Uneven Rib Cage in Adolescents: Scoliosis, Kyphosis, and Lordosis

Asymmetric rib cage prominence in a teenager often reflects spinal deformity:

• Scoliosis: Lateral curvature + vertebral rotation → rib hump on convex side (posterior), rib flattening on concave side. Adam’s forward bend test reveals asymmetry.
• Kyphosis: Excessive thoracic flexion → rounded shoulders, anterior chest compression, posterior rib prominence.
• Lordosis: Excessive lumbar extension → prominent lower ribs anteriorly, “swayback.”

Other Causes

• Pectus excavatum/carinatum (chest wall deformities)
• Muscular dystrophy, connective tissue disorders (Marfan, Ehlers‑Danlos)
• Leg‑length discrepancy with pelvic tilt

Evaluation

Clinical exam, scoliometer, standing PA/lateral spine X‑rays (Cobb angle). Referral to pediatric orthopedics or spine specialist if Cobb >10° or progression.

Early bracing (Rigo‑Chêneau, Boston) can halt progression in moderate curves; surgery for severe (>45–50°).