BMS150 Student Version Practical Lab Manual Week 3.pdf

Thoracic Spine Assessment *What follows is key observations, anatomy palpation, ranges of motion, & special orthopaedic tests* OBSERVE (patients posture seated and standing) • Pectus excavatum (funnel chest) • Pectus carinatum (pigeon chest) • Barrel chest Side view • Anterior/posterior diameter of...

Thoracic Spine Assessment *What follows is key observations, anatomy palpation, ranges of motion, & special orthopaedic tests* OBSERVE (patients posture seated and standing) • Pectus excavatum (funnel chest) • Pectus carinatum (pigeon chest) • Barrel chest Side view • Anterior/posterior diameter of chest • Are shoulders anteriorly rotated? • Kyphosis, Lordosis, scoliosis, other Posterior view • Curvatures of the spine (Scoliosis) • Symmetry from one side of the spine to the other • medial edge of spine of scapula should be at the T3 level • inferior angle is in the T7 usually • medial border of scapula should be about 5cm from spine • Asymmetry of musculature • Rib cage • Note differences in space between the ribs • Assess motion of the ribs during inhale and exhale Palpation Bony Palpation • Anterior aspect o Clavicle o Sternum o Sternocostal Joints o Ribs 11 & 12 • Posterior aspect o Scapula (Spine, Medial Border, Inferior Border) o AC Joint o SP of the thoracic vertebrae (T1-12) o Facet joints/TVP’s o Ribs Soft tissue palpation • Anterior o Pec Major and Minor Attachments o Supraclavicular fossa • Posterior o Trapezius Muscle o Paraspinals o Levator Scapulae o o o o Rhomboids Latissimus Dorsi Rotators (Supraspinatus, Infraspinatus, Teres Minor) Teres Major Ranges of Motion of Thoracic Cage Active ROM (AROM) - Patient copies movement of practitioner or is told to move in particular direction Movements should be done in an order such that expected painful ones are done last and no residual pain is carried over from the previous movement. If very acute, some movements may be left out to avoid exacerbation of symptoms. • Flexion = 20 - 45 degrees • Patient Seated or standing • Have them reach for their toes • Extension = 25 - 45 degrees • Patient seated or standing • Place hand at small of back to add stability • Extension should be straight and even with no side bending or rotation • Side bending = 20 - 40 degrees • Patient standing will slide hand down side of the leg • Patient seated will laterally bend • Rotation = 35 - 50 degrees • Seated to avoid hip movement • cross arms over shoulders and rotate Passive ROM • Patient seated • Examiner applies an over pressure to the end of each active ROM to assess end feel Resisted ROM • Patients is seated and in neutral • Examiner resists all of the thoracic spine AROM • Assess for weakness Special Test (Orthopaedic Testing) Scapular protraction (winging) • Patient pushes against a wall with both hands with the feet farther away from the wall then the shoulders • Positive = scapular winging, pain and weakness during maneuver • Indicates = Serratus anterior muscle weakness, long thoracic n. dysfunction, lower trapezius dysfunction Elevated Arm Stress Test (ROOS) • Patient externally rotates the shoulders with the elbows slightly behind the head • Patient opens and closes her hands slowly for 3 minutes • Positive = pain, heaviness, or profound arm weakness or numbness and tingling of the hand • Indicates = Thoracic outlet syndrome Costoclavicular test • Examiner monitors patients radial pulse • Examiner draws the patients shoulder down and back as the patient assumes a "military" posture • Positive = disappearance or diminution of the pulse, or if symptoms are elicited • Indicates = thoracic outlet syndrome, usually subclavian artery being compressed b/t the 1st rib and the clavicle Wright’s Hyperabduction test • Examiner monitors radial pulse • Examiner then elevates patients arm up to 180 degrees • Positive = diminishment of the pulse or provocation of the symptoms • Indicates = thoracic outlet syndrome, usually due to compression of subclavian artery and brachial plexus behind the pectoral muscle and under the coracoid process Adson's test (Picture Shown) • Examiner abducts the patients arm and palpates the radial pulse • Patient is instructed to turn his head toward the affected side, extend the neck, and take a deep inhalation • Positive = disappearance or diminution of the pulse or provocation of symptoms • Indicates = thoracic outlet syndrome, usually related to tight scalene musculature Halstead’s (REVERSE ADSON’S) - (No Picture) • Examiner abducts the patients arm and palpates the radial pulse • Patient is instructed to turn his head AWAY from the affected side, extend the neck, and take a deep inhalation • Positive = disappearance or diminution of the pulse or provocation of symptoms • Indicates = thoracic outlet syndrome, usually related to tight scalene musculature Adam’s Sign • The purpose of the Adam’s forward bend test is detecting structural or functional scoliosis • The patient takes off his/her t-shirt so that the spine is visible. The patient needs to bend forward, starting at the waist until the back comes in the horizontal plane, with the feet together, arms hanging and the knees in extension. The palms are hold together. • The examiner stands at the back of the patient and looks along the horizontal plane of the spine, searching for abnormalities of the spinal curve, like increased or decreased lordosis/ kyphosis, and an asymmetry of the trunk. • Positive = Functional if curve disappears upon bending • Positive = Structural if curve does not disappear upon bending Dural Slump Test • This should be done in 3 stages, each of which is increasingly provocative. If symptoms are produced, one does not need to progress to the next stage. • Stage 1 = Patient is seated and asked to SLUMP. The patient flexes their thoracic spine and shoulders sag forward, all while the examiner holds the chin and head erect • Stage 2 = Examiner passively flexes the patient’s neck while patient is maintaining stage 1 position • Stage 3 = Examiner passively extends one of the patients knees • Stage 4 = Examiner passively dorsiflexes extended leg • Stage 5 = Repeat with other leg at start at stage 3 • Positive = Sciatic Pain or a reproduction of patient’s symptoms • Indicates = Impingement of the dura and spinal cord or nerve roots Passive Scapular Approximation ( NO PICTURE PROVIDED) • The patient lies prone • The examiner passively approximates the scapulae by lifting the shoulders up and back • Positive = Pain in the scapular area • Indicates = T1 or T2 Nerve root problem on the side of the pain