Orthopedic Tests: Thoracic Spine Mrs Evaluation And Meningeal Tests

Front 1

Rib Motion Test

Back 1

The patient is seated and Dr. stands posteriorly, finger tips of each hand are placed, mid-clavicularly in the intercostal spaces anteriorly for ICS 2-5. Ask patient to fully inhale and exhale.
Repeat along the mid-axillary line for ICS 6-9 and posteriorly along the paraspinal muscles for 10 - 12

(+): any lack of rib motion and excursion/asymmetry

Front 2

Soto-Hall Test (afebrile)

Back 2

With the patient supine, the examiner places knife edge contact or rolled towel on the sternum and flexes the cervical spine

(+): any report of pain in the cervicothoracic spine

Indication: a non-specific indicator of fracture, disc herniation, sprain or strain, subluxation of thoracic or cervical spine

Front 3

Brudzinski's Sign (febrile)

Back 3

Same as Soto-Hall but WITHOUT stabilization
With the patient supine, the examiner places knife edge contact or rolled towel on the sternum and flexes the cervical spine

Present: knee flexion lumbar extension, increased head and neck pain (opisthotonis position)

Indication: meningeal inflammation/meningitis

Front 4

Kernig's Test (febrile)

Back 4

Examiner flexes the knee and hip of one leg to 90°. Then attempts to straighten the flexed leg at the knee

(+): diffuse pain in cervicothoracic area, involuntary flexion of the opposite hip and knee and/or cervical and lumbar extension

Indication: meningeal inflammation/meningitis

Front 5

L'Hermitte's Sign

Back 5

Upon performance of any passive cervical flexion manever (including cervical range of motion, Soto-Hall, Brudzinski's, etc.), note any report of shock-like dysesthesias down the spine/into any of the extremities or performed as an active test where patient is seated and asked to drop their head into full flexion

Present: report of schok-like dysesthesias down the spine or into any of the extremities

Indication: cord demyelination or compression

Front 6

Shepelmann's Sign

Back 6

When a patient presents with thoracic cage pain, upon standing, ask them to laterally flex toward the side of pain, then to laterally flex away from the side of pain. Ask the patient to indicate which movement results in exacerbation of the complaint

Official Indication
- Intercostal Neuritis: increase in pain leaning toward symptomatic side
- Pleural Inflammation: increase in pain leaning away from symptomatic side

Practical Indication
- Increase in pain leaning toward suggests fracture, subluxation
- Increase in pain leaning away suggests fracture, subluxation, intercostal muscle strain, or myofascitis, costochondritis, pleuritic inflammation

Front 7

Forestier's Bowstring Sign
(Ankylosing Spondylitis)

Back 7

The patient is standing and asked to laterally flex to each side.
Note: observe the spine with gown open in the back. Correlate with palpation of the erector spinae

Present: contracture or tightening of the musculature ipsilateral to lateral flexion

Indication: ankylosing spondylitis or spinal ankylosis due to other causes

Front 8

Lewin's Supine Test
(Ankylosing Spondylitis)

Back 8

With the patient supine and the examiner holding down the patient's legs, the patient attempts to sti up (without use of the arms)

(+): inability to sit up

Indication: some texts indicates that this is specific for ankylosing conditions of the spine. Others indicate other conditions as well, such as arthritis and disc herniation

Front 9

Beevor's Test/Umbilical Migration
(MRS of Thoracic Spine)

Back 9

With the patient's hands behind their head and knees bent, instruct the patient to raise the gown high enough to observe the umbilicus and then perform a partial sit up

(+): deviation of the umbilicus toward one quadrant or in a cephalad or caudad direction

Indication: abdominal muscle weakness in the quadrant(s) opposite deviation

Front 10

Thoracic Dermatomes: Posterior
(MRS of Thoracic Spine)

Back 10

Patient is seated, gown is opened to observe thoracic spine. Dr. uses Whartenburg wheel to evaluate 4 levels at a time paraspinally

Front 11

Thoracic Dermatomes: Mid-Axillary
(MRS of Thoracic Spine)

Back 11

Patient is seated, gown is opened to observe the throacic spine. Patient is asked to cross arms out in front of them. Dr. uses Whartenburg wheel to evaluate 4 levels at a time in the mid-axillary line

Front 12

Thoracic Dermatomes: Anterior
(MRS of Thoracic Spine)

Back 12

Patient is supine, asked to move gown down to expose clavicular region. Dr. stands at the inferior of the table and compares dermatomes parasternally

Front 13

Superficial Abdominal Reflex
(MRS of Thoracic Spine)

Back 13

Using the sharp end of a reflex hammer, draw a 'star' or a diamond shape pattern on patient's abdomen. Have patient bend knees to enhance reflex. Umbilicus should move toward the quadrant being stimulated

(+): No reflex/asymmetry

Indication
T7-9: upper quadrants
T10-12: lower quadrants