[스크랩] 10장 Evaluation of Respiration

[백호진/서울]

Eval‎uation of Respiration

Purpose

·         To identify if the accessory muscles of respiration are being utilized excessively

·         To identify paradoxical breathing patterns

Respiration Coordination Test

The patient is placed in the supine position and is first asked to simply relax. It may be noted at that point that the patient is overutilizing his/her scalenes and sternocleidomastoid to accomplish quiet respiration. If it is not noticeable, have the patient place one hand on their abdomen and one on their chest and ask them to take a deep breath in. Note if the abdomen depresses or expands as a result of downward diaphragmatic excursion. In addition, note if the scalene muscles and/or the SCM are visibly active during respiration or the chest elevates prematurely and excessively. Patients who have experienced a whiplash injury, have respiratory difficulties, are under stress, have forward head posture, or who have pain may develop the faulty breathing pattern. If the abdomen depresses while the chest elevates, it is considered paradoxical breathing. If there is simply excessive chest breathing, it is just considered a faulty respiratory pattern.

Altered Respiration (abnormal or paradoxical respiration)

Agonist:                                      Diaphragm

Overactive synergist:               Scalenes, upper trapezius, SCM intercostals

Muscle Length Tests

When respiration is determined to be altered, the following muscles need to be eval‎uated to determine muscle hypertonicity:

·         Scalenes

·         SCM

·         Upper trapezius

Postural Analysis

When respiration is determined to be altered, the following postural faults may be noted:

·         Head forward posture

·         Prominence of scalenes and SCM

·         Rounded shoulders

·         Thoracic kyphosis

Clinical Considerations

When the respiratory pattern is altered, due to overactivity of the scalene muscles (plus the SCM & upper trapezius), the posture and stability of the cervical spine is altered. Compression of the brachial plexus by the scalene muscles, plus the formation of myofascial trigger points, commonly occur and result in a Scalenius Anticus Syndrome (Thoracic Outlet Syndrome). Patients will present with pain and parasthesias in one or both extremities. Frequently the parasthesias will involve C6, C7, & C8, and the pain will primarily involve the antebrachium. Chest pain and/or interscapular pain will often accompany the symptoms in the upper extremity. A double crush syndrome can also occur where there is minimal compression at the brachial plexus and secondary compression at the carpal tunnel. Quite often, treatment of the scalene muscles and correction of the respiratory pattern can eliminate the carpal tunnel syndrome symptoms. Faulty respiratory patterns can also perpetuate and/or exacerbate the myofascial trigger points in the SCM and upper trapezius.

Faulty respiratory patterns can result in the development of pain in the following structures:

Joint Pain:

·         Lower Cervical Spine

·         First Rib

·         Cervicothoracic Junction

Myofascial Trigger Point Pain:

·         Scalenes

·         SCM

·         Upper Trapezius

·         Diaphragm

Patient Presentations

Patients who present with a faulty respiratory pattern and decreased cervical spine stability will often complain of the following symptoms:

·         Unilateral or bilateral arm pain and parasthesias/numbness. The arm(s) can feel heavy and tired and quite often wake the patient at night.

·         Restricted motion and pain in the lower cervical spine.

·         Anterior chest wall pain and/or interscapular pain can often be the primary presentation.

·         Diaphragmatic spasm resulting in shortness of breath on exertion, pain at the costal margin or thoracolumbar junction.

·         Double crush symptoms with diffuse antebrachial pain (distal from the elbow) and carpal tunnel symptoms.