Lab 1: Ribs Dx & Tx MET/ART Flashcards
Which ribs follow a bucket handle motion; which direction is this movement and what diameter is increased?
- Ribs 1, 7-10
- Move superiorly and laterally
- Increase transverse diameter
Which ribs follow a pump handle motion; which direction is this movement and what diameter is increased?
- Ribs 1, 2-6
- Move superiorly and anteriorly
- Increase anterior/posterior (A/P) diameter
Which ribs follow a caliper-like motion; which direction is this movement; what diameter increases?
- Ribs 11-12
- Move inferior & posterior
- Increases transverse & vertical diameter
What are the Atypical ribs and why is each group classified this way?
Ribs 1, 10, 11, and 12
- Only articulate w/ their own vertebrae (NOT the one above as well)
RIbs 11, 12
- Do NOT have tubercles (and therefore do not articulate w/ TP’s)
What are the accessory muscles of respiration for ribs 1 and 2 (mnemonic for remembering them)?
Rib 1: Anterior and Middle Scalenes
Rib 2: Posterior Scalenes
“Woke up at 1 AM 2P”
What kind of dysfunction can contraction of the pectoralis muscles (mainly pec major) lead to?
- Anterior (inhalation) rib dysfunction
- Engaging pec minor can help tx exhalation dysfunctions by pulling the rib back up
What is the accessory muscle of inhalation when the scapula is fixed in plan (i.e., COPD patient grasping bedrail)?
Serratus anterior m.
When evaluating the caliper motion of Ribs 11-12 (floating ribs), any restriction of motion is influenced by which muscle?
Quadratus Lumborum
If one rib is statically cephalad and stops before the other ribs during exhalation (less caudad movement), what is the restriction and dysfunction?
- Restricted to exhalation
- Inhalation dysfunction
What is the key rib and how does this differ for inhalation vs. exhalation dysfunctions?
- Always treat the Key rib 1st!
- BITE
- Inhalation: treat the bottom (most inferior) rib first
- Exhalation: treat the top (most superior) rib first
If one rib stops is statically caudad and stops before the other ribs during inhalation (less cephalad movement), what is the restriction and the dysfunction?
- Restricted to inhalation
- Exhalation dysfunction
You’re palpating ribs 11-12 and notice that on one side the ribs move more posteriorly and inferiorly w/ inhalation and less anteriorly/superiorly w/ exhalation; what type of dysfunction is this?
Inalation dysfunction
You’re palpating ribs 11-12 and notice the patients ribs move more anteriorly and superiorly during exhalation, but less posteriorly/inferiorly with inhalation; what type of dysfunction is this?
Exhalation dysfunction
Tx for a inhalation dysfunction of rib 1 w/ ME/ART?
- Patient is supine and doc sitting at head of table
- Thumb ipsilateral to dysfunctional rib placed on anteromedial aspect of dysfunctional rib
- Contralateral hand maneuvers head into flexion, sidebent towards and rotated away from dysfunctional rib
- Follow the rib down and forward into exhalation; during inhalation resist the motion of rib
- Repeat 5-7x or until motion is maximally improved
Tx for a inhalation dysfunction of Ribs 2-6 w/ ME/ART?
- Patient supine w/ dysfunctional rib resting on doc’s knee, sidebent towards dysfunction
- Place web of ipsilateral thumb-index finger in the intercostal space superior to the dysfunctional rib
- During exhalation: doc exaggerates the motion
- During inhalation: doc resists the motion
- Repeat 5-7x or until motion maximally improved
Tx for a inhalation dysfunction of Ribs 7-10 w/ ME/ART?
- Pt is supine w/ ipsilateral shoulder abducted, doc stands on side of dysfunctional rib
- Ipsilateral thumb and index finger on supeior surface of dysfunctional rib
- Sidebend to the level of dysfunctional rib and during exhalation exaggerate motion, while resisting during inhalation
- Repeat 5-7x or until motion is improved
Tx for an inhalation dysfunction of Ribs 11-12 w/ MET/ART?
- Pt is prone w/ legs sidebent 15-20° towards the dysfunction (decreases the tension on Quadratus lumborum m.). Doc stands opposite the dysfunctional rib
- Hypothenar eminence of cephalad hand is medial and inferior to the angle of the dysf. rib
- Caudad hand grasps ASIS to stabilize pelvis
- Apply sustained lateral and cephalad traction to dysf. rib, exaggertaing the motion during exhalation and resisting during inhalation
- Repeat 5-7x or until motion improved
Which muscles are utilized during tx of exhalation dysfunctions: Rib 1, 2, 3-5, 6-8, 9-10, and 11-12?
Rib 1: Anterior, Middle Scalenes
Rib 2: Posterior Scalene
Ribs 3-5: Pectoralis Minor
Ribs 6-8: Serratus Anterior
Ribs 9-10: Latissimus dorsi
Ribs 11-12: Quadratus Lumborum
Tx for a exhalation dysfunction of Ribs 1-2 w/ MET/ART?
- Pt supine, head rotated 30° away from dysf. rib w/ dorsum of ipsilateral wrist on forehead
- Doc stands contralateral to dysf. rib w/ cephalad hanf on top of pt’s hand on forehead. Caudad hand grasps the superior angle of the dysf. rib
- While applying caudad, lateral traction w/ caudal hand instruct the pt to flex the head and neck (while maintaining rotation) and apply counterforce for 3-5 seconds, then relax
- Increase traction and repeat steps of muscle energy
Tx for a exhalation dysfunction of Ribs 3-5 w/ MET/ART?
- Pt supine w/ arm ipsilateral to dysfunctional rib fully flexed and doc contralateral to dysfunctional rib
- Cephalad hand rests on pt’s arm, while caudad hand grasps the superior angle of the dysfunctional rib
- While applying caudad, lateral traction on the affected rib w/ caudad hand, instruct the pt to push elbow against docs cephalad hand while applying a counterforce for 3-5 secs then relax
- Increase traction and repeat steps of MET
Tx for a exhalation dysfunction of Ribs 6-8 w/ ME/ART?
- Pt supine w/ ipsilateral shoulder flexed to 90°, with doc ipsilateral to dysf. rib
- Cephalad hand grasps superior angle of the dysf. rib, while caudad manuevers the elbow
- Exert caudad, lateral traction w/ cephalad hand, while patient pushes elbow towards the ceiling (scapular protraction) against your resistance for 3-5 secs and then relax
- Increase traction and repeat step of MET
Tx for a exhalation dysfunction of Ribs 9-10 w/ ME/ART?
- Patient is supine with doc ipsilateral to dysf. rib
- Cephalad hand abducts ipsilateral shoulder to 90° and stabilizes elbow. Caudad hand grasps the superior angle of the dysf. rib
- Pt asked to push their elbow caudally (into adduction) and counterforce is applied for 3-5 secs
- Increase traction and repeat steps of MET
Tx for a exhalation dysfunction of RIbs 11-12 w/ ME/ART?
- Pt is prone w/ legs sidebent 15-20° away from dysfunction (increase tension on ipsilateral quadratus lumborum). Doc stands contralateral to dysf. rib
- Cephalad hand placed inferior to dysf. rib, while caudad hand grasps iliac crest ipsilateral to dysf. rib (increase tension on quadratus)
- Cephalad hand exerts cephalad pressure while patient pull iliac crest ipsilateral to dysf. towards the ipsilateral shouldeer while counterforce is maintained for 3-5 secs.
- Increase tension and repeat steps for MET
What are the typical ribs?
Ribs 3-9
