Sites for measurement of chest expansion in females

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Chest expansion in females is measured at the xiphisternal level, just below the breasts.

The tape goes around the chest at that level. Measure the difference in circumference between maximal inspiration and maximal expiration. Ask the patient to breathe out fully first, then take a maximal breath in.

Females: just below the breasts, at the xiphisternal level.
Males (for comparison): the level of the 4th intercostal space, which is roughly at the nipple line.

This comes from the Chest Expansion section of Firestein & Kelley's Textbook of Rheumatology, which says to measure "on maximal inspiration after forced maximal expiration at the level of the fourth intercostal space in males and just below the breasts at the xiphisternal level in females."

Two other points on interpretation:

Chest expansion is mainly used to assess thoracic involvement in ankylosing spondylitis.
Normal expansion is more than 5 cm. Goldman-Cecil Medicine describes a difference of more than 5 cm between maximal inspiration and maximal expiration as normal (Goldman-Cecil Medicine, Physical Examination).

I didn't run the PubMed check for recent evidence, so I can't say whether newer work changes this.

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