OnExam
- Thoracic Spine Assessment
Inspection
- Inspect patient in standing: anteriorly, posteriorly and laterally
- Gait (arm swing, rotation)
- Postural deformities (exaggerated kyphosis, scoliosis
- Muscle atrophy, spasm or increased tone
- Shoulder height
- Scapulae (resting position, winging, anterior shoulder posture/abducted scapula)
- Height where hands hang
Palpation
- Note areas of pain, swelling, spasm, atrophy, deformity or crepitus in the following structures:
- Each thoracic spinous process form T1-T12
- Facet joints deep in paraspinal muscles from T1-T12
- Paraspinal muscles
- Scapulae: place hand on each scapula and patient flexes forward to 45˚, height of hands should remain symmetrical but if asymmetry then suggestive of scoliosis
- Cervical spine
- Lumbar spine
Percussion
- Percuss each spinous process from T1-T12 with the hypothenar aspect of a closed fist to suggest (or detect possible) malignancy, degenerative disease or osteomyelitis
- Malignancy
- Post-test probability if positive: 86%
- Specificity for malignancy: 60%
- Osteomyelitis
- Post-test probability if positive: 10.0% (LR+ = 2.1)
- Post-test probability if negative: 1.2% (LR- = 0.2)
Range of Motion
- Stand behind patient and stabilize hips or have patient sitting to eliminate lumbar spine motion
- Forward flexion (20°-40°)
- Extension (normal = 30°)
- Lateral flexion (normal = 35°). Assess for motion between each vertebral segment (is it consistent or moving as a "hinge" in one area
- Rotation (normal = 30°)
References
- Baxter S, ed., McScheffrey G, ed. Toronto Notes: Comprehensive Medical Reference & Review for MCCQE 1 & USMLE 2. 26th ed. Toronto: Toronto Notes for Medical Students Inc; 2010.
- Bickley L. Bate’s Guide to Physical Examination and History Taking. 10th ed. New York: Lippincott Williams & Wilkins; 2009.
- Filate W, Leung R, Ng D, Sinyor M, eds. Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto, 2005.
- Hurley K. OSCE and Clinical Skills Handbook. Halifax: Elsevier Canada; 2005.
- Pawa J, Lesniak, D., & Lott, A. Approach to the OSCE: The Edmonton Manual of Common Clinical Scenarios. Edmonton Manual; 2011.