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Stand behind the patient and instruct them to bend forwards. If one side of the thorax remains higher than the other = structural scoliosis |
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Ask the supine patient to lift his head off of the table. If this action causes the umbilicus to deviate to one side = damage to the spinal cord between T7 and T10 |
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Place a tape measure around the chest at the level of the 4th intercostal space and note the measurement. Instruct the patient to take a deep breath and measure the expansion. If the difference is less than 1½ inches = ankylosing spondylitis |
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Ask the standing patient to bend laterally to one side. If this causes the ipsilateral paraspinal muscles to tighten and contract = ankylosing spondylitis |
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Ask the patient to stand on their toes and drop their weight suddenly on their heels. If this action causes midline thoracic spine pain = thoracic vertebral fracture. Lateral thoracic spine pain = facet syndrome |
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Clenched fist over the precordium when asked to describe the chest pain is indicative of angina pectoris or myocardial infarction |
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Ask the patient to bend laterally with the hands held over the head. If this action causes pain on the convex side = strain/sprain, myofasciits or pleurisy. If this causes pain on the concave side = intercostal neuritis |
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Percuss the spinous processes from T1 downwards. If there is localized midline pain = vertebral fracture or osteomyelitis. |
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Place the ulnar edge of one of your hands over the sternum of the supine patient and push downwards. If this action causes localized lateral pain = rib fracture. |
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