Comp Eval-Thoracic Flashcards
Adam’s Position
• If the scoliosis, hyperkyphosis
or kyphoscoliosis is present
standing but reduces when
patient flexes forward
suspect the scoliosis is
functional – adaptation of the
spine and soft tissue
• If the scoliosis, hyperkyphosis
or rib hump is present
standing and does not
reduce with forward flexion
suspect a structural
deformity – hemivertebra,
compression fracture or
idiopathic scoliosis
Chest Expansion
• The normal chest expansion
for a man is 2+ inches and a
woman is 1+ inch
• A decrease in chest
expansion indicates an
ankylosing condition –
ankylosing spondylitis
• **you are testing for
EXPANSION hence the
name CHEST EXPANSION
Forestier’s Bowstring
• Normally the contralateral
musculature demonstrates
tightening
• Patients with Ankylosing
spondylitis will
demonstrate ipsilateral
tightening and contracture
of the paraspinal
musculature
Schepelmann’s Sign
• Pain created on concavity
side – suspect intercostal
neuritis
• Pain created on the
convexity side – suspect
intercostal myofascitis
but must be
differentiated from
pleurisy
Rib Compression
• A/P
• Pain or point tenderness
indicates fracture, contusion, or costochondral separation
• Lateral
• Pain or point tenderness
indicates fracture
Sternal Compression
• Localized severe pain
along the lateral border
of the ribs indicates
fracture
• Differentiate a fracture
from a contusion –
contusions do not
usually cause pain
during rib motion
Prone Unilateral Hypothenar/Transverse Push
• PP: Prone
• DP: Fencer or square stance facing
cephalad, side of adjustive contact • CH: Hypothenar of caudal hand on
Transverse Process (TP) (fingers
running parallel to the spine)
• IH: Pisiform in anatomical snuff box
of CH, with fingers around wrist.
• Vector: P-A
Prone Unilateral Hypothenar/Transverse Push (LF)
• PP: Prone • DP: Fencer or square stance facing
caudal, side of adjustive contact
• CH: Hypothenar of cephalic hand on
Transverse Process (TP) (fingers
running parallel to the spine)
• IH: Pisiform in anatomical snuff box,
with fingers around wrist.
• Vector: P-A and S-I • CLOSING THE WEDGE
Prone Bilateral Hypothenar, Thenar/Transverse Push-Rotation
• PP: Prone, patient permission to open gown
and contact
• DP: Modified fencer or square stance facing
patient, superior segment side of contact,
leaning anterior and tractioning contacts apart
• CH: Caudal hypothenar contact on superior
Transverse Process (TP)
• IH: Cephalad thenar or hypothenar with a
broad stabilizing contact on inferior Transverse
Process (TP) (contralateral side reaching
across the spine) . Internally rotate against
transverse process with torque, fingers along
spine
• Vector: P-A with stabilizing
T7 LR, RRR
• CH: P-A, IH: stabilizing
Prone Unilateral Hypothenar/Spinous Push (Rotation Malposition or Rotation with Ipsilateral Lateral Flexion)
• PP: Prone
• DP: Square or fencer stance facing caudal, side
of contact, at cephalad end of the table
• CH: Hypothenar of cephalad hand on lateral
surface of superior Spinous Process (SP) on the
side of rotation. Then, torque hand 45 degrees
so that little finger CROSSES the Spine.
• Left hand counterclockwise torque, right
hand clockwise torque
T6 RR and RLF, LRR and LLFR
• IH: Hypothenar in anatomical snuff box,
stabilize contact. • Vector: P-A and L-M with clockwise or
counterclockwise torque
Prone Knife Edge/Spinous Push - Extension
• PP: Prone
• DP: Fencer stance facing cephalad,
center of gravity caudal to contact
• CH: Mid-knife edge contact on
inferior Spinous Process (SP)
• IH: Calcaneal reinforcement with
fingers pointing cephalad
• Vector: I-S with enough P-A to stay on Spinous Process (SP)
Prone Knife Edge/Spinous Push - Flexion
• PP: Prone, head piece lowered
• DP: Fencer stance facing caudal,
at cephalad end of the table,
center of gravity over contact
• CH: Mid-knife edge contact on
superior interspinous space
• IH: Calcaneal reinforcement
with fingers pointing caudal
• Vector: P-A and S-I
Supine Opposite-Side Thenar/Transverse Drop (Figure 5-181F)
Rotation Malposition
• PP: Supine, arms crossed on shoulders, patient in flexed position
• DP: Modified fencer, opposite side of contact, tissue slack from below
• CH: Unilateral thenar contact on superior segment
• IH: Contacts the patient’s crossed arms
• Vector: A-P to induce rotation
Prone Knife Edge/Spinous Push – Extension
• PP: Prone
• DP: Fencer stance facing cephalad, center of gravity caudal to contact
• CH: Mid-knife edge contact on inferior Spinous Process (SP)
• IH: Calcaneal reinforcement with fingers pointing cephalad
• Vector: I-S with enough P-A to stay on Spinous Process (SP)
Prone Knife Edge/Spinous Push - Flexion
• PP: Prone, head piece lowered
• DP: Fencer stance facing caudal, at cephalad end of the table, center of gravity over contact
• CH: Mid-knife edge contact on superior interspinous space
• IH: Calcaneal reinforcement with fingers pointing caudal
• Vector: P-A and S-I
Supine Opposite-Side Thenar/Transverse Drop (Figure 5-181F)
Rotation Malposition
• PP: Supine, arms crossed on shoulders, patient in flexed position
• DP: Modified fencer, opposite side
of contact, tissue slack from below
• CH: Unilateral thenar contact on superior segment • IH: Contacts the patient’s crossed
arms
• Vector: A-P to induce rotation
Thumb/web axilla with knee extension; long axis distraction
PP: Supine, involved arm off table
DP: Bunny hop position, knees grasping distal humerus CH: Inside hand thumb/web contact in pt’s axilla with slight downward pressure to stabilize
IH: Outside hand digital contact over lateral aspect of the joint
VEC: LAD with knee extension
Bimanual thumb thenar grasp/proximal humerus with knee extension; anterior to posterior glide
-PP: Supine, glenohumeral joint off the table
-DP: Bunny hop position, knees grasping distal humerus -CH: Bilateral grasp on proximal humerus, thumbs/thenar in midline
-VEC: A-P shallow impulse with slight distraction with the knees
Interlaced digital/proximal humerus; superior to inferior glide in flexion
PP: Supine with involved arm raised to 90o DP: Standing on involve side in lunge position facing cephalad with pt elbow resting on INSIDE shoulder
CH: Grasp proximal humerus with interlaced fingers VEC: S-I; distract slightly with shallow S-I impulse
PP: Supine with involved arm raised to 90o
-DP: Standing on involve side in lunge position facing cephalad with pt elbow resting on INSIDE shoulder
CH: Grasp proximal humerus with interlaced fingers
VEC: S-I; distract slightly with shallow S-I impulse
6-51 Supine Index/ proximal humerus; superior to inferior glide in abduction
-PP: Supine with shoulder off table
-DP: Stand on side of table facing caudal
-CH: Index web contact on superior aspect of proximal humerus with cephalad hand
-IH: Caudal hand grasps distal humerus
-VEC: S-I with shallow impulse thrust
6-52 Bimanual thumb thenar grasp/proximal humerus with knee extension; internal and external rotation
-PP: Supine with arm in slight abduction off table
-DP: Face cephalad with knees straddling affected arm, squeezing distal humerus, holding arm in internal or external rotation
-CH: Bimanual grasp fingers interlaced on proximal humerus
-VEC: Shallow Internal or External rotation with LAD
6-53 Bimanual thumb thenar grasp/proximal humerus; mobilization with distraction
-PP: Supine with affected arm outstretched on edge of table
-DP: In a lunge position facing head of table, pt forearm against your thorax
-CH: Bimanual grasp to proximal humerus
-VEC: General circumduction and distraction, use body weight for slight distraction
6-54 Bimanual grasp/hand; pendular abduction mobilization
-PP: Supine with affected arm off table; arm is slightly abducted and elbow flexed 90o
-DP: At side of table on involved side, facing patient
-CH: Bimanually grasp patient’s hand
-VEC: S-I with passive swinging; increasing the range of abduction as tolerated
6-55 Bimanual thumb thenar grasp/proximal humerus with knee extension; posterior to anterior glide
PP: Prone with involved glenohumeral joint off the table in slight abduction
DP: Facing patient in bunny hop position; knees gently squeezing distal humerus
CH: Bimanual grasp to proximal humerus; thumbs midline VEC: Shallow P-A impulse with slight distraction with knees
6-56 Bimanual thumb thenar grasp/proximal humerus with knee extension; mobilization with distraction
PP: Prone with affected glenohumeral joint off side of table; arm hanging off table
DP: Stand or kneel off side of table
CH: Bimanual grasp; thumbs midline; fingers wrapped around into axilla
VEC: General circumduction and slight distraction using figure 8 motion
6-57 Standing Interlaced digital/proximal humerus; superior to inferior glide in flexion
PP: Standing with feet shoulder width apart with arm in 90o flexion DP: Stand in front of patient on affected side with patient elbow on your INSIDE shoulder; shoulders align with pt height;
CH: Use an interlaced digit contact on proximal humerus VEC: Shallow impulse S-I with slight distraction drawing away from pt
6-58 Standing Interlaced digital/proximal humerus; superior to inferior glide in abduction
PP: Standing with feet shoulder width apart with arm in 90o abduction DP: Stand in front of patient on affected side with patient elbow on your INSIDE shoulder; shoulders align with pt height;
CH: Use an interlaced digit contact on proximal humerus VEC: Shallow impulse S-I with slight distraction drawing away from pt
PP: Standing with feet shoulder width apart with arm in 90o abduction DP: Stand in front of patient on affected side with patient elbow on your INSIDE shoulder; shoulders align with pt height;
CH: Use an interlaced digit contact on proximal humerus VEC: Shallow impulse S-I with slight distraction drawing away from pt
6-59 Reinforced palmer olecranon; anterior to posterior glide
-PP: Patient seated with arm in forward flexion; elbow bent -DP: Stand behind patient; stabilizing pt’s shoulder girdle against your torso
-CH: Reinforced palmar contact to olecranon process
-VEC: Shallow A-P impulse thrust in axis of humerus
6-60 Supine Index distal clavicle; superior to inferior glide
PP: Supine with arm abducted 90o DP: Facing caudal on involved side CH: Index contact to distal clavicle IH: Outside hand grasps mid shaft of humerus and slightly distracts humerus VEC: S-I with shallow impulse
6-61 Supine Covered thumb/distal clavicle; inferior to superior glide
PP: Supine with arm straight in slight abduction
DP: Bunny hop position; knees grasping distal humerus
CH: Outside hand thumb contact to inferior distal clavicle
IH: Inside hand pisiform covers thumb contact VEC: Shallow I-S impulse thrust with slight knee extension to induce LAD
6-62 Supine Hypothenar distal clavicle with distraction; anterior to posterior glide
PP: Supine affected arm straight and forward flexed about 60o DP: On opposite side of table CH: Cephalad hand pisiform contact to anterior distal clavicle
IH: Grasps pt forearm providing distraction anteriorly VEC: Shallow A-P impulse
6-63 Supine Digital/distal clavicle with distraction; posterior to anterior glide
PP: Supine arm straight and flexed 60o in slight abduction DP: Stand on affected side facing cephalad between pt arm and table CH: Inside hand index and middle digital contact to posterior distal clavicle IH: Outer hand grasps pt distal forearm providing anterior distraction raising shoulder past 90o VEC: Shallow quick P-A impulse
6-64 Seated Web/distal clavicle; superior to inferior glide
PP: Seated with affected arm abducted DP: Stand behind patient on affected side CH: Web contact of inside hand on superior distal clavicle IH: Outside hand grasps distal forearm and lifts gently to distract/slightly abduct shoulder VEC: Shallow quick S-I impulse
6-65 Supine Hypothenar/proximal clavicle with distraction; anterior to posterior
PP: Supine; arm flexed to ~60o DP: Stand on affected side facing cephalad CH: Inside hand pisiform contact to anterior proximal clavicle IH: Outside hand grasps distal humerus at epicondyles; distracts shoulder anteriorly raising scapula off table VEC: Shallow A-P impulse
6-66 Supine Covered thumb proximal clavicle; superior to inferior glide
PP: Supine, pt’s head turned away, arm is abducted to 90o palm placed under head DP: At head of table facing caudal CH: Ipsilateral thumb on superior aspect of proximal clavicle
IH: contralateral hand pisiform over thumb contact VEC: Shallow quick S-I impulse
6-67 Supine Covered thumb proximal clavicle; inferior to superior glide
PP: Supine; arm slightly abducted DP: Stand on affected side in bunny hop position grasping distal humerus CH: Outside hand thumb on inferior proximal clavicle IH: Inside hand pisiform reinforces thumb VEC: Shallow impulse I-S with slight distraction with knees
6-68 Supine Digital/ proximal clavicle with distraction; posterior to anterior
PP: Supine; arm flexed DP: Standing on affected side facing cephalad CH: Inside hand index and middle finger digit contact to posterior proximal clavicle
IH: Outside hand grasps forearm; distracting shoulder anteriorly past 90o
VEC: Shallow impulse P-A; lifting clavicle
6-69 Supine Thenar /distal clavicle, thenar manubrium; long axis distraction
PP: Supine with rolled towel running down spine under upper thoracic spine; affected arm abducted 90o DP: Stand on affected side; lunge position facing cephalad
CH: Outside hand thenar on distal clavicle grasping deltoid IH: Inside hand thenar on manubrium of sternum; fingers laterally cross to contralateral clavicle VEC: Distraction; IH stabilizes manubrium with downward pressure; shallow impulse to distal clavicle
6-70 Seated Reinforced thenar/proximal clavicle; inferior to superior glide
PP: Seated with arms relaxed DP: Stand behind pt CH: Contralateral hand thenar on inferior proximal clavicle IH: Ipsilateral hand calcaneal contact reinforces CH VEC: Shallow I-S impulse *Stabilize pt against chair or your body; lean pt back slightly
PP: Seated with arms relaxed DP: Stand behind pt CH: Contralateral hand thenar on inferior proximal clavicle IH: Ipsilateral hand calcaneal contact reinforces CH VEC: Shallow I-S impulse *Stabilize pt against chair or your body; lean pt back slightly
6-71 Seated Digital/proximal clavicle, thenar/manubrium; long axis distraction
PP: Seated with affected arm abducted 90o DP: Stand behind pt, slightly to side of involvement CH: Ipsilateral hand reaches under affected arm; digital contact with index and middle finger on proximal clavicle
IH: Contralateral hand thenar contact on manubrium; forearm across contralateral clavicle VEC: Distraction; quick shallow impulse *IH stabilizes manubrium and pt shoulder into your torso; CH draws laterally with arm drawing affected shoulder posterior
6-72 Side Posture Bimanual thumb thenar/lateral scapula; lateral to medial glide
PP: Side lying; affected side up with arm resting on side of body DP: Stand at side of table facing patient CH: Bimanual thumb/thenar to lateral border of scapula VEC: L-M shallow impulse *take out all passive movement first before impulse
PP: Side lying; affected side up with arm resting on side of body DP: Stand at side of table facing patient CH: Bimanual thumb/thenar to lateral border of scapula VEC: L-M shallow impulse *take out all passive movement first before impulse
6-73 Side Posture Crossed bilateral mid-hypothenar (knife –edge)/scapula; medial to lateral
PP: Side-lying with affected arm hanging forward in front of table DP: Standing on involved facing cephalad in a fencer stance
CH: Caudal hand knife-edge to medial border of scapula; fingers over scapular spine IH: Cephalad hand calcaneal contact over lateral border of unaffected scapula VEC: M-L impulse thrust
*draw out lateral movement passively before impulse
6-74 Side Posture Bimanual digital thenar grasp/scapula; rotation- inferior angle lateral to medial
PP: Side-lying affected side up; pt arm behind back DP: Stand at side of table, facing pt CH: Caudal hand thenar contact on lateral border of inferior angle of scapula IH: Cephalad hand thenar contact on superior aspect of spine of scapula; fingers pointing to inferior angle VEC: Clockwise rotation; impulse thrust driving inferior angle medially
6-75 Side Posture Bimanual digital thenar grasp/scapula; rotation- inferior angle medial to lateral
PP: Side-lying affected side up; pt’s hand behind head DP: Standing on side of table facing pt CH: Caudal hand hypothenar contact on medial aspect of inferior angle of scapula IH: Cephalad hand digital contact along spine of scapula VEC: Counter-clockwise rotation impulse
PP: Side-lying affected side up; pt’s hand behind head DP: Standing on side of table facing pt CH: Caudal hand hypothenar contact on medial aspect of inferior angle of scapula IH: Cephalad hand digital contact along spine of scapula VEC: Counter-clockwise rotation impulse
Dugas
• Inability to touch opposite
shoulder or unable to
lower arm to chest
indicates anterior
dislocation of humerus.
Apley’s Scratch Test
• Exacerbation of pain
in the shoulder
indicates
degenerative
tendinitis of the
rotator cuff usually
supraspinatus
tendon
Subacromial Push Button
• An increase in pain
indicating a subacromial
bursitis
Subacromial Bursa Test (Dawbarn’s Sign)
• Decrease in
tenderness or
pain indicating
Subacromial
bursitis
Apprehension Test
• Pain over anterior
capsule the “look of
apprehension” on
patient’s face or
laxity compared to
the other side
indicates anterior
dislocation trauma
of the humerus
Relocation (apprehension is positive)
• If patient experiences relief
of symptoms that
manifested during the
apprehension test it
indicates anterior
instability. If no change in
pain, or apprehension then
possibility of another cause
for the pain other than
instability.
Sulcus Sign
• Sulcus or dimpling
appearing superior
to humeral
head/inferior to
lateral acromion
indicates
multidirectional
instability
Load Shift (shoulder drawer test)
• Increased
movement
and/or popping,
grinding or
slapping
indicates
instability of
glenohumeral
joint and
possible labrum
damage
Arm Drop Test (Codman’s Test)
• Pain and hunching of
shoulder indicating
rotator cuff tear or
rupture of the
supraspinatus
tendon
Empty Can (Supraspinatus Test)
• Weakness or pain
indicates a lesion of the
supraspinatus muscle or
tendon
Lift Off Test
• Weakness and or
pain indicates a
lesion of the
subscapularis
muscle or
tendon.
Yergson’s
• Pain or tenderness over
bicipital tendon and the
transverse humeral
ligament. This Indicative
of tenosynovitis of the
transverse humeral
ligament, inflammation
of the biceps tendon or
tendonitis. If popping
occurs suspect a lax
transverse humeral
ligament or a congenital
shallow bicipital grove.
Clunk
• Clicking or clunking
with or without pain
indicates labrum
tear
Crank
• Clicking with or
without pain
indicates labrum
tear
O’Brien’s Sign
• If the patient
experiences deep pain
in shoulder with
internal rotation which
is reduced or
eliminated with
external rotation it
indicates a torn glenoid
labrum
Hawkins-Kennedy
• Pain in the anterior
glenohumeral joint is
indicative of rotator
cuff tendonitis and
possible
impingement of
supraspinatus
tendon
Neer’s Test
• Pain in the
anterior
glenohumeral
joint is indicative
of rotator cuff
tendonitis
Impingement Relief
• Decrease in pain or
alleviation
indicates
mechanical
impingement
under the
acromion
