Thoracic Tests

Question 1

Checks for nerve pathology T7-T10 above the umbilicus, and T11-L1 below the umbilicus, checks for the nerve innervation to the rectus abdominus

Answer 1

Beevor’s Sign

Question 2

Beevor’s Sign: Procedure

Answer 2

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.

Question 3

Beevor’s Sign: Pathomechanics

Answer 3

Nerve pathology causes muscle weakness. And therefore the umbilicus can move away from the weak muscle or toward the strong muscle.

Question 4

Beevor’s Sign: Indications

Answer 4

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.

Question 5

Assesses for lateral curves (scoliosis), assesses for a functional versus a structural scoliosis.

Answer 5

Adam’s Sign (AKA Adam’s Position)

Question 6

Adam’s Sign: Procedure

Answer 6

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

Question 7

Adam’s Sign: Pathomechanics

Answer 7

In a functional scoliosis, the curve will disappear, or the posteriority flattens back down. Structural, the curve and posteriority will remain.

Question 8

Adam’s Sign: Indications

Answer 8

A functional scoliosis is a negative test; a structural scoliosis is a positive test

Question 9

Assesses for rib fracture, although if you strongly suspect a rib fracture, do not perform this test, and instead x-ray the patient.

Answer 9

Sternal Compression Test

Question 10

Sternal Compression Test: Procedure

Answer 10

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

Question 11

Sternal Compression Test: Pathomechanics

Answer 11

This will compress the ribs and make them bow. Torn periosteum will make the patient’s pain worse

Question 12

Sternal Compression Test: Indications

Answer 12

Local, moderate to severe, stabbing like pain along the rib, indicates fracture.

Question 13

Assesses for intercostals neuralgia/neuritis, intercostal myalgia/myositis, and may assess for pleuritis.

Answer 13

Schepelmann’s Sign

Question 14

Schepelmann’s Sign: Procedure

Answer 14

Patient puts their hands over their heads, and lateral flex to one side and then to the other

Question 15

Schepelmann’s Sign: Pathomechanics

Answer 15

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

Question 16

Schepelmann’s Sign: Indications

Answer 16

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

Question 17

Tests for rib ankylosis

Answer 17

Chest Expansion

Question 18

Chest Expansion: Procedure

Answer 18

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.

Question 19

Chest Expansion: Pathomechanics

Answer 19

Without lung pathology, decreased chest expansion can indicate a problem with the joints of the spine or the costal-vertebral or costal-transverse.

Question 20

Chest Expansion: Indications

Answer 20

Normal expansion is 1.5 to 3 inches decrease indicates thoracic ankylosis

Question 21

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)

Answer 21

Forestier’s Bowstring Sign

Question 22

Forestier’s Bowstring Sign: Procedure

Answer 22

Observe the patient’s back while they lateral flex

Question 23

Forestier’s Bowstring Sign: Pathomechanics

Answer 23

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).

Question 24

Forestier’s Bowstring Sign: Indications

Answer 24

In lateral flexion, a finding of palpable muscle hypertonicity, indicate spinal ankylosis (Ankylosing Spondylitis)