Thoracic Spine Examination

From WikiMSK

This article is a stub. Please help WikiMSK by expanding it.

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

References

  1. Foster et al.. Pediatric regional examination of the musculoskeletal system: a practice- and consensus-based approach. Arthritis care & research 2011. 63:1503-10. PMID: 21954040. DOI.