Rib Flashcards
Rib screening
Palpate the posterior angle of ribs, feel for tenderness and tightness. Can use both hands at once going down the ribs all way down to rib 12. Then palpate the anterior thorax with them lying supine. For females, say “im gonna be on yourr ibs, if anything makes you feel uncomfortable or tender let me know”. Palpating up kinda on lateral side of ribs. feeling for motion and stuff from earlier. so basically on lateral side, thats for bucket handle motion. For pump handle motion, you are going down the very front of the chest on either sides of the sternum.
Rib screening summary
So for posterior and anterior thorax (anterior do pump and bucket handle), you are doing tenderness, static asymetry, tissue texture abornmalities, motion asymetry and restriction of motion.
Inhalation rib dysfunction
Statically cephalad and greater cephalad motion with inhalation,
Exalation rib dysfunction
Statically caudal, and less cephalad movement with inhalation, more caudal movement with exhalation.
Palpation of ribs 1-2
Patient supine, put index finger on clavicle right behind, middle finger below clavicle on 1st rib. See the relative inferior and superior of those ribs also if they prominent anterior or not, then have them inhale and exhale deeply and see what the problem is. Then find rib 2 (its at the sternal angle), and have them take a deep breath in out, if a side doesnt move well with exhalation they have an inhalation disfunction etc.
Palpation of ribs 3-6
(Go sternal angle, move out laterally, go down one speedbump to rib 3)Go down to rib 3 (you standing over them they supine), goinng to side of sternum using finger tips. For female patients you can have them cover and move breasts to sides. Then do same as what you did above
Palpation ribs 7-10
(Go to xiphoid process, go up to gladiolus, follow rib 6 across, then go down to rib 7) Rib 7 no longer attached to sternum, its on side of body, use tipds of fingers to get those and repeat stuff from above.
Ribs 11-12 Palpation
On inhalation, ribs 11-12 move down and out, when you exhale they move out and in . To find them go to illiac crest move up and when you hit bone again that’s iliac crest. If one moves farther down with inhalation, that’s an inhalation dysfunction. If one moves farther up with exhalation, thats an exhalation dysfunction
BITE
Treat the bottom of inhalation dysfuntion ribs, and treat the top of exhalation dysfunction ribs
Rib diagnosis naming
Single rib (Rib 8 inhaled right) Group (Ribs 5-9 exhaled right)
Rib treatment
for exhalation, their arent muscles that bring the ribs down so we are physically pulling them down. for inhalation we using the muscles.
Key rib
Treat key rib first
Inhalation treatment
These are held up, we need to push them down. We treating the bottom of inhalation rib groups.
Rib 1 inhalation dysfunction
They supine, you at back of their head, hand around the rib so that thumb is at front and back of hand is at back of rib. With their head flex, side bent toward, and rotate away from rib to take tension off scalene. THen have them breathe in and out, on inhalation resist, then exhalation push down. Then repeat.
Ribs 2-6 inhalation dysfunction treatment
They supine, flex them up to level of affected rib (cause this pump handle motion) (knee or table). Sidebend their head towards the rib slightly. Put web of hand above intercostal space of rib you want to treat, or for females put their hand their and then your hand on their hand, for inhalation resist, for exhalation push down. repeat then recheck
Ribs 7-10 inhalation dysfunction
They supine, bring arm up, find rib 8, then bring arm back down. They take breath in, as let out sidebend their head and body towards rib (This is cause this more of a buckethandle motion so doing more sidebending)
Ribs 11-12 inhalation
They prone, you opposite side of affected, push legs towards that side (away from you), one hand hypothenar eminence on the lower affected ribs, other hand on opposite side asis pullling up, they take deep breath in you resist, on exhalaton push farther up.
Rib 1-2 exhalation
They supine, stand opposite side of ribs you gonna treat, bring their arm across towards you, find the 1st rib, then put their arm on their forehead. Have them flex head neck through hand foreward, you resist, then have them relax, on relaxation increase pulling of rib downward.
Ribs 3-5 exhalation
They supine, stand opposite side of ribs gonna treat, pull arm across body, find ribs 3-5, then put his arm above his head, have them flex forward with their arm while you resist at bicep, then they relax and you pull down. Make sure for 3-5 to be between the scapula and the spine.
Ribs 6-8 exhalation
They supine, you on side that you want to treat, take elbow on your side and slide across to get scapula out of way to find key rib, then bring elbow up to 90 degrees so sitting up rested on other shoulder, they try bring elbow towards ceiling you resist, then relax pull the ribs down.
Ribs 9-10 exhalation
They supine, you on side that you want to treat, bring their arm directly out to side and rest on leg or cradle in your arm, other hand grab the rib, tell them to bring arm up, you hold down, then have relax and pull rib down.
Ribs 11-12 exhalation
This one weird, using hip a lot more
They prone, you stand on opposite side, open ribs up by bringing legs towards you, come up below the rib above and push up, then with other hand pull hip down towards foot, he take deep breath and try and pull hip towards shoulder, you resist, then pull down
