Thoracic Excursion Assessment: What Is It?

Respiratory function is often assessed using the pulmonary function test (PFT), which measures parameters such as forced vital capacity (FVC) and forced expiration. Diaphragmatic excursion, the movement of the thoracic diaphragm during breathing, is a common cause of thoracic spine pain. The pulmonary exam is a crucial and often practiced exam by clinicians, with auscultation being the most commonly used technique.

The patient’s history determines the scope and intensity of the chest examination. If the history elicits suspicion of a chest problem, the physical examination of the thorax must be performed. Palpation can identify areas of tenderness, lesions, masses, or crepitation, and respiratory expansion can be assessed in anterior or posterior chest.

Assessment of the thorax and lungs should be completed as part of a comprehensive assessment, like during a routine physical exam, or as part of a focused exam if a client is experiencing respiratory issues. Thoracic excursion is defined as that circumferential measurement at the xiphoid level from full forced expiration to absolute maximum inspiration.

The examiner assesses for pain provocation and mobility of each joint, determining whether it is hypomobile, hypermobile, or normal. This measure measures the contraction of the diaphragm and is usually symmetrical and is at least 2.5 centimeters between full and partial exhalations.

Thoracic and Lumbar Spine palpatory landmarks for physical examination and osteopathic structural exam are also important. Measurement of thoracic excursion (TEM) during maximal ventilation is part of the physiotherapy assessment in children with cystic fibrosis (CF).

What does decreased excursion mean?

The study reveals that Chronic Obstructive Pulmonary Disease (COPD) significantly impacts diaphragmatic excursion and lung function. It found that diaphragmatic excursion is reduced in COPD patients compared to controls, indicating a reduction in the contractile ability of the diaphragm. This is due to the disease’s pathophysiology, which includes bronchitis and emphysema, which cause airway obstruction and air trapping in the lungs. The diaphragm moves caudally during inspiration and cranially during expiration, leading to mechanical disadvantages.

Previous studies have shown that reduced diaphragmatic mobility is associated with increased dyspnea perception. Structural changes also cause flattening of the diaphragm, reducing its ability to move cranially and caudally. The study also found a strong correlation between sonographic assessment of diaphragmatic excursion and spirometry results, with diaphragmatic excursion strongly correlated with FEV1/FVC and weakly with FEV1.

The progression of the disease causes shortening of diaphragm fibers and decreased resting diaphragm muscle length, affecting ventilator capacity and lung function. COPD can also cause hyperkyphosis, reducing chest wall expansion, and thus, affects diaphragmatic mobility and lung function.

What does decreased diaphragmatic excursion mean?

The study reveals that Chronic Obstructive Pulmonary Disease (COPD) significantly impacts diaphragmatic excursion and lung function. It found that diaphragmatic excursion is reduced in COPD patients compared to controls, indicating a reduction in the contractile ability of the diaphragm. This is due to the disease’s pathophysiology, which includes bronchitis and emphysema, which cause airway obstruction and air trapping in the lungs. The diaphragm moves caudally during inspiration and cranially during expiration, leading to mechanical disadvantages.

Previous studies have shown that reduced diaphragmatic mobility is associated with increased dyspnea perception. Structural changes also cause flattening of the diaphragm, reducing its ability to move cranially and caudally. The study also found a strong correlation between sonographic assessment of diaphragmatic excursion and spirometry results, with diaphragmatic excursion strongly correlated with FEV1/FVC and weakly with FEV1.

The progression of the disease causes shortening of diaphragm fibers and decreased resting diaphragm muscle length, affecting ventilator capacity and lung function. COPD can also cause hyperkyphosis, reducing chest wall expansion, and thus, affects diaphragmatic mobility and lung function.

How do you assess chest excursions?

Joe is instructed to take a deep breath, then hold and repeat the process of chest wall expansion, ensuring that all air is expelled and the chest wall is fully expanded.

What does thoracic expansion do?

Thoracic Expansion Exercises (TEE) are deep breathing exercises that aim to get air behind the sputum in smaller airways. They involve relaxing the chest and shoulders, taking a long, slow breath in through the nose, feeling the ribs expand, and gently breathing out. Repeat 3-4 deep breaths, and if lightheaded, return to relaxed breathing. Some people find holding their breath helpful. Forced Expiratory Techniques (FET) or Huffing involves breathing out through an open mouth and throat by contracting tummy muscles, aiming to squeeze air quickly from the lungs. Huffing should be followed by breathing control to avoid wheezing or chest tightness. Both techniques can help improve overall respiratory health.

What does thoracic expansion assess?

Thoracic expansion is a method used to assess the symmetry and extent of thoracic movement during inspiration. It is usually symmetrical and can be diminished in various conditions, such as ankylosing spondylitis or chronic fibrotic lung disease. Percussion, the act of tapping on a surface, is used to determine the underlying structures’ fluid-filled, gas-filled, or solid state. It penetrates the chest cavity and produces a low-pitched, resonant note over normal gas-filled lungs.

It can produce a dull, short note when fluid or solid tissue replaces air-filled lung or when there is fluid in the pleural space. Hyperresonant notes are produced over hyperinflated lungs, while tympanitic notes are produced over no lung tissue.

What does diaphragmatic excursion tell you?

Diaphragmatic excursion is the movement of the thoracic diaphragm during breathing, typically 3-5 cm. It can be increased to 7-8 cm in well-conditioned individuals. The procedure involves the patient exhaling and holding it, with the doctor percussing down their back in the intercostal margins until sounds change from resonant to dull. The patient then takes a deep breath in and holds it, with the provider percussing down again.

The distance between the two spots is measured, and repeating on the other side, usually higher up on the right side. If the diaphragmatic excursion is less than 3-5 cm, the patient may have pneumonia or a pneumothorax, which can be diagnosed with a chest x-ray.

How do you assess chest excursion?

To assess chest expansion, use a tape to encircle the chest around the nipple level and measure at the end of deep inspiration and expiration. Normally, a 2-5″ chest expansion can be observed, but any lung or pleural disease can cause a decrease. Asymmetrical chest expansion is abnormal, with the abnormal side expanding less and lags behind the normal side. Any unilateral lung or pleural disease can cause asymmetry of chest expansion.

Apply different amounts of pressure and have the patient sit erect to observe the effect on the symmetry of chest expansion. If the patient has decreased chest expansion on the right side, it may indicate a pushing lesion from the right, such as pneumothorax, pleural effusion, or large mass.

What does decreased chest excursion mean?

The study reveals that Chronic Obstructive Pulmonary Disease (COPD) significantly impacts diaphragmatic excursion and lung function. It found that diaphragmatic excursion is reduced in COPD patients compared to controls, indicating a reduction in the contractile ability of the diaphragm. This is due to the disease’s pathophysiology, which includes bronchitis and emphysema, which cause airway obstruction and air trapping in the lungs. The diaphragm moves caudally during inspiration and cranially during expiration, leading to mechanical disadvantages.

Previous studies have shown that reduced diaphragmatic mobility is associated with increased dyspnea perception. Structural changes also cause flattening of the diaphragm, reducing its ability to move cranially and caudally. The study also found a strong correlation between sonographic assessment of diaphragmatic excursion and spirometry results, with diaphragmatic excursion strongly correlated with FEV1/FVC and weakly with FEV1.

The progression of the disease causes shortening of diaphragm fibers and decreased resting diaphragm muscle length, affecting ventilator capacity and lung function. COPD can also cause hyperkyphosis, reducing chest wall expansion, and thus, affects diaphragmatic mobility and lung function.

Why is diaphragmatic excursion important?

Diaphragmatic excursions, which are sensitive to changes in respiratory patterns and related to the volume-generating capacity of the diaphragm after abdominal surgery, have been used to identify diaphragmatic weakness in patients with acute exacerbation of COPD. The study aimed to evaluate the effect of diaphragmatic excursions, assessed by ultrasonography (US), on exercise tolerance and dynamic lung hyperinflation (DLH) in COPD patients. The pathophysiological mechanisms involved in dyspnea and poor exercise tolerance in COPD patients are complex, with dynamic lung hyperinflation playing a central role.

What does chest wall excursion measure?

Ventilatory excursion assessment involves evaluating the synchrony of expansion and chest expansion associated with deep forceful inspiration. Asymmetrical expansion may indicate decreased ventilation to one side, which may be due to thoracic wall abnormalities, structural immobility, defect, pain, or obstruction of airways. Other factors may include inflamed, fibrosed, or malignantly infiltrated pleura, unilateral pleural effusion, interstitial pulmonary processes, or complete obstruction of airways on the ipsilateral side.

Functional severing of the phrenic nerve or intraabdominal process causing paralysis of the ipsilateral hemidiaphragm may also cause asymmetrical expansion. Palpation is used to assess further abnormalities, such as gynecomastia suspected due to observed breast enlargement or spider hemangiomas confirmed by palpation of breast tissue. Deviation of the trachea to one side can indicate either pulling the trachea to one side or pushing it away, such as tumors or inflammatory masses. Spontaneous movement of the trachea in synchrony with the pulse suggests the presence of an aortic aneurysm.

Why do we do chest excursions?

The measurement of chest excursion is of paramount importance in the evaluation of a patient’s respiratory status, as it is integral to the formulation of a treatment plan and the determination of activity goals. This assessment encompasses age, vital capacity, and excursion for both men and women, including those who are active and those who are sedentary.