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An 11 year old girl who is otherwise healthy presents to her family physician with asymmetry in her torso. She is a competitive golfer and plays for her school volleyball team. Her parents comment that her coach noticed asymmetry of her shoulders during her lessons, prompting them to schedule a visit with their general practitioner. The girl has no complaints about pain in her back or lower extremities. She has no functional concerns and no restrictions on range of motion. She has no family history of scoliosis or spine deformity. She is one month post menarche. Observation of her posture shows right shoulder elevation and waistline asymmetry. On Adams forward bend, there is trunk rotation with right thorax elevated. A 3 foot standing spine x ray image shows a severe right main thoracic curve measuring over 50°. She is referred to an orthopaedic spine specialist for further assessment and management.