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An objective clinical study of chest expansion.

Rigidity of the thoracic cage as a characteristic feature of ankylosing spondylitis has been recognized for over 250 years since the classical description by Bernard Connor in 1691 (Hartung, 1954). The generally accepted importance of this sign is evidenced by its inclusion by two recent international symposia as a major criterion for the diagnosis of ankylosing spondylitis (Kellgren, Jeffrey, and Ball, 1963; Bennett and Wood, 1968). However, considering the significance of chest expansion as a useful measure of disease, not only in ankylosing spondylitis but also in chest disorders, it is surprising that no previous objective work to assess the normal range of this movement has been reported. Despite the lack of such objective chest data, recent attempts to quantify chest expansion by international agreement (Bennett and Wood, 1968) have resulted in the arbitrary definition of 2 5 cm. as the borderline between normal and abnormal expansion. As a result of an objective clinical study of chest expansion in a large group of normal sub:jects, we have attempted to demonstrate the biological unreality of this inflexible and arbitrary definition. In addition, attention has been drawn to the importance of regarding chest expansion in terms of a widely varying normal range of values, significantly influenced by age and sex, and also by diseases other than spondylitis.