Thoracic Orthopedics Flashcards

1
Q

Which test is great to use before ordering films on a patient with scoliosis concerns?

A

Adams Position

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2
Q

How do we perform Adam’s Position?

A

Patient flexes forward at the waist with hands in a prayer position. Doctor observes for any change in scoliosis.

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3
Q

What is the purpose of Adam’s Position?

A

To determine of the patient has a structural or functional scoliosis. Perform this test if patient has a high shoulder or visible scoliosis while standing.

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4
Q

What are the findings of Adam’s Position?

A

If scoliosis disappears when patient flexes forward, it is a functional scoliosis

If scoliosis remains when the patient flexes forward, it is a structural scoliosis and x-ray is warranted.

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5
Q

How do we perform Amoss Sign?

A

Patient rises from a side-lying position to a sitting position. Doctor observes for signs of pain, and to see if patient uses upper body strength to assist in rising.

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6
Q

What is the purpose of Amoss Sign?

A

To see if there is pain, weakness, or decreased flexibility in the thoracics or thoraco-lumbar area.

Could indicate severe sprain, AS, or IVD syndrome

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7
Q

What are the findings of Amoss Sign?

A

Positive findings are if pain is elicited while rising and patient uses upper body strength to assist them while getting up

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8
Q

What is the best neurological test of the thoracic spine?

A

Beevor’s Sign

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9
Q

How do we perform Beevor’s Sign?

A

Doctor observes the umbilicus while the patient is lying supine and does an abdominal crunch followed by a leg lift

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10
Q

What is the purpose of Beevor’s Sign?

A

To see if the umbilicus deviates (it should not)

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11
Q

What are positive findings of Beevor’s Sign?

A

Umbilicus will deviate to opposite direction of abdominal weakness.

DDx: Tumor, cord lesion, cortical problem

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12
Q

How do we perform Chest Expansion Test?

A

Doctor wraps tape measure around patient’s chest (at 4th intercostal space), then asks patient to inhale and exhale maximally

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13
Q

What is the purpose of Chest Expansion test?

A

Looking for normal chest expansion, which is 1.5-3 inches

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14
Q

What is the purpose of Forestier Bowstring Test?

A

Looking for unequal ROM from side to side

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15
Q

How do we perform Forestier Bowstring Test?

A

Doctor observes ROM while patient laterally bends side to side

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16
Q

What are positive findings for Forestier Bowstring?

A

Muscle Spasm
AS
Pain inhibiting motion
Stacking

17
Q

What is the procedure for Rib Motion Test?

A

Doctor places both hands on patient’s chest at sternocostal angle while patient is supine. Doctor observes for movement of ribs as patient inhales/exhales

18
Q

What are positive findings for Rib Motion Test?

A
  • If a rib stops moving during expiration, there is an elevated rib
  • If a rib stops moving during inhalation, there is a depressed rib
These could be due to:
Subluxation
Muscle Strain
Fracture
Arthritis
Pleuritis
19
Q

What is the procedure for Schepelmann’s Sign?

A

Patient is seated with arms extended over their head, then pt laterally flexes to the left and right.

20
Q

What is the purpose for Schepelmann’s Sign?

A

To note any intercostal pain

21
Q

What are positive findings for Schepelmann’s Sign?

A

If there is pain on the CONCAVE side, there is neuralgia (compression of intercostal nerve)

If there is pain on the CONVEX side, there is myalgia or myofascitis (stretching of muscle/fascia)