Rib Evaluation and Tx Flashcards
How do evaluate ribs 1 and 2?
mostly bucket handle motion have pt inhale and exhale and monitor motion
How do you evaluate ribs 3-6?
mostly pump handle motion
place fingers just lateral to sternum on costal cartilage
monitor relative cephalad or caudal motion of
for ribs 4-6: palpate at costochondral ends w/ thumbs and midaxillary lines w/ fingertips
How do you evaluate rib 7?
primarily pump handle
pt supine
palpate rib 7 w/ thumbs at costochondral articulation for pump handle motion
How do you evaluate ribs 8-10?
mostly bucket handle
contact at midaxillary line w/ fingertips
monitor through respiration
How do you evaluate ribs 11 and 12?
Pt prone
palpate posterior aspect w/ thumbs
fingers 2 and 3 to palpate lateral and anterior aspects
monitor through respiration
*restriction of motion is influenced by quadratus lumborum
What is an inhalation dysfunction?
if one rib stops moving before the other during exhalation = exhalation restriction –> inhalation dysfunction
BITE = Bottom rib for inhalation dysfunction is the target of treatment
What is an exhalation dysfunction
if one rib stops moving before another during inhalation = inhalation restriction –> exhalation dysfunction
BITE = Top rib is target of treatment for Exhalation dyfunction
Rib 1 inhalation SD Tx
Pt supine, doc at head of table
Thumb ipsilateral to dysfunctional rib on anteromedial aspect of rib (top rib)
contralateral hand moves head into flexion, sidebent toward, rotated away from dyfunctional rib
follow rib down and fwd in exhalation
resist during inhalation
3-5x or until maximal improvement
Ribs 2-6 Inhalation SD Tx
Pt supine w/ thorax flexed up, doc uses knee to sidebend toward dysfunctional rib
web of ipsilateral thumb is on intercostal space superior to dysfunctional rib
during exhalation, exaggerate motion
resist during inhalation
3-5x or until maximal improvement
Ribs 7-10 inhalation SD Tx
Pt: supine w/ ipsilateral shoulder adducted
Doc on side of dysfunctional rib
ipsilateral thumb and index finger on superior surface of dysfunctional rib
sidebend to level of dysfunctional rib
during exhalation: exaggereate
during inhalation: resist
Ribs 11-12 inhalation SD Tx
Pt: prone w/ legs sidebent towards dysfunction
doc: on opposite side of SD
cephalad hand: hypothenar em medial and inferior to angle of dysfunctional rib
caudad hand: grasp ASIS ipsilateral to SD
Apply sustained lateral and cephalad traction to dysfunctional rib
exaggerate during exhalation
resist during inhalation
3-5x
What muscles do you utilize during exhalation SD of rib 1?
anterior, middle scalenes
What muscles do you utilize during exhalation SD of rib 2?
posterior scalene
What muscles do you utilize during exhalation SD of rib 3-5?
pectoralis minor
What muscles do you utilize during exhalation SD of ribs 6-8?
serratus anterior
What muscles do you utilize during exhalation SD of ribs 9-10?
latissimus dorsi
What muscles do you utilize during exhalation SD of ribs 11-12?
quadratus lumborum
ribs 1-2 exhalation SD Tx
Pt: supine, head rotated 30 degrees away from SD rib w/ back of ipsilateral wrist on forehead
doc: stands contralateral to SD
cephalad hand on pt’s hand on forehead
crawdad hand on superior angle of SD rib
apply caudad, lateral traction w/ caudad hand and have pt flex head and neck. Apply counterforce
isometric contraction 3-5 sec, then have pt relax
increase traction and repeat
Ribs 3-5 exhalation SD tx
Pt: supine w/ arm ipsilateral to SD fully flexed
doc: contralateral to SD
cephalad hand on pt’s arm
crawdad hand on sup angle of dysfunctional rib
apply caudad, lateral traction on affected rib; have pt push elbow against cephalad hand while applying counterforce
MET principles
Ribs 6-8 exhalation SD Tx
Pt: supine w/ ipsilateral shoulder flexed to 90 degrees
doc: ipsilateral to SD
cephalad hand: grasp superior angle of dysfunctional rib
caudad hand = maneuver elbow
caudad, lateral traction w/ cephalad hand on rib
have pt push elbow toward ceiling and apply counterforce
MET
Ribs 9-10 exhalation SD Tx
Pt: supine w/ arm on SD side abducted
doc: ipsilateral to SD
cephalad hand: abducts ipsilateral should to 90 degrees and stabilizes elbow
caudad hand: grasps sup angle of SD rib
have pt push elbow caudally and apply counterforce
MET
Ribs 11-12 exhalation SD Tx
Pt: prone w/ legs sidebent away from SD
doc: contralateral to SD
ceph hand: stabilizes rib superior to SD
crawdad hand: grasps iliac crest ipsilateral to SD
ceph hand exerts cephalad pressure while pt pulls iliac crest ipsilateral to SD toward same side shoulder while doc applies counterforce
MET
