Thoracic Orthopedics

Question 1

Which test is great to use before ordering films on a patient with scoliosis concerns?

Answer 1

Adams Position

Question 2

How do we perform Adam’s Position?

Answer 2

Patient flexes forward at the waist with hands in a prayer position. Doctor observes for any change in scoliosis.

Question 3

What is the purpose of Adam’s Position?

Answer 3

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.

Question 4

What are the findings of Adam’s Position?

Answer 4

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.

Question 5

How do we perform Amoss Sign?

Answer 5

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.

Question 6

What is the purpose of Amoss Sign?

Answer 6

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

Question 7

What are the findings of Amoss Sign?

Answer 7

Positive findings are if pain is elicited while rising and patient uses upper body strength to assist them while getting up

Question 8

What is the best neurological test of the thoracic spine?

Answer 8

Beevor’s Sign

Question 9

How do we perform Beevor’s Sign?

Answer 9

Doctor observes the umbilicus while the patient is lying supine and does an abdominal crunch followed by a leg lift

Question 10

What is the purpose of Beevor’s Sign?

Answer 10

To see if the umbilicus deviates (it should not)

Question 11

What are positive findings of Beevor’s Sign?

Answer 11

Umbilicus will deviate to opposite direction of abdominal weakness.

DDx: Tumor, cord lesion, cortical problem

Question 12

How do we perform Chest Expansion Test?

Answer 12

Doctor wraps tape measure around patient’s chest (at 4th intercostal space), then asks patient to inhale and exhale maximally

Question 13

What is the purpose of Chest Expansion test?

Answer 13

Looking for normal chest expansion, which is 1.5-3 inches

Question 14

What is the purpose of Forestier Bowstring Test?

Answer 14

Looking for unequal ROM from side to side

Question 15

How do we perform Forestier Bowstring Test?

Answer 15

Doctor observes ROM while patient laterally bends side to side

Question 16

What are positive findings for Forestier Bowstring?

Answer 16

Muscle Spasm
AS
Pain inhibiting motion
Stacking

Question 17

What is the procedure for Rib Motion Test?

Answer 17

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

Question 18

What are positive findings for Rib Motion Test?

Answer 18

• 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

Question 19

What is the procedure for Schepelmann’s Sign?

Answer 19

Patient is seated with arms extended over their head, then pt laterally flexes to the left and right.

Question 20

What is the purpose for Schepelmann’s Sign?

Answer 20

To note any intercostal pain

Question 21

What are positive findings for Schepelmann’s Sign?

Answer 21

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)