REIDER PART 2
47

Chapter 8_Cervical and Thoracic Spine 307

Figurę 8-16. Active thoracic extension.

cm above and 5 cm bclow the lumbosacral junction in the extended spine. The patient is then asked to maximally flex, and the cxaminer measures the distance between the same two points (Fig. 8-18). Normally, the length of the dorsal aspect of the spine should appear to inerease about 6 cm. Excursion of much less than this amount suggests the presence of ankylosing spondylitis, particularly if a kyphotic deformity is present.

Another screening test for ankylosing spondylitis is to measure the amount of chest expansion possible. This is normally doneby encircling the patients chest with a flex-ible tape measure at the nipple linę. The patient is then asked to maximally exhale and the chest circumference is noted (Fig. 8-19,4). Next, the patient is asked to maximally inhale and the circumference again is documented (Fig. 8-19B). The distance between these two measurements should be about 5 cm. If it is less than 2.5 cm, chest expan-sion is decreased. This may be a sign of ankylosing spondylitis. This measurement is morę difficult to perform in females, in whom ankylosing spondylitis is fortunately less common.

■ PALPATION

Palpation has sevcral uses in the evaluation of the cervi-cal spine. First, it may reveal a subtle deformity or malalignment that was overlooked during inspcction or hidden from visual examination because an acutely injured patient was encountered in a supinc position. Second, palpation may detect paraspinous muscle spasm. Such spasm may reflect injury to the muscle itself or may merely be an involuntary response to a painful condition involving adjacent structures. Finally, careful palpation may identify an area of point tenderness. Point tenderness may allow the examiner to identify the level of a discrcte lesion or even the cxact sile of injury, such as a posterior facet joint. In a patient with a history of recent trauma,

Figurę 8-17. A and B_t Measurement of apparent elongation of the spine with flexion.