Thoracic Spine and Ribs

Question 1

AROM Thoracic Spine

Answer 1

• Flexion (20°- 45°)
• Extension (25°- 45°)
• Lateral flexion (20°- 40°)
• Rotation (35°-50°)

Question 2

Rib Motion Test

Answer 2

Purpose:

• To assess for the normal movement of the rib cage

Procedure:

• The patient is supine
• The practitioner stands adjacent to the patient
• The practitioner places their hands over the ribs that they wish to assess and asks the patient to take several, slow in-breaths and out-breaths
• The procedure is performed on the upper, middle, and lower ribs
• The practitioner takes note of the type and quality of the motion

Positive:

• The normal movement for the upper ribs is a pump handle motion
• The normal motion of the lower and middle ribs is described as a bucket handle motion
• The normal motion of the floating ribs is described as a 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/rib cage

Question 3

Costovertebral Explansion Test

Answer 3

Purpose:

• To asses the normal expansion of the chest

Procedure:

• Patient is sitting
• The practitioner stands behind the patient
• The practitioner carefully wraps a tap measure around the patient making sure that the tape measure is parallel to the examination table and not twisted
• The practitioner asks the patient to first fully expire and hold it while the practitioner measures the chest circumference
• The patient is then instructed to take a full breath in and hold it as the practitioner again measures the chest circumference
• The practitioner notes the difference between the two measurements
• The test is performed at four points:
  
  • Axillary line
  • Fourth intercostalspace
  • Nipple line
  • Tenth rib

Positive:

• Normal chest expansion for men is ≥ 5cm
• Normal chest expansion for women is ≥ 3cm

Indication of a Positive:

• Abnormal chest expansion
• Ankylosing Spondylitis
• Tight chest wall musculature
• Costovertebral, costotransverse, costochondral joint conditions
• Other conditions that may limit chest expansion

Note:

• This test is used most commonly as a tag test

Question 4

Intersegmental Motion: Thoracic Spine

Answer 4

Upper Thoracic Spine:

• Flexion – Extension – Lateral Flexion – Rotation

Lower Thoracic Spine:

• Flexion – Extension – Lateral Flexion – Rotation

Note:

• The patient is seated for the intersegmental motion assessment
• Different coupling patterns between the upper and lower thoracic spine

Question 5

Intersegmental Motion: Ribs

Answer 5

The practitioner may also assess the movement of the ribs (1 – 10) relative to the transverse processes of the thoracic vertebrae by placing a thumb just medial to the rib angle and a thumb on the TVP and then asking the patient move their torso:

• Flexion – Extension – Rotation

For the assessment of lateral flexion the practitioner places their fingers in the intercostal spaces at the lateral thorax and asks the patient laterally flex to the homolateral side:

• The intercostal spaces should close down evenly on the side of lateral flexion
• The patient is seated for the intersegmental motion assessment