Comp 7 Flashcards
For ME for rib 1 exhalation pump handle dysfunction, what is the position of the patient?
Supine with hand on side of dysfunctional rib on forehand and palm up
For ME for rib 1 exhalation pump handle dysfunction, where is the student and the hands?
Standing at edge of table on dysfunctional rib side
Contact superior aspect of affected rib angle with one hand
Place other hand on top of patient’s hand on forehead
What does the student do during inhalation for ME for rib 1 exhalation pump handle dysfunction?
Pull inferior on affected rib, encouraging engagement into inhalation barrier of rib
While simultaneously applying a posterior pressure to patient’s hand that is on forehead
What does the patient do when holding his breath and force is being applied to rib angle for ME for rib 1 exhalation pump handle exhalation dysfunction? What muscle is activating to correct the dysfunction?
Patient raises his head off table into student’s hand for 3-5 seconds (isometric contraction)
Then relax and breathe (post-isometric relaxation)
Anterior scalene muscle is activating to correct dysfunction
Describe how to diagnose rib 1 bucket handle exhalation somatic dysfunction
Patient supine
Student at head of table
Student places thumbs on angle of rib 1 and index fingers posterior to clavicle and over lateral aspect of rib 1 on midaxillary line
Student monitors through inhalation/exhalation
Note dysfunctional rib lagging behind upon inhalation compared to other side
Describe position of patient for ME for rib 1 exhalation bucket handle dysfunction?
Patient supine with head and neck rotated 30 degrees away from affectd side
Patient has hand on side of dysfunctional rib on forehead and palm up
Describe position of student and hands for ME for rib 1 bucket handle exhalation dysfunction?
Student at edge of table on dysfunctional rib side
Contacts superior aspect of affected rib angle with one hand
Places other hand on top of patient’s hand on forehead
What does the student do during patient inhalation for ME for rib 1 exhalation bucket handle dysfunction?
Student pulls inferior on affected rib, encouraging engagement into the inhalation barrier of rib
While simultaneously applying posterior pressure to patient’s hand that is on forehead
What does the patient do when holding his breath and force is being applied to rib angle during ME for rib 1 bucket handle exhalation somatic dysfunction? What muscle is activating to correct dysfunction?
Patient raises his head off table into student’s hand for 3-5 seconds (isometric contraction)
Then relax and breathe (post-isometric relaxation)
Middle scalene muscle
Describe how to diagnose rib 2-10 exhalation pump handle somatic dysfunction
Patient supine
Student at head of table
Fingers or medial aspects of hands parasternally for ribs 2-6 then over costochondral junctions of ribs 7-10.
Monitor through inhalation/exhalation
Dysfunctional rib lags behind upon inhalation copmared to other side
For a group dysfunction, treatment will be focused to superior rib of group
Where is the patient for ME for ribs 2-10 exhalation pump handle somatic dysfunction?
Patient supine
With hand on side of dysfunctional rib on forehead palm up
Describe how to diagnose a rib 1 pump handle exhalation somatic dysfunction
Patient supine
Student at head of table
Place thumbs on angle of rib 1
Place index fingers posterior to clavicle and over anterior aspect of rib 1
Monitor through inhalation and exhalation
Dysfunctional rib lagging behind upon inhalation compared to other side
Where is the student and hads for ME for ribs 2-10 exhalation pump handle somatic dysfunction?
Student standing at edge of table on dysfunctional rib side
Contact superior aspect of affected rib angle with one hand
Other hand on top of pt’s hand on forehead
What does the student do during pt inhalation for ME for ribs 2-10 pump handle somatic dysfunction?
Pull inferior on affected rib
Encourage engagement into inhalation barrier of rib
While simultaneously applying a posterior pressure to pt’s hand that is on forehead
During ME for ribs 2-10 exhalation pump handle somatic, what does the patient do while holding breath and force is applied to rib angle? What muscles are activating the force?
Pt raises hand on forehead toward ceiling and into student’s hand for 3-5 seconds (isometric contraction)
Then relax and breathe (post-isometric relaxation)
Pectoralis and serratus anterior muscles
Describe diagnosis of rib 2-10 bucket handle exhalation somatic dysfunction
Patient supine Doc at head of table Doc fingers on ribs in midaxillary line Monitor through inhalation/exhalation Dysfunctional rib lags during inhalation Treatment will be focused to superior rib of group
For ME for ribs 2-10 exhalation bucket handle somatic dysfunction, describe pt placement
Pt supine with hand on side of dysfunctional rib placed on forehead, palm up
For ME for ribs 2-10 exhalation bucket handle somatic dysfunction, where is the students and hands?
Student at edge of table on dysfunctional side
Contact superior aspect of affected rib angle
Other hand on top of pt’s hand that is on forehead
During inhalation for ME for ribs 2-10 exhalation bucket handle somatic dysfunction, what does the student do?
Pull inferior on affected rib
Encourage engagement into inhalation barrier
While simultaneously applying a posterior pressure to pt’s hand on forehead
When pt holds breath during ribs 2-10 exhalation bucket handle somatic dysfunction, what does the pt do? What is the activating muscle?
Raise hand toward ceiling and laterally at 45 degree angle and into student’s hand (isometric contraction)
Relax and breathe (post-isometric relaxation
Lateral part of serratus anterior muscle
Describe diagnosis for ribs 11-12 exhalation caliper somatic dysfunction
Pt prone
Student at side of table
Place fingers on body of ribs 11-12
Monitor through inhalation/exhalation
Dysfunctional rib lags behind inhalation compared to other side
Group dysfunction will be treated by focusing on superior rib
What is the position of the pt for ME for ribs 11-12 exhalation caliper dysfunction? Student position?
Pt prone
Student standing at side opposite dysfunctional rib
While monitoring dysfunctional rib, student moves pt’s lower extremities to induce side-bending of spine away from rib
Student moves pt’s involved side arm above head in abduction
With caudad hand, student grasps ASIS on side of dysfunction and pulls posterior to induce spinal rotation toward side of dysfunction
Cephalad hand will be placed on posterior aspect of involved rib just proximal to rib angle
What do the student and pt do when pt holds breath during ME for ribs 11-12 exhalation caliper dysfunction? What muscles provide activating force?
Student applies lateral distraction force on affected rib
Pt pulls ipsilateral hip toward table
Lateral part of latissimus dorsi and quadratus lumborum
Describe student and pt positions for ME for rib 1 inhalation pump handle somatic dysfunction?
Pt supine
Student at head of table and contacts superior/anterior aspect of dysfunctional rib with thumb (between 2 heads of SCM)
Student flexes head and neck to engage exhalation barrier
What does the student do during exhalation and inhalation for ME for rib 1 inhalation pump handle? Activating muscle?
During exhalation, apply force to anterior aspect of rib to follow dysfunctional rib inferiorly into its exhalation position
During inhalation, resist rib motion
SCM
Describe student and pt position for ME for rib 1 inhalation bucket handle?
Pt placed in supine
Student at head of table and contacts lateral aspect of dysfunctional rib with thumb (lateral to SCM)
Student flexes head and neck and sidebends toward dysfunctional rib to engage exhalation barrier
WHat does student do during exhalation and inhalation for ME For rib 1 inhalation bucket handle?
During exhalation, student applies force to lateral aspect of rib to follow dysfunctional rib motion inferiorly into exhalation position
During inhalation, resist rib motion
SCM
Describe student and pt position for ribs 2-10 inhalation pump handle?
Pt supine
Student at head of table with knee on table and under patient at level of dysfunctional rib to flex trunk to encourage rib into exhalation barrier
Contact affected rib parasternally/costochondral junction as well as superior aspect of dysfunctional rib
what does the student do during exhalation and inhalation for ME for ribs 2-10 inhalation pump handle? Activating muscles?
During exhalation, student applies force to anterior aspect of rib to follow dysfunctional rib inferiorly into its exhalation position
Resist rib motion during inhalation
Intercostal muscles and descent of diaphragm
Describe student and pt position for ME for ribs 2-10 inhalation bucket handle
Pt supine
Student standing at head of table with knee on table under pt at level of dysfunctional rib to flex trunk to encourage rib into exhalation barrier
Sidebend pt’s rib toward affected rib until relief of tissue tension is felt
Contact affected rib laterally (midaxillary line) as well as superior aspect of dysfunctional rib
What does student do during exhalation and inhalation for ME for ribs 2-10 inhalation bucket handle? Activating muscles?
During exhalation, student applies force to lateral aspect of rib to follow dysfunctional rib inferiorly into exhalation barrier
Resist during inhalation
Intercostal m and descent of diaphragm
Describe pt and student position for ME for ribs 11-12 inhalation caliper somatic dysfunction?
Pt prone
Student standing at side of table, opposite side of dysfunctional rib
While monitoring dysfunctional rib, pull pt’s lower extremities to induce side-bending away from dysfunctional rib. Keep pt’s arms at side
With caudad hand, student grasps ASIS on side of dysfunction and pulls posterior to induce spinal rotation toward side of dysfunction
Place cephalad hand on posterior aspect of involved rib just distal to rib angle
During exhalation, what do student and pt do for ME for ribs 11-12 inhalation caliper? Activating muscles?
Lateral distraction force is applied on affected rib
Pt pulls ipsilateral hip toward table
Quadratus lumborum m
Describe diagnosing posterior rib somatic dysfunction
pt prone or seated
Student loads and springs on rib angles, noting for hard end feel
Rib angle will be posterior in comparison to other side
Tissue texture changes and pain
Describe student and pt position for modified Kirksville HVLA for posterior rib head
Pt supine
Student standing on contralateral side of dysfunction (opposite)
Student has pt’s arm on side of dysfunction reach toward opposite ASIS, while contralateral arm grasps opposite shoulder
Student rolls pt toward self by grasping opposite shoulder, then places caudad thenar eminence on posterior rib angle to act as a fulcrum
Student flexes upper extremity at shoulder closest to student, to place pt’s elbow directly over posterior rib angle
Cephalad hand and arm can be under pt’s head to add slight tension
Roll pt onto back and past midline to direct pressure to rib angle
Describe the thrust for modified Kirksville HVLA for posterior rib head
Student will increase posterior pressure into thoracic cage
Then provide an anterior to posterior thrust (into table) to dysfunctional rib angle
Describe pt and student position for chin pivot HVLA for ribs 1-4
Pt prone and cup chin with ipsilateral hand
Student at head of table opposite side of dysfunctional rib
Contact dysfunctional rib by placing thenar/hypothenar eminence at dysfunctional rib angle with one hand
Move ipsilateral elbow cephalad until motion is palpated at dysfunctional to gap rib and transverse process
Place other hand on same side of patient’s head at dysfunctional rib and rotate head/neck toward side of dysfunction into restrictive barrier
Describe the thrust for chin pivot HVLA for ribs 1-4
with exhalation, student increases force onto rib angle and simultaneously into rotation barrier with head and neck
At end of exhalation, student applies thrust onto dysfunctional rib in an anterior/lateral direction
Thrust is not onto patient’s head/neck. Hand is only stabilizing head to maintain side bending/rotation barrier
Describe diagnosis for elevated 1st rib
Pt supine
Student at head of table
Load and spring inferior onto 1st rib at midaxillary line noting for hard end feel
Describe pt and student position for J-stroke HVLA for elevated 1st rib
Pt seated
Student behind patient. Place foot opposite dysfunctional rib on table and have patient drape arm over knee and allow pt to lean into student’s leg
Student contacts dysfunctional rib with second MCP joint of hand on side of dysfunction rib in midaxillary line.
Other hand on top of patient’s head
Side bend pt’s head/neck toward dysfunctional rib
Describe thrust for J-stroke HVLA for elevated rib 1
With exhalation, student provides inferior force onto first rib to engage restrictive barrier
At end of exhalation, apply thrust inferiorly/medialy (in shape of J) on superior 1st rib
Ipsilateral shoulder girdle is not held in cephalad position to be sure that pt relaxes for procedure
