thoracic assessment.pdf طبعي تقيم الصدر علاج

تقييم الصدر

1. THORACIC
SPINE
by Dr. Khaled AL-Sayani

2. THORACICSPAIN
Itisthesecondsegment
Locatedbetweenthecervicalandlumbarvertebral
segment
Consistof12vertebrae,separatedby
intervertebraldisc
Alsofrompartofthoraciccage
Itliesintheupperbackandprovideattachmentfor
theribs
Natural,slightkyphoticcurveexistinT-spain

4. OBSERVATION
Fromtheside
Kyphosis(posteriorconvexityofthespine)
•Senilekyphosis(withosteoporosis,osteomalaciaor
pathologicalfracture)
•scheuermann’sdisease(osteochondritisinvolvingoneor
moreofthevertebrae)
•Gibbus(angularkyphosis)
•Fracture
•Tuberculosisofthespine
•Congenitalabnormality
.

5. OBSERVATION
Fromthebehind
Listingoftrunk(duetomusclespasm)
Scoliosis(lateralcurvatureofspine)
•Postural:scoliosisdisappearswithforwardflexionofthe
spine
•Structural:scoliosispersistswithforwardflexionofthe
spineandaribhumppresents
Scapula(spinascapulaT3,endofscapulaT7-T9,Medial
borderofthescapulaand spinousprocesses5cm).
Softtissues(Skincolor,Swellingandscars)

6. kyphoscoliosis

7. PALPATION
•Skintemperature
•Softtissues
•Tenderness
•Increasedordecreasedprominenceofbones,thepositionof
vertebraeandribs
•Supine-sternum,ribs,clavicle,sternocostaland
costochondraljoints
•Prone-spinousprocess,costotransverseandcostovertebral

9. MEASUREMENT SCOLIOSIS
Inspection:
Oneshoulderbladebeingmoreprominentthantheother
Leaningtooneside
Palpation:
Unevenshoulders,hips,waist,legsorribcage
SpecialTests:
Adam’sforwardbendtest
X.ray:
Cobbangle
‘significant’25-30degrees
‘severe’45-50degrees.

10. SCOLIOSISCNOT…

11. MEASUREMENT KYPHOSIS
Inspection
Palpation
X-ray
Cobbangle

12. FLEXION
•Startingposition:Thetapeisplacedproximallyonthe
spinous processofC7anddistaltoS1.
•Endingposition:followingflexionofthevertebral
usingthe samelandmark
•ROM:Approximately 4inches
•Precaution:Thepelvicandhipjointsarestabilized
•FactorslimitingROM:
Tensionofspinalextensormuscles
Contactoflastribswithabdomen
Boneblockage:contactoflipsofvertebralbodies
withsubjacentvertebraeanterriorly
Tensionofligaments:Posteriorlongitudinal,
Interspinal ligament,supraspinalligament.

14. EXTENSION
•Rom:2inches
•Precaution:
Preventhipextension
Preventtrunkrotation
•FactorslimitingROM:
Tensionofanteriorabdominalmuscles(musclesoftrunk
flexion)
Contactofspinousprocesses
Tensionoflongitudinalligamentofspine.

15. LATERALFLEXION
•Position:standingerect.
•Goniometer
Axis:S1spinousprocess
Stationaryarm:vertical
Movingarm:C7spinousprocess
•ROM:20-40°
•Stabilization:Thepelvisisstabilized

16. ROTATION
•Position:sittingwithoutbacksupport,feetflatonthefloor
•Goniometer
Axis:centerofsuperior aspectofhead
Stationaryarm:alignedwithanteriorsuperioriliacspines
Movingarm:alignedwithacromionprocesses
•ROM :45°
•Stabilization:Thepelvicisstabilized.
•Precaution
Preventpelvicrotation
Avoidtrunkflexion,extensionandlateralflexion
•FactorslimitingROM
Tensionofobliqueabdominalmuscleofoppositesidebeingtested
Inthoracicarea:tensionofcostovertebralligament.
Inlumberarea:interlockingofarticularfacets

17. BEEVOR'SSIGN

18. ADAMS-FORWARD-BEND-TEST

19. 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 held 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.
A positive test is indicated if asymmetry is observed
(one side of the spine is higher than the other).