1. Thoracic Spine

2. Thoracic Cage Anterior

3. Thoracic Cage Posterior

4. Parathoracic Musculature

5. Thoracic Musculature

6. Adam’s Position
Procedure: Patient standing. Stand directly behind and inspect for scoliosis, hyperkyphosis, or kyphoscoliosis. Next. Patient should flex forward at hips. Inspect again.
Positive Test:
If scoliosis, hyperkyphosis, or kyphoscoliosis reduces with forward bending: poor posture, overdevelopment of unilateral spinal and/or upper extremity musculature, nerve root compromise, leg length deficiency, or hip contracture.

7. Adam’s Position
If scoliosis, hyperkyphosis, or kyphoscoliosis does not reduce with forward bending: structural deformity (i.e. hemivertebra, compression fracture) or idiopathic scoliosis.

8. Adam’s Position

9. Spinal Percussion
Procedure: Patient seated, head slightly flexed, percuss the spinous processes and associated musculature.
Positive Test:
Local pain may indicate a fractured vertebra without neurological compromise or ligamentous sprain.
Radicular pain may indicate a fractured vertebra with neurological compromise or a disc defect with neurological compromise.

10. Spinal Percussion

11. Soto-Hall Test
Procedure: Patient supine, assist him in flexing the chin to the chest.
Positive Test:
Local pain indicates osseous, discal, or ligamentous pathology.
Non-specific test. Simply isolates cervical and thoracic spine in passive flexion.

12. Soto-Hall Test

13. Sternal Compression Procedure: Patient supine. Push down on sternum.
Positive Test: Pressure on the sternum compresses the lateral borders of the ribs. If a fracture is present here, pain will be produced or exacerbated.
Note: If trauma has occurred and you suspect a fractured rib, radiographs should be performed first before performing this test.

14. Sternal Compression

15. Beevor’s Sign
Procedure: Patient supine. Patient should hook fingers behind neck and raise the head towards the feet. Mimic a sit-up.

16. Beevor’s Sign Positive Test:
The umbilicus will not move in a patient with not thoracic root lesion.
Umbilicus moves superiorly: bilateral T10 – T12 lesion
Umbilicus moves superiorly and laterally: Unilateral T10 – T12 nerve root lesion on opposite side.
Umbilicus moves inferiorly: bilateral T7 – T10 nerve root lesion.
Umbilicus moves inferiorly and laterally: Unilateral T7 – T10 nerve root lesion of the opposite side.

17. Beevor’s Sign

18. Schepelmann’s Sign
Procedure: Seated patient. Flex at waist to right and left.
Positive Test:
Pain on side of lateral bending: intercostal neuritis.
Pain on opposite side of lateral bending: fibrous inflammation of the pleura or intercostal sprain.

19. Schepelmann’s Sign

20. Chest Expansion
Procedure: Patient seated. Place a tape measure around the patient’s chest at the level of the nipple. Instruct patient to exhale and record the measurement. Instruct the patient to inhale maximally and record the measurement.

21. Chest Expansion Positive Test:
Normal chest expansion for a man is 2 inches or more.
Normal chest expansion for a woman is 1 inch or more.
A decrease in chest expansion indicates an ankylosing condition at the costotransverse or costovertebral articulation.

22. Chest Expansion