. f. orth. Chir., x
. Lateral curvature of the spine and round shoulders . h.) spine. The thorax and shoulders will be twisted backward onthe right, and when the patient bends forward, this twisted posi-tion of the shoulders may be carried over into the position offorward bending if the case has been of long standing, and theright side of the back will be higher in this position. This reverserotation, concave torsion, retrotorsion, as it has been called,has been much discussed- and is an accompaniment of total scoli- ^ Srhulthess: Zeitsch. f. orth. Chir., vi, 399-566, 1902.^ Schulthess: Zeitsch. f. orth. Chir., x, page 489. 52 DESCRIPTION AND SYMPTOMS. osis, but it is a physiological matter easily understood by studyingthe mechanics of the normal spine. It has been claimed that totalscoliosis is really a triple-compound curve/ and that the torsion to theconcave side is really due to a slight right dorsal curve; x-rays of suchcases taken in the standing position show, however, in many cases, agradual curve to the left without compensating curves (Fig. 37); in. Fig. 40.—Boy with Left Total Scoliosis Photographed from Overhead, Showing THE Carrying Back of the Shoulder-girdle on the Right. The front edge of the board on the floor marks the lateral plane of the pelvis. other cases apparently total curves in .T-rays taken in this way seemto be transitional cases. TRANSITIONAL many cases which on first inspection appear to be postural morecareful examination will show that the curve is obviously changing fromthe postural to the structural type, i. e., is beginning to show changesof structure. The mechanism of this is as follows: If total scoliosis tends to increase, it must do so by an increase of the existingside bend and of the existing twist, since both are correlated, not necessarily of bothin exact proportion, but to some extent both factors must share in it. The shoulder- * Reiner and Werndorff: Verhandl. Deut. Gesel. f. orth. Chir., 1906, page 232. TRANSITIONAL CURVES. 53
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