Thoracic Exam Vitals Appearance. Mood, Orientation Visual Inspection Seated BP (L & R), Respiration, Pulse, Ht, Wt, Temp Appearance. Mood, Orientation A&OX3, No Apparent Distress, Well Dev. Well Nour Visual Inspection Thoracic Muscle symmetry, Thoracic Posture (P-A & Lat) Palpation Normal tone, no tenderness, swelling, masses, heat Interspinous spaces, Lymphnodes, Cardio Resp. Sensory Thoracic Dermatomes, Other Sensory Sharp/Dull, Vib, Position sense

Thoracic Exam ROM Flexion Extension Rotation Lat Flexion 20-40 degrees

Thoracic Exam Orthopedics Seated Spinous Percussion Schepelman’s Chest Expansion Dejerine’s Triad* Valsalva* Standing Gait Adam’s Sign Supine Soto-hall Sternal Compression Beevor’s Sign * This test shows up in more than 1 Exam

Thoracic Exam Orthopedics SPINAL PERCUSSION: Procedure: patient seated with head flexed, dr. percusses the sp’s and paravertebral musculature. (+): if localized or radiating. Indicates: 1. local – fracture or severe sprain. 2. radicular – IVD syndrome. Clinical note: ultrasound may aggravate the condition.

Thoracic Exam Orthopedics SCHEPELMAN’S SIGN: Procedure: patient seated and raises arms and then bends laterally to each side. (+): if pain on either side. Indicates: pain on concave side = intercostal neuritis. Pain on convex side = intercostal myofascitis.

Thoracic Exam Orthopedics Chest Expansion

Thoracic Exam Orthopedics DEJERINE’S TRIAD*: Procedure: patient seated, then cough, sneeze, and strain. (+): pain. Indicates: disc protrusion, spinal cord tumor or spinal compression fracture.

Cervical Exam Orthopedics VALSALVA*: Procedure: do I have to explain??? (+): /reproduce pain. Indicates: space occupying lesion (herniated disc or tumor), or osteophyte.

Thoracic Exam Orthopedics Gait

Thoracic Exam Orthopedics Adams Sign

Thoracic Exam Orthopedics SOTO-HALL: Procedure: patient supine with hands above head and dr. passively flexes the patient’s chin to chest, while holding onto the sternum. (+): pain. Indicates: subluxation, sprain/strain, fracture, disc lesion, exostoses, or meningitis.

Thoracic Exam Orthopedics STERNAL COMPRESSION: Procedure: patient supine and dr. presses on sternum. (+): if pain. Indicates: localized pain at lateral border of rib = rib fracture.

Thoracic Exam Orthopedics BEEVOR’S SIGN: Procedure: patient supine and does a ½ sit up and dr. inspects the umbilicus for deviation. Then patient lies flat and lifts the legs up, while dr. palpates and observes the umbilicus. (+): if umbilicus deviates in any direction. Indicates: a spinal cord lesion at T7 – T10 depending on where the umbilical deviation was. Clinical note: in the presence of prolonged illness followed by lower extremity paresthesia, this test needs to be performed.