Counterstrain Anterior Ribs

Question 1

Thoracic Outlet Borders

Answer 1

Middle and anterior Scalenes
1st Rib
Clavicle
Cervicle Rib (if present)

Question 2

Thoracic Outlet Syndrome Affects

Answer 2

Brachial Plexus
Subclavian artery
Subclavian vein

Question 3

Anterior and middle scalenes compress

Answer 3

Brachial Plexus

Subclavian artery

Question 4

common site of impingement

Answer 4

anterior and middle scalenes
clavicle and 1st rib
costo-prctoral-coraco reigon

Question 5

Roos Test

Answer 5

checks for TOS
arms parallel to ground and elbows flexed 90° superior
open and close hands X 3 minutes
+ = paresthesias

Question 6

Adsons Test

Answer 6

• Shoulder & arm held in slight extension and abduction
• Slight extension of head turned toward affected side
• Physician palpates wrist for radial pulse
• (+) Test = Weakened radial pulse or paresthesias in arm

Question 7

Wrights Test

Answer 7

Hyperabduct arm above the head in the coronal plane
• Palpate radial pulse
• Instruct the patient to turn their head away
• (+) Test = Weakened radial pulse or paresthesias in arm

Question 8

AR1 Location

Answer 8

Inferior to the clavicle on the first chondrosternal articulation

Question 9

AR2 Location

Answer 9

Superior aspect of rib 2 in mid- clavicular line

Question 10

AR3 - AR6 Location

Answer 10

Anterior axillary line on the corresponding rib

Question 11

Scalene Muscles

Answer 11

Origin:
Transverse processes of cervical vertebrae
Insertion:
Rib 1: Anterior & middle scalenes
Rib 2: Posterior scalene
Action:
Elevates ribs 1 & 2

Question 12

Pec Minor

Answer 12

Origin:
• Ribs 3,4, & 5
PECTORALIS MINOR
Insertion:
• Coracoid process of the scapula
Action:
• Depresses scapula
• Rotates scapula inferiorly
• Elevates the ribs of origin, if the scapula is fixed

Question 13

Serratus Anterior

Answer 13

Origin:
• Upper 8 ribs
Insertion:
• Medial border & inferior angle of scapula
Action:
• Accessory muscle of respiration
• Protraction of scapula
• Elevation of the ribs of origin if scapula is fixed

Question 14

AR1 Treatment

Answer 14

• Patient supine
• Slight flexion
• Sidebending toward
• Moderate rotation toward - FSTRT

Question 15

AR2 Treatment

Answer 15

• Patient supine
• Slight flexion
• Sidebending toward
• Moderate rotation toward - FSTRT

Question 16

AR3 Treatment

Answer 16

• Patient seated
• STRT with slight flexion
• Patient has feet on the table on the treatment side,
  but is supported by the physician’s knee under the opposite side

Question 17

AR4 Treatment

Answer 17

• Patient seated
• STRT with slight flexion
• Patient has feet on the table on the treatment side,
  but is supported by the physician’s knee under the opposite side

Question 18

AR5 Treatment

Answer 18

• Patient seated
• STRT with slight flexion
• Patient has feet on the table on the treatment side,
  but is supported by the physician’s knee under the opposite side

Question 19

AR6 Treatment

Answer 19

• Patient seated
• STRT with slight flexion
• Patient has feet on the table on the treatment side,
  but is supported by the physician’s knee under the opposite side

Question 20

Treatment Position for all

Answer 20

FSTRT
1-2: supine
DO seated at head of table supporting pt head
3-6: seated with legs on table on affected side
DO behind pt with foot on table and leg supporting pt on unaffected side