THORACIC SPINE

CHAPTER 7


THORACIC SPINE


image





SELECTED MOVEMENTS



ACTIVE MOVEMENTS13 image







GENERAL INFORMATION


Movement in the thoracic spine is limited by the rib cage and the long spinous processes of the thoracic spine. When assessing the thoracic spine, the examiner should be sure to note whether the movement occurs in the spine (thoracic or lumbar) or in the hips. A patient can touch the toes with a completely rigid spine if the hip joints have sufficient range of motion (ROM). Likewise, tight hamstrings may alter the results. The thoracic movements may be done with the patient sitting to reduce or eliminate the effect of hip movement.


If the patient history indicates that repetitive motion, sustained postures, or combined movements aggravate the symptoms, these movements also should be tested; however, this should be done only after the original movements of flexion, extension, side flexion, and rotation have been tested. Repetitive motion testing depends partly on the patient’s irritability (i.e., the ease with which symptoms are aggravated). If the patient’s symptoms are highly irritable (easily aggravated), repetitive motion testing is not advisable. Combined movements that may be tested in the thoracic spine include forward flexion and side bending, backward bending and side flexion, and lateral bending with flexion and lateral bending with extension. Any restriction of motion, excessive movement (hypermobility) or curve abnormality should be noted. Shoulder motion may be restricted if the upper thoracic segments or ribs are hypomobile.





Forward Flexion





CLINICAL NOTES




• An alternative test method involves having the patient bend forward and try to touch the toes while keeping the knees straight. The examiner then measures from the fingertips to the floor and records the distance. With this method, the examiner must keep in mind that, in addition to the thoracic spine movement, movement also may occur in the lumbar spine and hips; in fact, movement could occur totally in the hips.


• Each of the methods described is indirect. Measurement of the ROM at each vertebral segment requires a series of radiographs. The examiner can decide which method to use. It is of primary importance, however, to note on the patient’s chart how the measuring was done and which reference points were used.


• While the patient is flexed forward, the examiner can observe the spine from the “skyline” view. With nonstructural scoliosis, the scoliotic curve disappears on forward flexion; with structural scoliosis, it remains. With the skyline view, the examiner is looking for a hump on one side (convex side of the curve) and a hollow on the other side (concave side of the curve). This “hump and hollow” sequence is caused by vertebral rotation in idiopathic scoliosis, which pushes the ribs and muscles out on one side and causes the paravertebral valley on the opposite side. The vertebral rotation is most evident in the flexed position.


• When the patient flexes forward, the thoracic spine should curve forward in a smooth, even manner with no rotation or side flexion. The examiner should look for any apparent tightness or sharp angulation, such as a gibbus (hump) when the movement is performed. If the patient has an excessive kyphosis to begin with, very little forward flexion movement occurs in the thoracic spine.


• McKenzie1 advocates testing flexion while the patient is sitting to reduce pelvic and hip movements. While sitting, the patient slouches forward, flexing the thoracic spine. The patient can put the hands around the neck to apply overpressure at the end of flexion. If symptoms arise from forward flexion on the spine with the neck flexed by the hands, the examiner should repeat the movement with the neck slightly extended and the hands removed. This can help differentiate between cervical and thoracic pain.



Extension





CLINICAL NOTES




• Because extension occurs over 12 vertebrae, the movement between the individual vertebrae is difficult to detect visually.


• McKenzie1 advocates having the patient place the hands in the small of the back to add stability while performing the backward movement or to do extension while the patient is sitting or in the prone-lying (sphinx) position.


• As the patient extends, the thoracic curve should curve backward or at least straighten in a smooth, even manner with no rotation or side flexion.


• Lee2 advocates asking the patient to fully forward-flex the arms during extension to facilitate extension.


• The examiner should look for any apparent tightness or angulation when the movement is performed.


• If the patient shows excessive kyphosis, the kyphotic curvature remains on extension; that is, the thoracic spine remains flexed, whether the movement is tested while the patient is standing or lying prone.


• The test also may be done with the patient in the prone-lying position. If this position is used, the normal kyphotic posture should flatten. If it does not, the patient has a structural kyphosis.


Stay updated, free articles. Join our Telegram channel

Jun 7, 2016 | Posted by in ORTHOPEDIC | Comments Off on THORACIC SPINE

Full access? Get Clinical Tree

Get Clinical Tree app for offline access