MID BACK ORTHO
Orthopedic tests for the mid-back (thoracic spine) help clinicians assess potential issues like spinal deformities, thoracic joint dysfunction, and nerve impingement. Here are some commonly used orthopedic tests for the mid-back, with in-text references and a reference list at the end.
1. Adam’s Forward Bend Test
This test is used primarily to screen for scoliosis in the thoracic and lumbar spine. The patient bends forward at the waist with arms hanging loosely. The examiner observes the spine from behind to check for rib hump or spinal asymmetry, which indicates scoliosis (Magee, 2020).
2. Schepelmann’s Test
Schepelmann’s test is performed to differentiate between intercostal muscle strain and intercostal neuralgia. The patient raises their arms overhead and bends laterally to each side. Pain on the convex side suggests intercostal muscle strain, while pain on the concave side points to intercostal nerve compression (Cleland & Koppenhaver, 2011).
3. Thoracic Compression Test
The thoracic compression test is used to evaluate for thoracic vertebral compression fractures or other structural issues. The patient is seated, and the examiner applies downward pressure on the patient’s shoulders. An increase in mid-back pain indicates a potential fracture or other structural pathology (Evans, 2014).
4. Slump Test
The slump test is a neural tension test primarily used to assess thoracic and lumbar nerve root involvement. The patient sits with their arms behind their back, slumps forward, and extends the leg while dorsiflexing the foot. Neck flexion is added at the end of the movement. Reproduction of symptoms like pain or tingling along the spine or legs may indicate nerve root impingement (Magee, 2020).
5. Thoracic Outlet Syndrome (TOS) Tests
These tests evaluate for compression of the neurovascular bundle (brachial plexus, subclavian artery, or vein) at the thoracic outlet. Tests such as the Roos test (the patient opens and closes their hands with arms elevated for 3 minutes) or Adson’s test (the examiner palpates the radial pulse while the patient rotates the head and takes a deep breath) are commonly used to assess for thoracic outlet syndrome (Cleland & Koppenhaver, 2011).
6. Costovertebral Expansion Test
This test assesses thoracic spine and rib mobility. The examiner measures the patient’s chest circumference at full expiration and full inspiration. A decrease in chest expansion (less than 5 cm) could indicate conditions like ankylosing spondylitis or thoracic joint restriction (Evans, 2014).
7. Kibler’s Scapular Assistance Test
This test is used to assess scapular movement and its effect on thoracic spine pain. The examiner assists the scapula with its motion during arm elevation, and a decrease in thoracic spine pain indicates dysfunctional scapular movement as a contributor to the pain (Magee, 2020).
Reference List
- Cleland, J. A., & Koppenhaver, S. (2011). Orthopaedic Manual Therapy: An Evidence-based Approach. Elsevier Health Sciences.
- Evans, R. C. (2014). Illustrated Orthopedic Physical Assessment (4th ed.). Elsevier.
- Magee, D. J. (2020). Orthopedic Physical Assessment (6th ed.). Elsevier.
These tests provide a thorough assessment for common conditions affecting the thoracic spine, helping clinicians identify underlying causes of mid-back pain and dysfunction.