L13 Ribs and Radicular

Question 1

Rib Review

Answer 1

• joints include costovertebral and sternocostoal koints
• increasing mobility as you progress from cranial to caudal
• lower ribs transition from bone to cartilages as you transition from lateral to anterior and share attachment point on sternum
• superior ribs = water pump handle motion
• inferior ribs = bucket handle motion

Question 2

Rib pathology

Answer 2

Dislocations (rare)
Fractures (common)

Question 3

Fractures of rib

Answer 3

• trauma
• concern for organ damage if displaced
• concern for respiratory compromise if not displaced

Question 4

Rib Dysfunctions

Answer 4

• lack of rib mobility can cause chest wall pain, respiratory dysfunction, intercostal neuralgia, contribute to limited ROM, decreased sleep, reduced exercise tolerance
• occurs for 1-5% of pop
• poorly understood MOI
• possible types of dysfunctions include inhalation, exhalation, A/P

Question 5

Cervical Radiculopathy

Answer 5

• disc disorders or cervical spondylosis are associated
• less common than lumbar radiculopathy
• most common nerves impacted are C6, C7
• RF include 5th decade of life, smoking, manual labor career

Question 6

Cervical Radiculopathhy Test Clusters

Answer 6

• pos Spurling
• pos Distraction test
• pos Cervical rotation < 60°
• pos Upper limb tension test

if 3/4 are present, +6.1
if 4/4 are present, +30.3

Question 7

Myelopathy vs Radiculopathy vs Peripheral Nerve Entrapment

Answer 7

Myel = compression of spinal cord
Rad = compression of nerve root
PN = compression of nerve

Question 8

Prognosis of Cervical Radiculopathy

Answer 8

• 85% of acute cervical radiculopathy resolves without any specific treatments in 8-12 weeks
• ability to centralize is POSITIVE prognostic factor
• significant myotomal loss is NEGATIVE prognostic factor
• pain severity and irritability is not predictive factor

Question 9

Acute phase for Cervical Radiculopathy

Answer 9

• Patient education to stay active aerobically, change posture, centralization, sleeping posture
• Manual traction
• McKenzie Repeated motions with progression of forces
• soft tissue mob
• ROM
• avoid neural mobs

Question 10

McKenzie MDT Approach

Answer 10

• forward head posture is typical in modern ADLS and work
• retraction is the opposite of this
• consists of upper cervical flexion and lower cervical extension
• expect 10 reps for centralization
• may need to do AAROM or traction in supine if really irritable

Question 11

Examples of Mckenzie MDT Approach

Answer 11

• Beginning with mid range
• static holds to then dynamic reps
• loaded WB and then unloaded traction
• patient OP to PT OP
• retraction with extension
• stay in sagittal plane with timing
• retraction with lateral flexion

Question 12

Cervical traction added to manual therapy and exercise is better than

Answer 12

manual therapy and exercise alone

Question 13

Traction Parameters

Answer 13

• Supine > sitting due to relax of postural muscle
• typical angle of 15-20°, can progress to 30°
• Disc 10-15 lbs, 7-10% BW, 5-10 min, static
• Jt 20-30 lbs, 20% BW, 15-30 min, intermittent

Question 14

Subacute/Chronic management for Cervical Radiculopathy

Answer 14

• can reclassify if possible and have maintained centralization
• track neuro signs for changes
• encourage PA
• wean off mechanical techniques and encourage self-management
• neural mobs including flossing

Question 15

Indirect manual therapy for CR

Answer 15

regional interdependence
soft tissue mob for pain, guarding

Question 16

Direct manual therapy fro CR

Answer 16

traction
grade 2 local rotation mobs