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