Physical Examination

Some potential diagnoses you should consider are postural syndrome, thoracic disc disease, joint dysfunction, Marfan syndrome and lung disease.

Age:                    51 yrs.

Height:                68 in.

Weight:               104 lbs.

Temp:                  97.9 F

Pulse:                   84 regular, smooth, symmetrical

BP:                      122/82

Somatotype:        Ectomorph

The patient is tall and slender with generalized, poor muscle tone. There is rounding of the shoulders and a forward translation of the head (upper cross syndrome). The thoracic musculature is hypotonic and tender. Thoracic ranges of motion are unrestricted with pain reported at the end range of flexion and extension. There is general ligamentous laxity throughout the extremities. Auscultation and percussion of the lung fields are unremarkable. Schepelmann's test is negative. Cutaneous sensation to light touch over the abdomen is decreased, particularly over the lower quadrant on the right. Beevor’s sign is present on the right. Abdominal examination is unremarkable.

Question: What is your working diagnosis at this point and what imaging or laboratory studies would you order?