Pneumothorax : Physiotherapy
Assessment Include Goals And
Treatment
Ms. Shilpasree Saha
BPT, MPT (Cardio Thoracic Disorders)
MIAP

Pneumothorax
 A pneumothorax is a collection of air
outside the lung but within the pleural
cavity.
 It occurs when air accumulates
between the parietal and visceral
pleurae inside the chest.
 The air accumulation can apply
pressure on the lung and make it
collapse.

 Air can enter the pleural space by two
mechanisms, either by trauma causing
communication through the chest wall
or from the lung by rupture of the
visceral pleura.

Pneumothorax:
Traumatic
Atraumatic/Spontaneous
Primary Secondary

 A primary spontaneous pneumothorax
(PSP) occurs automatically without a
known eliciting event, while a
secondary spontaneous
pneumothorax (SSP) occurs after an
underlying pulmonary disease.
 A traumatic pneumothorax can be the
result of blunt or penetrating trauma.

 A simple pneumothorax does not shift
the mediastinal structures, as does a
tension pneumothorax.
 Open pneumothorax is an open
wound in the chest wall through which
air moves in and out.

Aetiology
I. Rupture of a
pleural bleb in the
region of apex of
lung.

Computed tomography (CT) showing blebs.
Chest x-ray showing pneumothorax with blebs.

II. Rupture of emphysematous bulla.
III. Rupture of lung abscess or
tuberculosis lesion into pleural
cavity.

a The chest radiography image shows a large lucency occupying the right upper thorax with mediastinal shift and
patchy opacities of the left apical area. b The coronal computed tomography image shows giant bullae occupying
the right thorax and multiple opacities over the left upper lung

Other causes
 Penetrating rib fracture
 Penetrating wounds
 Accidental opening of pleural cavity
during abdominal surgery
 Penetration of pleura during central
venous pressure catheter insertion.

Physical findings
 The most common symptoms are:
 Chest pain
 Shortness of breath.
 The chest pain is pleuritic, sharp,
severe, and radiates to the ipsilateral
shoulder.

On examination, the following findings are
noted:
 Diminished chest movement
 Absence of breath sound over apex of
effected lung.
 Respiratory discomfort
 Increased respiratory rate
 Asymmetrical lung expansion
 Decreased tactile fremitus
 Hyper resonant percussion note
 Decreased intensity of breath sounds or
absent breath sounds

In tension pneumothorax following
additional findings are seen:
 Tachycardia of more than 134 beats
per minute
 Hypotension
 Jugular venous distension
 Cyanosis
 Respiratory failure
 Cardiac arrest

Treatment
 A small pneumothorax requires few
days of bed rest until it resolves.
 A large pneumothorax (›25 percent of
pleural space is filled with air) is
treated with needle aspiration or by an
intercostal drain.
 Pleurodesis or pleurectomy may
indicated for recurrent pneumothorax.

PT-Treatment
 Expansion breathing exercise to
reexpand the lung.
 Shoulder ROM exercises to maintain
shoulder, shoulder girdle and thoracic
mobility