CPA 1.3: LAB Ribs Flashcards

1
Q

Upper Ribs 1-2 EVALUATION

*** primarily bucket handle

A

Patient supine or seated. Examiner at head of table or behind patient. To evaluate bucket handle motion of rib 1, place thumbs posteriorly on the angle of rib 1. Place index fingers in the supraclavicular fossa anterior to the trapezius, over the superior lateral aspect of rib 1. Instruct patient to inhale and exhale and monitor motion through respiration.

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2
Q

Middle ribs 3-6 EVALUATION

A

Primarily bucket handle motion

Patient supine. Examiner places two fingers just lateral to the sternum on the costal cartilage of each rib set. Monitor the relative cephalad or caudal relation of the pair and, on the symptomatic side, determine whether that rib is more prominent or less prominent or superiorly or inferiorly positioned. The examiner then monitors the ribs through inhalation and exhalation. Next, palpate ribs 4-6 at their costochondral ends with the thumbs and at their midaxillary lines with the fingertips. Repeat this process for each set of ribs.

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3
Q

Lower ribs 7-10 EVALUATION

A

Rib 7: Primarily pump handle

Ribs 8-10: Primarily bucket handle

Patient supine. Examiner stands to the side of patient. Using thumbs, palpate rib 7 bilaterally at its costochondral articulation for pump handle motion. Contact ribs 8-10 at the midaxillary line with the fingertips for bucket handle motion. Monitor through respiration.

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4
Q

Floating ribs 11 and 12 EVALUATION

A

Caliper

Patient prone. Examiner at side of table and uses thumbs to palpate the posterior aspect and 2nd and 3rdfingers to palpate the lateral and anterior aspects of ribs 11 and 12 bilaterally. Monitor through respiration.

**Restriction of motion is influenced by quadratus lumborum

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5
Q

Diagnosis of elevated first rib

A

Position

Patient: seated

Doctor: standing behind patient

Hand Position

  • Thumbs palpate posterolateral body of the first rib lateral to the costotransverse articulation
  • Index fingers palpate anterior infraclavicular space

Technique

  • Induce a caudad force alternately on each rib
  • Monitor relative cephalad or caudad position of the pair
  • Assess for prominence, pain and spring with downward pressure
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6
Q

Describe what happens in inhalation and exhalition in evaluation and diagnosis

A

INHALATION

If one rib stops moving before the other rib during exhalation, that rib has an exhalation restriction, therefore an inhalation dysfunction

*Moves into inhalation position, restricted to exhalation position

The most inferior (bottom) rib in a group of ribs is the key rib to target treatment.

“BITE”

EXHALATION

If one rib stops moving before the other rib during inhalation, that rib has an inhalation restriction, therefore an exhalation dysfunction.

*Moves into exhalation position, restricted to inhalation position

The most superior (top) rib in a group of ribs is the key rib to target treatment.

“BITE”

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7
Q

Rib 1 inhalation treatment

A

Position

Patient: supine

Doctor: sitting at head of table

Hand Position

  • Thumb ipsilateral to dysfunctional rib placed on anteromedial aspect of dysfunctional rib
  • Contralateral hand maneuvers the head into flexion, sidebent towards and rotated away from dysfunctional rib

Technique

  • Follow rib down and forward into exhalation
  • As patient inhales, resist the motion of the dysfunctional rib

Repeat 3-5 times or until motion is maximally improved

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8
Q

Ribs 2-6 inhalation treatment

A

Position

Patient: supine with dysfunctional rib resting on doctor’s knee, sidebend towards dysfunctional rib

Doctor: standing with flexed knee ipsilateral to dysfunctional rib on the table

Hand Position

-Web of ipsilateral thumb-index finger is placed in the intercostal space superior to the dysfunctional rib

Technique

  • During exhalation: doctor exaggerates the motion
  • During inhalation: doctor resists the motion
  • Repeat 3-5 times or until motion is maximally improved
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9
Q

Ribs 7-10 inhalation treatment

A

Position

Patient: supine with ipsilateral shoulder adducted (abduction is shown only to illustrate proper hand placement)

Doctor: stands on side of dysfunctional rib

Hand Position

-Ipsilateral thumb and index finger on superior surface of dysfunctional rib

Technique

  • Sidebend to the level of dysfunctional rib
  • During exhalation: doctor exaggerates the motion
  • During inhalation: doctor resists the motion
  • Repeat 3-5 times or until motion is maximally improved
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10
Q

Ribs 11-12 inhalation treatment

A

Position

Patient: prone with legs sidebent 15-20° towards the dysfunction (decrease tension on quad. lumborum m.)

Doctor: stands opposite the dysfunctional rib

Hand Position

–Cephalad hand – hypothenar eminence medial and inferior to the angle of the dysfunctional rib

–Caudad hand – grasps ASIS ipsilateral to dysfunction to shorten quadratus lumborum

Technique

  • Apply sustained lateral and cephalad traction to dysfunctional rib
  • During exhalation: doctor exaggerates the motion
  • During inhalation: doctor resists the motion
  • Repeat 3-5 times or until motion is maximally improved
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11
Q

Ribs 1-2 exhalation treatments

A

Position

Patient: supine, head rotated 30° away from dysfunctional rib with dorsum of ipsilateral wrist on forehead

Doctor: stands contralateral to dysfunctional rib

Hand Position

–Cephalad hand – placed on top of patients hand on forehead

–Caudad hand – grasps the superior angle of the dysfunctional rib

Technique

  • While applying caudad, lateral traction with caudal hand instruct the patient to flex the head and neck (while maintaining rotation) and apply counterforce
  • Maintain isometric contraction 3-5 seconds then have patient relax
  • Increase caudad, lateral traction and repeat steps of muscle energy
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12
Q

Ribs 3-5 Exhalation treatment

A

Position

Patient: supine with arm ipsilateral to dysfunctional rib fully flexed

Doctor: contralateral to dysfunctional rib

Hand Position

–Cephalad hand – rests on patients arm

–Caudad hand – grasps the superior angle of the dysfunctional rib

Technique

  • While applying caudad, lateral traction on the affected rib with the caudad hand, instruct patient to push elbow against doctors cephalad hand while applying a counterforce
  • Maintain isometric contraction 3-5 seconds then have patient relax
  • Increase caudad, lateral traction and repeat steps of muscle energy
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13
Q
A
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14
Q

Ribs 6-8 exhalation treatment

A

Position

Patient: supine with ipsilateral shoulder flexed to 90°

Doctor: ipsilateral to dysfunctional rib

Hand Position

Cephalad hand – grasps the superior angle of the dysfunctional rib

Caudad hand – maneuvers elbow

Technique

  • While exerting caudad, lateral traction with cephalad hand, instruct patient to push elbow towards the ceiling (scapular protraction) and apply counterforce
  • Maintain isometric contraction 3-5 seconds then have patient relax
  • Increase caudad, lateral traction and repeat steps of MET
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15
Q

Ribs 9-10 exhalation treatment

A

Position

Patient: supine with arm on dysfunctional side abducted

Doctor: ipsilateral to dysfunctional rib

Hand Position

Cephalad hand – abducts ipsilateral shoulder to 90° and stabilizes elbow

Caudad hand – grasps the superior angle of the dysfunctional rib

Technique

  • Instruct patient to push their elbow caudally (into adduction) and apply counterforce
  • Maintain isometric contraction 3-5 seconds then have patient relax
  • Increase caudad, lateral traction and repeat steps of MET
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16
Q

Ribs 11-12 exhalation treatment

A

Position

Patient: prone with legs sidebent 15-20° away from dysfunction (increase tension on ipsilateral quadratus lumborum)

Doctor: stands contralateral to dysfunctional rib

Hand Position

Cephalad hand – stabilizes rib superior to the dysfunctional rib

Caudad hand – grasps iliac crest ipsilateral to dysfunctional rib (increase tension on ipsilateral quadratus lumborum)

Technique

  • Cephalad hand exerts cephalad pressure while patient pulls iliac crest ipsilateral to the dysfunction towards the ipsilateral shoulder while physician applies counterforce
  • Maintain isometric contraction 3-5 seconds then have patient relax
  • Increase caudad, lateral traction and repeat steps of MET