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Thoracic Spine Examination
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Thoracic Spine
Observation
- Carriage of head and shoulders
- Muscle bulk symmetry
- Scolosis/Kyphosis
- Flat spots
- Axillary creases
- From side
- From front
Surface landmarks
- Medial spines scapulae T3
- Inferior angle scapulae T7
- 12th rib T10
- Ribs 1 to 12 posterior angles and attachments
- in front
- 7th and 9th costal cartilages
- Trapezius
- Levator scapulae
- Rhomboids
- Lateral border scapula and muscle attachments
- Supraspinatus
- Infraspinatus
Active movements
- Flexion
- Extension
- Sidebending
- Rotation
Passive movements
(Gross and segmental)
- Flexion
- Extension
- Sidebending
- Rotation
Segmental Pain
- Skin drag
- Skin rolling
- Vertebral springing
- Zones of irritation supra sp lig
- Spinous processes
- PA palpation
- Transverse palpation
- Transverse processes
- Provocation test
Neurological Exam
- Observe for abdominal wall bulging as a sign of motor weakness
- Sensation over cutaneous segments, the intercostal nerves follow from the angle that the ribs form. Epigastrium is T6. Umbilicus is T10
- Abdominal reflex
The Ribs
Observation
- Thoracic observation
- Full inhalation
- Full exhalation
Landmarks
- As for thoracic spine
Palpation
- Hands on rib cage
- Front to, back springing
- Monitor 2 to 10 supine inh/exh
- Costal cartilages + inh/exh
- Monitor 2 to 10 prone
- Mid Trapezius
- Rhomboids
- Serratus Posterior Superior
- Pectoralis Major
- Pectoralis Minor
- Sternalis
- Serratus anterior
Paediatric Examination of the Whole Spine
A consensus approach to the MSK examination in children was developed by Foster et al in 2011.[1] They did not differentiate between cervical, thoracic, and lumbar spine. The underlined components are those that are additional to the adult examination. The italicised components are those that the doctor should be aware of but not necessarily competent in.
With the patient standing:
- Look at the spine from the side and from behind
- Look at the skin and natal cleft
- Look at limb and trunk proportions
- Look at the face and jaw profile
- Feel the spinal processes and paraspinal muscles and Temporomandibular joints (TMJs)
- Assess movement: lumbar flexion and extension and lateral flexion; cervical flexion, extension, rotation and lateral flexion, thoracic rotation
- Assess TMJ opening
- Options – Schober’s test, “stork test”
With the patient sitting on couch (standing in younger child):
- Assess thoracic rotation
With the patient lying on couch:
- Perform straight leg raising and dorsi-flexion of the big toe
- Assess limb reflexes
