Physical Examination 207: Thoracic Spine and Rib Cage

The examination of the thoracic spine and rib cage as a chiropractor performs it: the anatomy of the thoracic vertebrae, facets and demifacets, costovertebral joints, rib cage (true, false and floating ribs, sternum, costal cartilage), intercostal muscles and scapulothoracic joint; the conditions — hyperkyphosis and postural kyphosis, thoracic disc herniation, scapular dyskinesis and intercostal strain; the consultation and visual examination; compression palpation of the sternum, thoracic spine and rib cage; manual muscle testing with the 0–5 grading scale; cervical, lumbar and rib-cage-expansion range of motion; the sternal compression test, Soto-Hall test, Schepelman's sign, scapular retraction test, scapular pinch test and scapular flip sign; x-ray and MRI; and four thoracic and costovertebral adjustments. The key tests and the adjustments are demonstrated on video.

Donald Ozello, DC, CCN, CCSM — sports chiropractor, founder of Championship Chiropractic in Las Vegas and CCEDseminars faculty for the Sports Injuries, Rehabilitation and Adjusting & Manual Therapy series — teaches the 2-hour course. It is written for Doctors of Chiropractic who want a repeatable thoracic and rib cage examination: the anatomy that explains the findings, the palpation and muscle-testing routine, each orthopedic test with its positive finding and indication, and the imaging that confirms it.

With the sequence the course teaches. Intercostal strain — the most common cause of muscular chest wall pain — has a mechanism (a sudden contraction of the intercostals in a stretched position, or repetitive lateral flexion and rotation) and a symptom pattern: sharp, stabbing or tight pain with point tenderness, shallow breathing because the rib cage cannot expand, and pain intensified by deep inspiration, sneezing and coughing. Compression palpation of the sternum, spine and rib cage localizes the pain. The sternal compression test — light anterior-to-posterior pressure on the sternum with the patient supine — reproduces localized rib pain in a possible rib fracture, rib subluxation or intercostal strain. Schepelman's sign then sorts the side: pain on the side of lateral bending points to intercostal neuralgia, rib fracture or rib subluxation; pain on the opposite side points to pleural inflammation, intercostal sprain, fracture, subluxation or costochondritis. Where fracture is in question, x-ray confirms it.

Physical Examination 207 is online and on-demand: you start immediately after checkout and work at your own pace. When you pass the post-course assessment your completion is recorded electronically and your certificate is issued right away. CCEDseminars is PACE Provider #34015544 and the course is co-sponsored by Texas Chiropractic College; completions are reported to CE Broker for the states served. Approved states are listed at the bottom of this page, and confirming your own board's requirements remains your responsibility.

Dr. Ozello's Adjusting & Manual Therapy 207: Thoracic Spine & Rib Cage is the treatment half of the same region — 207 here is the examination, that course is the adjusting — and his Physical Examination 205: Cervical Spine continues the examination sequence up to the occiput, so the two Physical Examination courses together cover the spine from C1 to T12 on video for $80. Add any third Physical Examination course — Dr. O'Hara's 202, 203 or 206, Dr. Riggs' 204 or Dr. Hall's 201 — and the three reach 6 CE hours, where the automatic 10% multi-course discount starts ($108 instead of $120). New Physical Examination titles are released as faculty complete them; the current list with pricing lives on the category page.