LAB - Ribs Dx and Tx MET/ART

Question 1

How are you going to palpate the posterior thorax?

Answer 1

they sit up for this…

Put your hands flat along their back and move down and note which side is more posterior at which point.

it might mean posterior ribs or exhalation dysfunction.

Question 2

How do you palpate the anterior thorax?

Answer 2

similar to posterior –> but laying down.

Question 3

How do you assess for bucket handle motion

Answer 3

translate from side to side starting from the lowest point of the ribs to assess for rib motion

come up to the region of the breast tissue and engage the sides

move up to the axilla until you get to the third rib and evaluate it’s motion.

Question 4

how do you assess for pump handle motion?

Answer 4

move the breast tissue out of the way

find the sternum, go out to about rib two and move the tissue out to the side

then do you do gentle compression on each side to see which ribs are tender or more anterior.

Question 5

What’s an inhalation dysfunction?

Answer 5

If we find a rib that is STATICALLY CEPHALAD and has GREATER cephalic motion.. this is an INHALATION RIB DYSFUNCTION

Question 6

What’s an exhalation dysfunction?

Answer 6

if the rib on the symptomatic side is STATICALLY CAUDAL and on inhalation has LESS cephalad motion… this is an exhalation rib dysfunction

Question 7

How do you palpate ribs 1 and 2?

Answer 7

index finger right by clavicle, middle finger just below the clavicle finding where the first rib attaches to the sternum

1) look at them statically and look for what is more anterior and what is not.
2) have the pt take a big breath in and out. see if something is moving more anterior or posterior

Question 8

if someone is exhaling and it’s not moving down easily as they breathe out, what is the SD?

Answer 8

if during exhalation a side doesn’t move easily, it might be stuck in inhalation, so an inhalation SD

Question 9

How do we palpate rib 2?

Answer 9

you go down to the sternal angle and you Come out laterally and that’s Rib 2.

1) look at it statically
2) deep breath and see its movement!

Question 10

How do you palpate ribs 3-6

Answer 10

you go below the sternal angle and follow the speed bump until rib 3.

1) you put your fingers on each (on the side of the sternum) –> laterally!
2) You have them take a deep breath

go from 3-6.

Question 11

How do you palpate ribs 7-10?

Answer 11

you come down to the bottom of the xiphoid process and you slide up to the last attached rib which is rib 6.

you go below that and its rib 7.

because you’re below breast tissue, you can swing your whole hand along the rib for 7-10, and then go one finger for specific ribs.

Question 12

What are the rules to note for ribs 11-12? (how do they move)

Answer 12

they move differently than the other ribs (because they don’t attach to the transverse process or the vertebra above.

When you have the pt take a deep breath when palpating, your 11th and 12 ribs go down and out (laterally)

when you breath out they go up and medial.

Question 13

where do you find 11 and 12

Answer 13

go to the iliac crest, go medially and then go up again and the next bone you hit is going to be rib 12.

Question 14

What is the process for rib diagnosis?

Answer 14

1) screen ribs for gross motion and TART
2) palpate group of ribs to determine inhalation/exhalation dysfunction
3) palpate individual ribs to determine the key rib.

Question 15

What is the mnemonic to know for rib treatment and groups of ribs?

Answer 15

BITE

Bottom Inhalation –> inhalation dysfunction, treat the bottom of the group

Top Exhalation –> exhalation dysfunction, treat top of the group

Question 16

How do you name rib diagnoses?

Answer 16

Rib 8 Inhaled Right

Rib 4-6 Inhaled Left

Question 17

For ribs 1-10 with an inhalation dysfunction (restricted to exhalation), what muscles pull the ribs back down?

Answer 17

we don’t have muscles that pull them down back into the correct position

Question 18

What do you treat first for rib dysfunction?

Answer 18

KEY RIB FIRST

Question 19

How do we treat inhalation ribs?

Answer 19

if they’re held up, or stuck up, or won’t go into exhalation, we treat those first.

we have our finger and thumb on top of the superior surface of the rib to push it down with exhalation.

remember to work on the BOTTOM OF THE GROUP (BI OF BITE)

Question 20

Rib 1 inhalation dysfunction MET?

Answer 20

doesn’t like to move with exhalation

you’re going to resist inhalation and exaggerate exhalation

so hand facing up in a claw like position, wrap it around shoulder/neck with them on that first rib on the anterior side.

with their head, you rotate it away and side bend it towards the dysfunctional side

have them take a deep breath in.. as they breathe out, exaggerate the pushing of that rib while exaggerating rotation away and sidebending towards!

3-5 times, return to neutral, and reassess through breathing and structural test again.

Question 21

Ribs 2-6 Inhalation Dysfunction MET?

Answer 21

Helps to treat pump handle motion

doesn’t like to move into exhalation

supine.

the patient has their body sidebent a bit (flex is the more appropriate thing for pump handle)

flex them up a bit (for rib 2 you can just use their head and upper body to flex them and side bend them towards SAME SIDE)

but for 4-6 you can put your knee under the dysfunctional side and just flex them up a bit really and side bend a bit)

(you can have them put their hands over their breast tissue and use that barrier when pushing down)

put your hand on the dysfunctional rib and when they exhale exaggerate that pushing force and the sidebending more of their right side of their body.

DON’T LET THEM INHALATE IN, RESIST THAT MOTION

repeat 3-5x until it’s improved

Reassess

Question 22

Rib 7-10 Inhalation MET/ART

Answer 22

SUPINE

1) move the patients arm up, find the rib, move the arm back down
2) take a breath in, and as they take a breath out, physically sideband them to that SAME SIDE and push in on that rib when they exhale.

on inhalation RESIST RIB MOTION

3) 3-5x or until motion is increased

Question 23

Ribs 11,12 Inhalation dysfunction MET/ART?

Answer 23

doesn’t exhale well

treating the ribs on the OPPOSITE SIDE of where you’re standing.

1) pull the feet toward away from you (side bending legs to affected rib side)
2) find the dysfunctional rib, put your HYPOTHENAR (not thenar) eminence right below that (so when you push up it’ll close it more.
3) reach around and grab the hip and lift it up (helps relax the quadratus lumborum that
4) have them inhale, resist that motion, and with your thenar eminence push superior and lateral.
5) 3-5x

Question 24

What muscles are associated with the following for Exhalation dysfunctions (restricted to inhalation)

Answer 24

Rib 1 - Ant/Med Scalene

Rib 2 - Posterior Scalene

Rib 3-5 - Pectoralis Minor

Rib 6-8 - Serratus Anterior

Rib 9-10 - Latissimus Dorsi

Rib 11-12 - Quadratus Lumborum

Question 25

When treating exhalation dysfunctions and grouped dysfunctions, what are you treating?

Answer 25

TOP RIB

Question 26

Ribs 1-2 Exhalation dysfunction MET/ART1

Answer 26

supine

1) take the wrist of the opposite arm, pull it towards you, and take your arm and go underneath the body on the superior surface of the rib your treating (so you can pull it downwards since it’s stuck in exhalation)
2) have them look away from the side of rib dysfunction, put their hand on their forehead
3) take a deep breath in, and when they have, hold it, and they push their hand toward the ceiling for 3-5 seconds.
4) relax and breathe while you pull that rib towards the floor.
5) 3-5x for 3-5 seconds or until improvement

Question 27

Ribs 3-5 Exhalation dysfunction MET?

Answer 27

1) take arm across body like ribs 1-2, find rib 3 or whatever rib it is.
2) take arm and put it above their head and grasp the elbow
3) deep breath in, hold it and push elbow towards the cieling (3-5 seconds, 3-5x)
4) relax and breathe, while you pull that rib towards the floor
5) 3-5x for 3-5 sec until improvement
6) reassess

Question 28

Ribs 6-8 Exhalation dysfunction MET?

Answer 28

you sit down for this and work on the same side!

1) take their elbow and move it across the body to find the key rib
2) bring elbow up to 90 degrees in flexion and anterior flexion so it site right out in front
3) take a deep breath and push elbow towards the ceiling, not hitting you. towards the ceiling. 3-5 seconds
4) you push inferiorly during breathing normally
5) 3-5x, 3-5s
6) reassess

Question 29

Ribs 9-10 Exhalation Dysfunction MET?

Answer 29

pt laying supine

1) find the rib posteriorly
2) bring arm directly out to the side
3) have them take a deep breath and have them push elbow towards their feet
4) relax and breathe, pushing that rib inferiorly
5) 3-5x, 3-5s
6) reassess

Question 30

Rib 11 + 12 Exhalation Dysfunction MET?

Answer 30

Treat the opposite side you are on.

because they exhale well, they don’t inhale well.

1) treating the opposite side, so stand opposite
2) legs towards you (opposite the dysfunctional side)
3) put your hypothenar eminence on the inferior portion of the upper rib that isn’t effected (if rib 12, go to inferior rib 11). you’re going to be pushing cephalad again.
4) grab hip but pull the hip DOWNWARDS
5) take a deep breath in and try to pull hip towards shoulder, you resist that
6) push your hand superiorly and laterally
7) repeat 3-5x, 3-5s
8) reassess