2nd Rib Dysfunction

Question 1

1st support for 2nd rib dysfunction

Answer 1

Boyle (1999): Dysfunction of 2nd rib costovertebral or costotransverse articulation in isolation is a cause of shoulder pain that is misdiagnosed as impingement and/or RTC partial tears. Presented a case of female with 2nd rib syndrome.

Question 2

T4 Syndrome

Answer 2

McGuckin (1986): Described T4 syndrome that presents with glove-like distribution of paresthesia and pain in one or both upper limbs. Vertebral segments T2-T7 may be cause of this syndrome.

Question 3

Anatomical justification of shoulder pain from 2nd rib

Answer 3

`Maigne (1991): Described the dorsal ramus of 2nd thoracic nerve continuing laterally to acromion, provides cutaneous distribution to posterolateral shoulder. Dorsal ramus passes through vertical opening limited caudally by the rib and laterally by superior costotransverse ligament. 2nd rib articulates with TP and demifacets of inferior border of T1 and superior border of T2. Tunnel may be narrowed due to superior and anterior subluxation of 2nd rib.

Question 4

Hawkins-Kennedy with 2nd rib dysfunction

Answer 4

May cause upward rotation force to rib articulations during GH IR, leading to further compromise of 2nd thoracic dorsal ramus. Resultant cutaneous pain in distribution of this nerve is false positive (Boyle 1999).

Question 5

What if no pain during 2nd rib accessory testing?

Answer 5

1. Palpate posterior scalenes for increased tone (attaches to 2nd rib)
2. Lower cervical (C5-C7) signs and symptoms may also be present on PAIVM or PPIVM testing. May be due to posterior scalene muscle tone/tightness.
3. Fixated T1-T4 segments likely give superior subluxation of 2nd rib on fixed thoracic vertebrae.

Question 6

Lindgren and Leino

Answer 6

(1988): Reported 4 case studies that described the association between subluxation of 1st rib and TOS. Role of anterior scalene repeatedly identified in literature with a compression of brachial plexus.

Question 7

Scalene relaxation after HVLAT

Answer 7

Anterior scalene originates from anterior tubercles of C3-C6 and middle scalene from posterior tubercles of C2-C7. There may be arthrogenic inhibition of segmentally associated muscles. Mechanoreceptors in facet joint capsule, ligaments, and proprioceptors (muscle spindles and GTO’s) of paravertebral muscles may alter afferents and inhibit alpha motor neuron pool, immediately reducing segmental muscle activity.

Question 8

Thoracic spine and shoulder pain

Answer 8

Sympathetic efferent outflow to UE is T5-T9.