Thoracic Spine and Rib Cage Flashcards
Thoracic Spine and Rib Cage
Physical Examination - Observation
Observation:
- Swelling
- Muscle Spasm
- Posture and postural asymmetry
- Scapula
- Skin Changes
- Deformity
- Respiratory Movements
- Scarring
- Chest Deformity
Thoracic Spine and Rib Cage
Palpation
- Vertebrae
- Scapula
- Ribs
- Sternum
- Manubrioum
- Xiphoid Process
- Intercostal Muscles
- Paravertebral Muscles
- Diaphragm
- Chest Expansion
- Facet Joints
- Costotransverse Joints
- Costochondral Joints
- Sternocostal Joints
- Sternoclavicular Joints
Thoracic Spine
Active Range of Motion
- Flexion (20-45)
- Extension (25-45)
- Lateral Flexion (20-40)
- Rotation (35-50)
Rib Motion Test
Purpose:
- To assess for normal rib cage movement
Procedure:
- Pt is supine and practitioner stands adjacent and places hands on the pts ribs and gets them to take a few slow breathes in and out
- Performed on the upper, middle and lower ribs
- Note the type and quality of motion
Positive:
- Upper ribs - pump hand motion
- Lower and middle ribs - bucket handle motion
- Floating ribs - pincer motion
- Abnormal, asymmetrical or inadequate movement of the ribs bilaterally or unilaterally
Indication of a Positive:
- Any condition, disease, syndrome that may affect the normal movement of the ribs or rib cage
Costovertebral Expansion Test
Purpose:
- Assess for normal chest expansion
Procedure:
- Pt is sitting and practitioner is behind
- Wrap a tape measure around the pt and ensure it is not twisted
- Pt is to then expire and measure chest
- Then ask to take a deep breath and measure chest
- Note the two measurements
- The test is performed at the axially line, 4th intercoastal space, nipple line and tenth rib
Postive:
- Nornal chest expansion for male >5cm
- Normal chest expansion for female is >3cm
Indication of Positive:
- Abnormal Chest Expansion
- Ankylosing Spondylitis
- Tight chest wall musculature
- Costovertebral, costotransverse or costochondral joint condition
- other chest expansion limiting conditions
Note:
- Commonly used as a tag test
Thoracic Spine
Intersegmental Motion
Upper and Lower Thoracic Spine
- Flexion
- Extension
- Lateral Flexion
- Rotation
Information is derived from joint play movements.
Pt must be sitting during this assessment
Ribs
Intersegmental Motion
Feel motion of ribs in rleation to the TVP by placing thumb medial to the rib angle and thumb on the TVP and ask the patient to move torso.
- Flexion
- Extension
- Rotation
You can assess lateral flexion by placing in the intercostal space and laterallyt flexing on the homolateral side.
Pt to be seated
Resisted Isometric Movements
Thoracic Spine
Resisted Isometric Movements:
- Flexion
- Extension
- Lateral Flexion
- Rotation
Performed in a neural seated position
Hold for 5 seconds and do both sides before grading 0-5
