Thoracic Tests Flashcards
Checks for nerve pathology T7-T10 above the umbilicus, and T11-L1 below the umbilicus, checks for the nerve innervation to the rectus abdominus
Beevor’s Sign
Beevor’s Sign: Procedure
The patient is supine. (This is an active procedure for the patient). Examiner instructs the patient to perform a partial sit-up, while the examiner observes umbilical movement.
Beevor’s Sign: Pathomechanics
Nerve pathology causes muscle weakness. And therefore the umbilicus can move away from the weak muscle or toward the strong muscle.
Beevor’s Sign: Indications
If the umbilicus moves straight superior, then there is bilateral inferior rectus muscle weakness. If it is painless then it is T11-L1, Intercostal, or nerve root pathology bilaterally. Straight inferior movement of the umbilicus indicates superior rectus weakness, indicating T7-T10 nerve root, or intercostals nerve pathology. If the movement is superior and to the right, there is a weak, left inferior rectus abdominus, or indicating a left T11-L1 intercostal or nerve root. Movement superior and to the left indicates right inferior rectus abdominus weakness, right T11-L1 pathology. Movement inferior and to the right indicates a left upper weak rectus abdominus, T7-T10 left nerve pathology. Movement inferior and to the left indicates weak right superior rectus abdominus and right T7-T10 nerve pathology.
Assesses for lateral curves (scoliosis), assesses for a functional versus a structural scoliosis.
Adam’s Sign (AKA Adam’s Position)
Adam’s Sign: Procedure
The examiner stands behind the patient. Patient stands with their back exposed. Doctor looks for spinal curves or posterior rotation (posteriority of one side of the back indicating spinal rotation). Patient bends over at the waist as if to touch their toes, hands should be held together. Observe to see if the curve or posteriority disappears or stays
Adam’s Sign: Pathomechanics
In a functional scoliosis, the curve will disappear, or the posteriority flattens back down. Structural, the curve and posteriority will remain.
Adam’s Sign: Indications
A functional scoliosis is a negative test; a structural scoliosis is a positive test
Assesses for rib fracture, although if you strongly suspect a rib fracture, do not perform this test, and instead x-ray the patient.
Sternal Compression Test
Sternal Compression Test: Procedure
Patient is supine. Place the knife-edge of your hand on the sternum and other hand on top, and compress the sternum. On female patient’s place the hands over the sternum then compress
Sternal Compression Test: Pathomechanics
This will compress the ribs and make them bow. Torn periosteum will make the patient’s pain worse
Sternal Compression Test: Indications
Local, moderate to severe, stabbing like pain along the rib, indicates fracture.
Assesses for intercostals neuralgia/neuritis, intercostal myalgia/myositis, and may assess for pleuritis.
Schepelmann’s Sign
Schepelmann’s Sign: Procedure
Patient puts their hands over their heads, and lateral flex to one side and then to the other
Schepelmann’s Sign: Pathomechanics
On the side of lateral flexion, you compress the intercostal nerve. On the side away from lateral flexion, you stretch the intercostal muscles and the pleural
Schepelmann’s Sign: Indications
On the side of lateral flexion, symptoms could indicate neuritis/neuralgia. On the contralateral side, superficial symptoms could indication myalgia/myositis, and deep symptoms could indicate pleuritis
Tests for rib ankylosis
Chest Expansion
Chest Expansion: Procedure
Need a tape measure. The patient will stand and the examiner will stand behind the patient. Place the tape measure around the patient’s chest at approximately the level of T4 (nipple line). Have the patient take a deep breath in and force the breath out. Take a measurement. Have the patient force the air back in again, and remeasure.
Chest Expansion: Pathomechanics
Without lung pathology, decreased chest expansion can indicate a problem with the joints of the spine or the costal-vertebral or costal-transverse.
Chest Expansion: Indications
Normal expansion is 1.5 to 3 inches decrease indicates thoracic ankylosis
Checks for ankylosis of the vertebral bodies, particularly seen in-patients with early Ankylosing Spondylitis (Marie Strumpel’s Disease and maybe seen in patients with DISH Diffuse Idiopathic Skeletal Hyperostosis, also known as Forestier’s Disease)
Forestier’s Bowstring Sign
Forestier’s Bowstring Sign: Procedure
Observe the patient’s back while they lateral flex
Forestier’s Bowstring Sign: Pathomechanics
In thoracic ankylosis, the concave side of the spine shows a palpable hypertonicity of the muscles, this is opposite the normal patient (this finding is not well understood).
Forestier’s Bowstring Sign: Indications
In lateral flexion, a finding of palpable muscle hypertonicity, indicate spinal ankylosis (Ankylosing Spondylitis)
