title: The "ruler sign"--a semiquantitative physical sign of chronic obstructive pulmonary disease.
abstract: This report describes a simple and reproducible physical sign of chronic obstructive pulmonary disease--the "ruler sign." With the patient standing erect, a ruler is placed on the trapezius muscle and the clavicle at the midclavicular line. The ruler forms an angle with the horizontal line. At the end of a normal expiration this angle was 36 degrees +/- 4 SD in healthy control subjects as compared with 15 degrees +/- 4 SD in patients with severe chronic obstructive pulmonary disease. A simple device is described that enables convenient measurement of this angle at the bedside.
authors.affiliation: Department of Medicine, Meir General Hospital, Kfar Saba, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Ravid
authors.forename: D
authors.initials: D
authors.lastname: Schindler
authors.forename: J
authors.initials: J
authors.lastname: Shapira
authors.forename: B
authors.initials: B
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D002968:Clavicle; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008722:Methods; D008875:Middle Aged; D009132:Muscles; D010808:Physical Examination; D013909:Thorax