Procedure
- Ask the patient to remove clothing from the upper body and stand upright.
- From a distance of about 2 to 3 metres, inspect the ventral side, the dorsal side and both flanks.
- If necessary, palpate to better locate the position of a particular structure.
Ventral Side
Stand in front of the patient and inspect the shape and the position of the following structures [Figure 11].
1. Bones and Joints
- Sternum (pectus carinatum, pectus excavatum).
- Sternoclavicular articulation ((partial) dislocation).
- Clavicle (fracture).
- Acromion.
- Coracoid process (only visible in the case of severe atrophy of the deltoid muscle).
- Acromioclavicular joint ((partial) dislocation).
- Head of the humerus (only visible in the case of dislocation of the glenohumeral joint).
2. Soft Tissue
- Skin.
- Muscle contours of the:
- Sternocleidomastoid muscle (torticollis).
- Trapezius muscle (distal attachment).
- Deltoid muscle (atrophy with axillary nerve lesion).
- Pectoralis major muscle (agenesis).
- Biceps brachii (rupture).
3. Relative Position of Structures
- Position of the head.
- Position of the shoulders (clavicle in relation to the thorax, humerus in relation to the scapula); slight asymmetry can be a normal occurrence.
- Position of the sternum.
- Shape of the thorax.
- Waist triangle (space outline between arm and torso/pelvis).
Figure 11
Dorsal Side
Next inspect the following structures on the posterior side. Stand behind the patient or have them turn 180° [Figure 12].
Figure 12
1. Bones
- Scapula.
- Acromion.
- Scapular spine.
- Medial border (winging of the scapula).
- Inferior angle (palpate this structure to determine the position) [Figure 13].
- Spinous processes (scoliosis).
- Humeral epicondyles (landmarks used to determine possible rotation of the upper arm).
Figure 13
2. Soft Tissue
- Skin.
- Muscle contours of the:
- Trapezius muscle.
- Deltoid muscle.
- Supraspinatus muscle (atrophy).
- Infraspinatus muscle and teres minor muscle (atrophy).
- Teres major muscle.
- Latissimus dorsi muscle.
- Triceps brachii muscle.
3. Relative Position of the Structures
- Position of the spinal column, both cervical and thoracic (scoliosis).
- Position of the scapulae in relation to the thorax (winging of the scapula).
- Waist triangle.
Lateral Side
Finally, inspect both sides. For this, have the patient turn 90° and subsequently 180° [Figure 14].
Figure 14
1. Bones and Joints
These cannot be assessed.
2. Soft Tissue
- Skin.
- Muscle contours of the:
- Deltoid muscle.
- Triceps brachii muscle.
- Biceps brachii muscle.
- Serratus anterior muscle (winging of the scapula due to a long thoracic nerve lesion).
3. Relative Position of the Structures
For a better assessment of the scapulae and the thoracic kyphosis, let the patient turn their back slightly towards you [Figures 15, 16].
- Position of the head (tilting, torsion).
- Position of the cervical spinal column (lordosis).
- Position of the thoracic spinal column (kyphosis).
- Position of the scapulae in relation to the thorax (winging of the scapula).
- Shape of the thorax (dorsoventral diameter) (barrel chest).
Figure 15
Figure 16