- Position: Remove all clothing to waist. Sit on an exam table or stand.
- Inspection: Slope of Ribs - normally ribs are inserted into the spine at a 45E angle and inserted into the costal angle at a 45E angle.
- Palpation: Respiratory Excursion. (Thoracic expansion) Can be assessed in anterior or posterior chest. ...
- Percussion: Percussion penetrates to a depth of approximately 5-7 cm. It is used to determine the relative amounts of air, liquid, or solid material in the underlying lung.
- Auscultation: Presence of Adventitious Breath Sounds. Instruct client to breathe slightly more deeply and slowly than normal respiration.
How do you assess thoracic expansion in a chest xray?
(Thoracic expansion) Can be assessed in anterior or posterior chest. Tactile Fremitus (vocal fremitus) - client says "99" while examiner palpates the thorax using palmar surface of fingers or ulnar aspect of hand.
How do you assess thoracic thoracolumbar motion?
Assess for baseline symptoms including intensity and location prior to testing. Ensure the motion is purely thoracic by ensuring the patient is not compensating with lumbar and pelvis movement. Repeated motion may be performed to assess for centralization of symptoms or a directional preference.
How to assess thoracic expansion and tracheal deviation?
(Thoracic expansion) Can be assessed in anterior or posterior chest. Tactile Fremitus (vocal fremitus) - client says "99" while examiner palpates the thorax using palmar surface of fingers or ulnar aspect of hand. Palpate for Tracheal Deviation.
What should I look for in a thoracic assessment?
One of the key things to observe in a thoracic assessment is whether or not your subject has the normal thoracic curve. Many therapists are quick to spot kyphotic postures, and it is equally important to assess for a flat back. A flattened thoracic curve can contribute to localized pain.
How do you test for thoracic expansion?
0:011:28Chest Expansion Technique - YouTubeYouTubeStart of suggested clipEnd of suggested clipYou ask them to take a deep breath in and out. And you're looking for the movement with both fingersMoreYou ask them to take a deep breath in and out. And you're looking for the movement with both fingers. And they should move equally apart.
How do you assess thoracic cage?
PALPATION: Expose the patient's thorax providing for as much comfort and privacy as possible. Use the fingertips and flat of the hand in order to palpate the thorax. Use firm but gentle pressure to assess the breathing and movements of the thorax.
What order of assessment techniques would you use when assessing the lungs and thorax?
Thorough evaluation of the thorax and lungs is an essential component of a complete physical examination. The traditional systematic approach involves inspection, followed by palpation, percussion and then auscultation of both the anterior, lateral, and posterior thorax.
What is thoracic extension?
Thoracic extension is the ability for the t-spine to move from its normally kyphotic or forward rounded position to a flat or event arched back position. Lack of thoracic extension is one of the most common mobility restrictions we see.
What assessment is used to assess lungs?
Percussion is used to assess the density of the lungs. It is also used to assess the air in the lungs. Percussion of the thorax is another one of those assessment tools you will probably only see in the lab.
How do you perform a respiratory assessment?
Observe the patient for important respiratory clues:Check the rate of respiration.Look for abnormalities in the shape of the patient's chest.Ask about shortness of breath and watch for signs of labored breathing.Check the patient's pulse and blood pressure.Assess oxygen saturation.
What technique is correct when assessing the respiratory system?
Auscultation. Using the diaphragm of the stethoscope, listen to the movement of air through the airways during inspiration and expiration. Instruct the patient to take deep breaths through their mouth. Listen through the entire respiratory cycle because different sounds may be heard on inspiration and expiration.
Where is the thoracic column?
The thoracic column is joined to the neck at C7/T1, where the first thoracic vertebra (T1) joins the seventh thoracic vertebra (C7). The junction of the thoracic column and the lumbar spine is at T12/L1, where the 12th thoracic vertebra (T12) joins the first lumbar vertebra (L1).
How to measure scoliosis?
A simple method for measuring the degree of scoliosis is to place markers on various bony landmarks, using photographs taken before and after your intervention, and examine the markers to determine to what extent your intervention has affected the scoliotic posture of your subject. 1.
Why is my scapula tilting?
This may be due to a congenital abnormality or may be the result of injury to the long thoracic nerve. Weakness in trapezius and rhomboids can also contribute to scapular instability. Shortening of pectoralis minor could tilt the scapula anteriorly, making the inferior angle more prominent.
How to locate L4?
Locating L4. With your hands on the iliac crest, extend your thumbs and try to get your thumb tips to touch. Your thumb tips are pointing toward L4. Some people have an extra lumbar vertebra, in which case this assessment will be inaccurate, but for the general population this is a crude but useful way to locate L4.
What is the disadvantage of palpating through the thoracolumbar fascia?
The disadvantage of this method is that you are palpating through the thoracolumbar fascia and active erector spinae muscles. Also, when standing , your subject will have a tendency to lean back toward you in order to maintain balance as you palpate and this will further increase the tone in their muscles.
How to tell if a person has a scapula?
One quick way to identify the scapula is simply to ask your subject to place their hand behind their back. In doing so, the medial border and inferior angle of this bone become more prominent. Remember, however, as soon as your subject lowers their arm, the scapula position will change and become less prominent again. So use the test to identify the scapula but not to record its resting position.
Can a hypermobile thoracic spine cause pain?
Being able to assess whether a client has a hypomobile or hypermobile thoracic spine is useful as increased or decreased mobility in this part of the spine can cause or contribute to pain. However, unlike the cervical region of the spine, it can be difficult to accurately assess range of movement (ROM) in the thorax.
What is the setting for chest examination?
The setting for the chest examination must be environmentally comfortable for both clinician and patient. The physical examination begins with the commencement of history taking. The examiner extends a hand in greeting, asks about the symptoms that initiated the visit, and begins physical inspection, noting body position, ...
Why does the scalenus increase the diameter of the chest?
This increase is due to elevation of the ribs, contraction of the scalene and intercostal muscles, and descent of the diaphragm. Because of the structure of the ribs, the scalenus muscles elevate the first rib and the sternum anteriorly. This causes slight increase in the anteroposterior (A–P) diameter of the chest.
What is the physical examination of pulmonary artery?
The pulmonary examination consists of inspection, palpation, percussion, and auscultation. The inspection process initiates and continues throughout the patient encounter.
Anterior Chest
Expansion of the chest is tested with the palms of your hands resting symmetrically, first superiorly, then on the middle and finally on the lower chest, wall with the thumbs pointing towards the midline ( figure 17a–c ). This is to pick up possible asymmetry of expansion; this is highly suggestive of underlying pulmonary disease.
Posterior Chest
When examining the back of the chest, sit the patient upright, on a chair or a bed, so that you can sit or stand behind them ( figure 25 ). The procedure follows the same order described above: inspection, palpation, percussion and auscultation, using identical techniques. Again examine equivalent sites on the two sides consecutively.
Introduction
Initial Diagnosis
Functional Anatomy
- The function of the thoracic spine and ribcageis the: 1. protection of the heart, lungsand viscera, ventilation of the lungs 2. provide a stable base for the attachment of muscles of the upper limbs, head and neck, vertebral column and the pelvis. (at the expense of mobility). 1. The thoracic spine: 1. lies between the superior cervical spine and the inferior lumbar spine. It 2. consists of 12 vert…
Subjective Assessment
- Special Questions
Special questions are used to identify precautions or absolute contraindications to examination or treatment 1. General health 2. Weight loss 3. RA 4. Drug therapy 5. X-rays and medical imaging 6. Neurological symptoms - History of Present Condition
1. Known or unknown cause 2. Sudden/slow onset 3. How long ago did symptoms start 4. Route to physiotherapy
Objective Examination
- Observation
This should occur from in front, behind and from the side in sitting and standing 1. The examiners observe the patient’s thoracic spine region and assess for the presence of deviation from normal including the thoracic spine curvatures in the frontal and sagittal planes. 2. The overall impressi… - Movement Patterns
The examiner can ask the patient to perform the following movements to check for any change symptoms; looking up, transferring from sit to stand, lifting one or both arms overhead, and any other movements that aggravate or relieve symptoms. While the patient performs these movem…
Outcome Measures
- There are no validated region specific outcome tools for the thoracic spine, the following are recommended but require validation for use with patients with primary thoracic disorders: 1. Neck Disability Index(NDI) for upper thoracic complaints 2. Occiput to Wall Distance 3. Oswestry Disability Index(ODI) for lower thoracic complaints 4. Numeric Pain Rating Scale(NPRS) where p…
Conclusion
- Pain in the upper part of their back (the thoracic spine) is a common complaint. 1. This is sometimes present in the thorax alone 2. Often accompanied by symptoms in the neck or lumbar spine. 3. Symptoms range from feelings of stiffness to burning muscular pain, pain often associated with the retention of static postures. 4. Assessment of the region which links the cer…