Thoracic Spine Physical Examination

Thoracic Spine Physical Examination

Inspection

• Observe the patient's posture, noting any asymmetries or deviations from normal
• Check for any signs of scoliosis, kyphosis, or lordosis
• Inspect the skin for any lesions, scars, or areas of inflammation

Palpation

• Palpate the thoracic spine, noting any areas of tenderness or pain
• Use the pads of the fingers to apply gentle pressure to the spinous processes and transverse processes
• Palpate the costovertebral joints and the sternum

Range of Motion

• Active range of motion:
  • Have the patient perform flexion, extension, rotation, and lateral flexion
  • Note any limitations or pain with movement
• Passive range of motion:
  • Use gentle overpressure to assess for any limitations or pain

Muscle Strength

• Test the strength of the muscles that affect the thoracic spine, including:
  • Latissimus dorsi
  • Rhomboids
  • Trapezius
  • Levator scapulae
  • Serratus anterior

Special Tests

• Thoracic Rotation Test: measures rotation of the thoracic spine
  • Have the patient sit with their arms at their sides
  • Use a goniometer to measure the angle of rotation
• Chest Expansion Test: measures thoracic mobility
  • Have the patient stand with their arms at their sides
  • Measure the circumference of the chest at the axillary line
  • Have the patient take a deep breath and measure the circumference again
• Schober Test: measures thoracic flexion
  • Have the patient stand with their arms at their sides
  • Mark the spinous process of T12 and the level of the posterior superior iliac spine
  • Have the patient flex forward and measure the distance between the marks

Thoracic Spine Physical Examination

Inspection

• Observe patient's posture for asymmetries, deviations, scoliosis, kyphosis, or lordosis
• Inspect skin for lesions, scars, or areas of inflammation

Palpation

• Palpate thoracic spine for tenderness or pain
• Apply gentle pressure to spinous processes, transverse processes, costovertebral joints, and sternum

Range of Motion

• Assess active range of motion for flexion, extension, rotation, and lateral flexion
• Note limitations or pain with movement
• Assess passive range of motion with gentle overpressure

Muscle Strength

• Test strength of muscles affecting thoracic spine, including latissimus dorsi, rhomboids, trapezius, levator scapulae, and serratus anterior

Special Tests

Thoracic Rotation Test

• Measure rotation of thoracic spine with patient sitting and arms at sides
• Use goniometer to measure angle of rotation

Chest Expansion Test

• Measure thoracic mobility by measuring chest circumference at axillary line
• Measure before and after deep breath to assess expansion

Schober Test

• Measure thoracic flexion by marking spinous process of T12 and posterior superior iliac spine
• Measure distance between marks before and after flexion to assess range of motion

This quiz covers the steps involved in physically examining the thoracic spine, including inspection and palpation techniques. It assesses knowledge of how to identify signs of spinal deformities, lesions, and areas of tenderness or pain.