Lab Ribs Dx and Tx

Question 1

ribs that exhibit bucket handle movement

Answer 1

ribs 1-2, 8-10

Question 2

ribs that exhibit pump handle movement

Answer 2

3-7

Question 3

ribs 1-10
ribs that are statically cephalad and have greater cephalad movement (and less caudad on exhalation) are said to have what dysfunction

Answer 3

inhalation rib dysfunction

Question 4

ribs 1-10
ribs that are statically caudad and have greater caudad movement (and move less cephalad on inhalation) are said to have what dysfunction

Answer 4

exhalation dysfunction

Question 5

how to palpate ribs 1-2

Answer 5

patient supine
1st rib - palpate at infraclavicular position at sternoclavicular articulation
2nd rib - one finger breadth below and one finger breadth lateral

monitor relative superior and inferior relation of the pair
monitor inhalation/exhalation

Question 6

how to palpate ribs 3-5

Answer 6

patient supine
palpate rib at chostochondral articulations for pump handle motion
palpate rib at midaxillary line for bucket handle motion

note which is more cephalad/caudad and superior/inferior
monitor inhalation and note movement

Question 7

how to palpate ribs 6-10

Answer 7

patient supine, doc at one side
palpate at their costochondral articulations for pump handle movement
palpate at the midaxillary line for bucket handle movement

monitor cephalad/caudad and superior/inferior position of ribs
monitor inhalation/exhalation movement

Question 8

ribs 11-12
if rib moves more posteriorly and inferiorly with inhalation and less anteriorly and superiorly with exhalation the rib is said to have

Answer 8

inhalation dysfunction

Question 9

ribs 11-12
if ribs move more anteriorly and superiorly with exhalation and less posteriorly and inferiorly with inhalation the rib is said to have

Answer 9

exhalation rib dysfunction

Question 10

BITE acronym

Answer 10

bottom of the
inspiration dysfunction group of ribs is the key rib
top of the
exhalation dysfunction group of ribs is the key rib

Question 11

exhalation dysfunction of rib 1 muscle to treat

Answer 11

anterior/middle scalene

Question 12

exhalation dysfunction of rib 2 muscle to treat

Answer 12

posterior scalene

Question 13

exhalation dysfunction of ribs 3-5 muscle to treat

Answer 13

pectoralis minor

Question 14

exhalation dysfunction of ribs 6-8 muscle to treat

Answer 14

serratus anterior

Question 15

exhalation dysfunction of ribs 9-10 muscle to treat

Answer 15

latissimus dorsi

Question 16

exhalation dysfunction of ribs 11-12 muscle to treat

Answer 16

quadratus lumborum

Question 17

inhalation dysfunction of ribs 1-10 method to treat

Answer 17

depress key rib

Question 18

inhalation dysfunction of ribs 11-12 method to treat

Answer 18

quadratus lomborum

Question 19

treat the ____ of inhalation ribs

Answer 19

bottom

Question 20

treat the ____ of exhalation ribs

Answer 20

top

Question 21

rib 1 MET/ART inhalation dysfunction setup

Answer 21

patient supine, doc sits at head of table
MCP of physician contacts superior surfaced of rib posterior and lateral to costotransverse articulation
sidebend towards and rotate away to reduce tension off the scalene muscle
follow rib into exhalation and resist inhalation
5-7 times
reassess

Question 22

rib 2-6 MET/ART inhalation dysfunction setup

Answer 22

patient supine, propped up until dysfunction rib has movement
sidebend towards side of dysfunction
induce downward force and resist inhalation and exaggerate exhalation
5-7 times
reassess

Question 23

ribs 7-10 MET/ART inhalation dysfunction setup

Answer 23

patient supine
abduct shoulder and place hand on the superior aspect of rib
side bend towards side of dysfunction
resist inhalation and exaggerate exhalation
5-7 times
reassess

Question 24

ribs 11-12 MET/ART inhalation dysfunction setup

Answer 24

patient prone
doc stands opposite the dysfunctional rib
sidebend towards dysfunctional rib to take tension off the quadratus lumborum
place hypothenar eminance of cephalad hand on inferior aspect of dysfunctional rib and exert lateral and cephalad traction
resist inhalation and exagerate exhalation
5-7 times
reassess

Question 25

ribs 1-2 MET/ART exhalation dysfunction setup

Answer 25

patient supine, arm on side of dysfunctional rib crossed over head with face turned away from dysfunction
doc places hand on superior aspect of dysfunctional rib and exerts lateral and caudad force
ask patient to push head up against force
pull hand more caudad and lateral
5-7 times
reassess

Question 26

ribs 3-5 MET/ART exhalation dysfunction setup

Answer 26

patient supine and arm fully flexed on side of dysfunction with hand behind head
doc puts hand on superior angle of dysfunctional rib and exerts caudad and lateral force
ask patient to try to adduct arm while doc stops force
pull hand more caudad and lateral
5-7 times
reassess

Question 27

ribs 6-8 MET/ART exhalation dysfunction setup

Answer 27

patient supine with arm of side of dysfunctional rib crossed over chest
doc puts hand on superior angle of dysfunctional rib and exerts caudad and lateral traction
ask patient to protract scapula against unyielding force
pull hand more caudad and lateral
5-7 times
reassess

Question 28

ribs 9-10 MET/ART exhalation dysfunction setup

Answer 28

patient supine with arm on side of dysfunctional rib laying off table
doc puts hand on superior angle of dysfunctional rib and exerts caudad and lateral traction
ask patient to adduct arm accross chest while doc provides unyielding force
pull hand more caudad and alteral
5-7 times
reassess

Question 29

ribs 11-12 exhalation dysfunction MET/ART

Answer 29

patient prone on table, sidebend patient through the legs away from the dysfunctional rib
cephalad hypothenar eminence exerts cephalad traction throughout technique
caudad hand grasps opposite iliac crest and pulls caudad
patient pulls iliac crest to shoulder while doc applies unyielding counterforce
caudad hand pulls more caudally
5-7 times
reassess