A pneumothorax occurs when air enters the pleural space between the lungs and chest wall, causing the lung to collapse. It can be caused by trauma, rupture of blebs or bullae in the lungs, or underlying lung conditions. Symptoms include chest pain and shortness of breath. On examination, findings may include diminished chest movement, absent breath sounds, and hyper-resonance on percussion. Treatment involves bed rest for small pneumothorax, needle aspiration or chest tube for large ones, and potential pleurodesis or pleurectomy for recurrent cases. Physiotherapy focuses on expansion exercises to re-expand the lung and shoulder exercises to maintain mobility.

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

2. 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.

3.  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.

4. Pneumothorax:
Traumatic
Atraumatic/Spontaneous
Primary Secondary

5.  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.

6.  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.

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

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

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

10. 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

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

12. 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.

13. 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

14. 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

15. 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.

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