What are the typical ribs?
3rd-10th ribs
Typical ribs will always have the following
- tubercle
- head
- neck
- angle
- shaft
What are the atypical ribs?
1st
- articulates only with T1 and has no angle
2nd
- large tuberosity on the shaft that attaches to the serratus anterior
11th & 12th
- articulate only w/ corresponding vertebra and lack tubercles
sometimes rib 10 is considered atypical since it articulates only T10
True ribs
Ribs 1-7
- attach to the actual sternum
False ribs
Ribs 8-10
- has anterior articulation and posterior articulation but no costal notches on the sternum
Floating ribs
11th /12th
- there is no anterior articulation and only attach to the spinal segments
What ribs exhibit a caliper/pincer motion?
Ribs 11 and 12th
What is the predominant motion of ribs 1-6?
Pump handle motions
- still has some bucket handle though
note that all ribs 1-10 have both motions, but as you go further up, pump handle motion begins to take predominance
What is the predominant motion of ribs 7-10?
Bucket handle motion
- still possess some pump-handle motion
note that all ribs 1-10 have both motions, but as you go further down, bucket handle motion begins to take predominance
What is motion of pump handle motions when inhaling and exhaling?
Inhalation
- anterior portion of the rib moves anterior and superior
- posterior angle moves posterior and inferior
Exhalation
- anterior portion of the ribs moves posterior and inferiorly
- posterior angle moves anterior and superior
- motion is in a sagittal plane and costovertebral-transverse line*
- best palpated at mid-clavicle are line*
What is motion of bucket handle motions when inhaling and exhaling?
Inhalation
- lateral margin of the rib moves lateral and superior
- increase in transverse diameter
Exhalation
- lateral margin of the ribs moves medial and inferiorly
- decrease in transverse diameter
- motion is in a coronal plane and costovertebral-sternal line*
- best palpated at mid-axillary are line*
What is motion of caliper motion ribs when inhaling and exhaling?
Inhalation
- rib moves posteriorly and inferiorly
Exhalation
- rib moves anteriorly and superiorly
- motion is in a transverse plane and cephalad-pedad (vertical) line*
- best palpated at 3-5 cm lateral to transverse process*
Accessory muscles of inspiration
SCM
Scalenes
Pectoralis major
BITE phrase
Describes where the key rib is in a group of ribs based on the SOMATIC DYSFUNCTION (NOT RESTRICTION)
Bottom
Inhalation
Top
Exhalation
What ribs does each scalene help move?
Anterior = rib 1 only
Middle = rib 1 only
Posterior = rib 2 only
How do you palapate the anterior ribs 2-6
Palpate the cartilaginous attachments at the costalsternal boarder
- Rib 1= upper portion of the manubrium
- Rib 2= angle of Louis
- Rib 3-6 = attached to the lateral side of the sternum, can feel in the intercostal spaces
make sure to assess static, passive and dynamic motions
Patient is supine w/ physician at head of table
- place hands over ribs 2-6 OR fingertips on ribs 2-6 at parasternal region attachment
How do you palapate the anterior ribs 7-11
Identified by the little notches that are created when the cartilage of one rib connects to the rib above
- Rib 7 = 1st notch palpable inferior lateral to diploid process
- Rib 8 = medial 1/3rd way from proximal clavicle (roughly between R7/R9
- Rib 9 = midclavicular line
- Rib 10 = lateral 1/3rd of clavicle
- Rib 11 = free floating with tip at midaxillary line
Patient supine, physician stands at side where dominant eye is midline
- place fingertips on ribs 7-10 w/ little finger on rib 10 and index finger on rib 7
What are the direct effects of performing OMT on the thoracic cage?
1) improves breathing mechanics
2) modulation of the sympathetic NS
- both turn on and off
3) decreases pain
4) improves posture
Ribs 1 and 2 exhalation somatic dysfunction ME treatment
Uses reciprocal inhibition
- rib 1 engages the anterior and middle scalenes
- rib2 engages the posterior scalene
Physician stands on side opposite of dysfunction
- grapes superior edge of key rib between transverse process and angle w/ fingers
- exert constant anterior pressure w/ caudad hand and lateral traction
- pt face is forward (rib1) and 30 degrees rotated away (rib2), with patients wrist on forehead
- pt takes deep breath in and holds inhalation as they lift head against physcian resistance (3-5 seconds)
- pt exhales and relaxes as physician increases caudad and lateral traction
- repeat 3-5 times
