Thoracic Orthopedics Flashcards
Which test is great to use before ordering films on a patient with scoliosis concerns?
Adams Position
How do we perform Adam’s Position?
Patient flexes forward at the waist with hands in a prayer position. Doctor observes for any change in scoliosis.
What is the purpose of Adam’s Position?
To determine of the patient has a structural or functional scoliosis. Perform this test if patient has a high shoulder or visible scoliosis while standing.
What are the findings of Adam’s Position?
If scoliosis disappears when patient flexes forward, it is a functional scoliosis
If scoliosis remains when the patient flexes forward, it is a structural scoliosis and x-ray is warranted.
How do we perform Amoss Sign?
Patient rises from a side-lying position to a sitting position. Doctor observes for signs of pain, and to see if patient uses upper body strength to assist in rising.
What is the purpose of Amoss Sign?
To see if there is pain, weakness, or decreased flexibility in the thoracics or thoraco-lumbar area.
Could indicate severe sprain, AS, or IVD syndrome
What are the findings of Amoss Sign?
Positive findings are if pain is elicited while rising and patient uses upper body strength to assist them while getting up
What is the best neurological test of the thoracic spine?
Beevor’s Sign
How do we perform Beevor’s Sign?
Doctor observes the umbilicus while the patient is lying supine and does an abdominal crunch followed by a leg lift
What is the purpose of Beevor’s Sign?
To see if the umbilicus deviates (it should not)
What are positive findings of Beevor’s Sign?
Umbilicus will deviate to opposite direction of abdominal weakness.
DDx: Tumor, cord lesion, cortical problem
How do we perform Chest Expansion Test?
Doctor wraps tape measure around patient’s chest (at 4th intercostal space), then asks patient to inhale and exhale maximally
What is the purpose of Chest Expansion test?
Looking for normal chest expansion, which is 1.5-3 inches
What is the purpose of Forestier Bowstring Test?
Looking for unequal ROM from side to side
How do we perform Forestier Bowstring Test?
Doctor observes ROM while patient laterally bends side to side
What are positive findings for Forestier Bowstring?
Muscle Spasm
AS
Pain inhibiting motion
Stacking
What is the procedure for Rib Motion Test?
Doctor places both hands on patient’s chest at sternocostal angle while patient is supine. Doctor observes for movement of ribs as patient inhales/exhales
What are positive findings for Rib Motion Test?
- If a rib stops moving during expiration, there is an elevated rib
- If a rib stops moving during inhalation, there is a depressed rib
These could be due to: Subluxation Muscle Strain Fracture Arthritis Pleuritis
What is the procedure for Schepelmann’s Sign?
Patient is seated with arms extended over their head, then pt laterally flexes to the left and right.
What is the purpose for Schepelmann’s Sign?
To note any intercostal pain
What are positive findings for Schepelmann’s Sign?
If there is pain on the CONCAVE side, there is neuralgia (compression of intercostal nerve)
If there is pain on the CONVEX side, there is myalgia or myofascitis (stretching of muscle/fascia)
