Thoracic Evaluation

Question 1

General principles for thoracic evaluation

Answer 1

rule out cardiopulmonary or other gen med conditions
small number of special tests, so palpation most important
identification of involved structures

Question 2

Compromised bone density

Answer 2

predisposition to fracture

Question 3

lifestyle and occupation

Answer 3

if prolonged sitting, what is posture like? length of time?
occupational habits and posture
prolonged driving/electronic use

Question 4

Questions relating to non-mechanical pathology

Answer 4

night pain
unexplained weight loss
hx of cancer
psychosocial factor

Question 5

Lateral view

Answer 5

seated and standing

ear in relation to shoulder
curvature of cervical spine
amount of kyphosis
position of shoulders

Question 6

Lateral view

Answer 6

seated and standing

ear in relation to shoulder
curvature of cervical spine
amount of kyphosis
position of shoulders

Question 7

Lateral view

Answer 7

seated and standing

ear in relation to shoulder
curvature of cervical spine
amount of kyphosis
position of shoulders

Question 8

posterior view

Answer 8

shoulder height
scapula position
presence of lateral curvature
arm to trunk distance
iliac crest height

Question 8

posterior view

Answer 8

shoulder height
scapula position
presence of lateral curvature
arm to trunk distance
iliac crest height

Question 9

posterior view

Answer 9

shoulder height
scapula position
presence of lateral curvature
arm to trunk distance
iliac crest height

Question 10

Measurement of kyphosis

Answer 10

kyphometer-captures Cobb’s angle

Occiput to wall distance
normal to have occiput touch
distance of > 2-4 cm is significant

no extension of the head (ear and nose stay in line)

Question 11

Prone palpations

Answer 11

spinous process alignment
transverse process
costotransverse mobilization
pa mobilization of spinous process

Question 12

prone palpation of musculature

Answer 12

erector spinae
multifidi
lats
rhomboids
trapezius
levator scapulae
suboccipitals

Question 13

costotransverse

Answer 13

the joint formed between the facet of the tubercle of the rib and the adjacent transverse process of a thoracic vertebra.

Question 14

hypothenar eminence

Answer 14

Opponens Digiti Minimi
Origin - the hook of hamate and associated transverse carpal ligament
Insertion - Ulnar border of 5th metacarpal
Nerve - Deep branch of ulnar nerve (C8, T1)
Artery - Ulnar artery
Function - flex and laterally rotate the 5th metacarpal about the 5th carpometacarpal joint
Abductor digiti minimi
Origin - pisiform bone and the tendon of flexor carpi ulnaris
Insertion - the ulnar base of the proximal phalanx of the small finger
Nerve - Deep branch of ulnar nerve (C8, T1)
Artery - Ulnar artery
Function - abduction of the 5th finger, as well as flexion of its proximal phalanx
Flexor digiti minimi brevis
Origin - the hook of hamate and associated transverse carpal ligament
Insertion - the base of the proximal phalanx of the small finger
Nerve - Deep branch of ulnar nerve (C8, T1)
Artery - Ulnar artery
Function - flexes the little finger at the metacarpophalangeal joint
Palmaris brevis
Origin - the transverse carpal ligament
Insertion - on the skin of the medial palm
Nerve - Deep branch of ulnar nerve (C8, T1)
Artery - Ulnar artery
Function - tenses the skin of the palm on the ulnar side during a grip action and deepens the hollow of the palm

Question 15

thenar eminence

Answer 15

Opponens Pollicis the largest of the 3 muscles
Origin - at the tubercle of the trapezium
Insertion - lateral margin of the metacarpal of the thumb
Nerve - recurrent branch of the median nerve
Artery - Superficial palmar arch from the radial artery
Function - performs opposition by flexing and medially rotating the metacarpal on the axis of the trapezium.
Abductor Pollicis Brevis positioned anteriorly to the opponens pollicis
Origin - tubercles of the scaphoid and trapezium
Insertion - lateral aspect of the proximal phalanx of the thumb
Nerve - recurrent branch of the median nerve
Artery - Superficial palmar arch from the radial artery
Function - primary muscle providing opposition. Also leads to abduction of the thumb which is drawing the thumb away from the midline
Flexor Pollicis Brevis
Origin - tubercle of the trapezium via the deep head, and the associated flexor retinaculum via the superficial head
Insertion - lateral aspect of the proximal phalanx of the thumb
Nerve - dual innervation with fibers from both the median ( superficial head) and ulnar ( deep head) nerves
Artery - branches of the radial artery; superficial palmar artery, branches of the princeps pollicis artery and radialis indicis artery
Function - flexion at the metacarpophalangeal and carpometacarpal joints leading to opposition of the thumb and, if continued, produces the medial rotation of thumb

Question 16

supine palpation

Answer 16

costosternal junctions
costochondral junction
anterior ribs

Question 17

anterior palpation of musculature

Answer 17

pec major
pec minor
subclavius
SCM
scalenes

Question 18

AROM

Answer 18

Seated flexion
Seated extension: hands behind head
Seated rotation: arms across chest or behind head
rotation in lumbar locked position (quadruped)
seated lateral flexion (hands across chest)

Question 19

MMT trunk flexion

Answer 19

hooklying position
perform abdominal curl with hands behind head- grade 5
hands across chest - grade 4
hands at side- grade 3

Question 20

MMT trunk rotation

Answer 20

hooklying position
perform abdominal curl and bring shoulder towards opposite side
grading as same as trunk flexion

Question 21

MMT trunk lateral flexion

Answer 21

sidelying
lift shoulders and trunk off table with hands behind head- grade 5
hands across chest -grade 4
hands at side- grade 3

Question 22

MMT trunk extension

Answer 22

prone
lift head and shoulder off table with hands behind head- grade 5
hands behind back- grade 4
hands at side- grade 3

Question 23

T1 dermatome

Answer 23

anteriormedial lateral forearm and arm to axilla

Question 24

T2 dermatome

Answer 24

medial arm to the axilla

Question 25

T4 dermatome

Answer 25

nipple line

Question 26

T6 dermatome

Answer 26

xiphoid process

Question 27

T 10 dermatome

Answer 27

umbilicus

Question 28

Superficial abdominal reflex

Answer 28

stroke from lateral to medial in each of the four quadrants following dermatomal pathways and using the hand end of a reflex hammer
may be absent in 15% of the population
difficult to elicit in patients that are anxious, elderly, or obese
reflexes will fatigue/diminish on repeated testing

Question 29

Adam’s forward bending test

Answer 29

scoliosis
Pt stands with feet togerher, put hand together, bends straight forward 
(+) rib hump and or visible curvature
indicates scoliosis
rib hump on the convex side

Question 30

Thoracic compression test

Answer 30

patient seated
apply axial load by pressing down on shoulders
(+) if reproduces pain
indicates discogenic pain or decreased foraminal space

Question 31

thoracic foraminal closure test

Answer 31

patient seated
passively flex to one side
apply axial load by pressing down on shoulders
(+) if reproduces pain
indicates decreased intervertebral foraminal space

Question 32

Anterior to posterior rib compression test

Answer 32

place hands on anterior and posterior rib cage and squeeze together
(+) pain or crepitus
indicates rib fracture

Question 33

Lateral rib compression test

Answer 33

place hands on the side of the rib cage and squeeze together
(+) pain or crepitus
indicates rib fracture or costochondrol seperation

Question 34

Postural conditions

Answer 34

scoliosis
hyperkyphosis
forward head posture
upper crossed syndrome

Question 35

rib pathologies

Answer 35

contusion
fracture
costrotransverse/costovertebral
costochondritis

Question 36

spinal pathologies

Answer 36

fracture

discogenic pain, stenosis, spondy, facet

Question 37

Muscular pathologies

Answer 37

strain

trigger point