Thoracic Spine Exam and Interventions

Question 1

ruling out tests

Answer 1

• percussion tests - fractures
• wright test - thoracic outlet syndrome
• adam’s forward flexion test - scoliosis

Question 2

How do you perform the wright test?

Answer 2

• palpate the radial pulse
• abduct shoulder 90 deg and flex elbows 90 deg
• rotate neck contralateral
• hold position 1-2 minutes

+ if reproduce paresthesia or a decrease in radial pulse
- thoracic outlet syndrome

Question 3

confirming tests for thoracic outlet syndrome

Answer 3

• Roo’s test
• Hyperabduction test
• Adson’s test

Question 4

confirming tests for restricted 1st rib

Answer 4

• cervical rotation lateral flexion test
• 1st rib spring test

Question 5

confirming test for disc/sympathetic nervous system

Answer 5

thoracic slump test

Question 6

How to perform Roo’s test?

Answer 6

• ER shoulders 90 deg w/ elbows flexed 90 deg
• rapidly open and close hands for 1 min

+ test is a reproduction of symptoms
- thoracic outlet

Question 7

How to perform hyperabduction test?

Answer 7

• palpate the radial pulse
• abduct shoulders 90 deg and fully ER shoulders w/ elbows flexed 90 deg
• hold for 1 minute

+ test is a change in radial pulse and patient report of paresthesia
- thoracic outlet

Question 8

How to perform Adson’s test?

Answer 8

• pt sitting w/ shoulders at ~15 deg of abduction
• palpate radial pulse
• pt inhales deeply and holds breath while tilting head back and rotate neck toward symptomatic side

+ test is a change in radial pulse and report of paresthesia
- thoracic outlet

Question 9

How to perform cervical rotation lateral flexion test?

Answer 9

• passively rotate neck away from affected side
• passively laterally flexed toward the chest

+ test os a bony restriction that blocks lateral flexion
- thoracic outlet/restricted 1st rib

Question 10

How to perform 1st rib spring test?

Answer 10

• passively rotate head toward the assessed rib
• mobilizing hand placed posterior to 1st rib
• caudal/ventral force applied to the rib
• opposite side is assessed

+ test is the rib is “stiff” compared to the contralateral side
- thoracic outlet/restricted 1st rib

Question 11

How to perform thoracic slump test?

Answer 11

• pt long sitting w/ knees flexed ~45 deg and hands placed behind back
• assess resting symptoms
• place caudal load through shoulders
• exaggerated forward head posture
• passively flex thoracic spine and/or rotated ipsilateral
• LE on symptomatic side is straightened and ankle DF

+ test if symptoms produced, asymmetry, and sensitization
- disc/sympathetic nervous system test