Apical Expansion
Patient lies in supine with knees flexed to flatten the lumbar spine. Patient inhales through nose, upon exhalation guide left rib cage down. Hold ribs down as patient attempts to fill opposite chest wall. Repeat on opposite side.
A Positive test is indicated when the patient is unable to draw air into the right thoracic chest wall as easily as on the left, through patient report or tester observation. Limitation in expansion of the right thoracic-apical chest wall reflects right rib internal rotation orientation with accompanying left rib external rotation orientation secondary to possible compensation of thoracic rib cage to the left as a result of thoracic “spinal” orientation to the right.
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