1. 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

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

3. 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

4. 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.

5. 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.

6. Thoracic Exam Orthopedics
Chest Expansion

7. 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.

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

9. Thoracic Exam Orthopedics
Gait

10. Thoracic Exam Orthopedics
Adams Sign

11. 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.

12. 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.

13. 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.