Rib Competency

Question 1

a. Perform the evaluation of the upper ribs (1‐2) for somatic dysfunction and document appropriately.

Answer 1

• Student states rib 1 is 50% bucket/50% pump handle. States rib 2 is primarily pump handle respiratory motion.

PATIENT SUPINE
- Examiner is at head of table, placing thumbs posteriorly on the angles of rib 1.

• Index fingers will be placed in the supraclavicular fossa anterior to the trapezius to feel the superior lateral aspect of rib 1.
• Monitor through respiration for bucket handle motion.
• Examiner then places index fingers posterior to the clavicle, over the superior anterior aspect of rib 1.
• Middle and ring fingers are placed over the anterior aspect of rib 2.
• Monitor through respiration for pump handle motion.
• Student notes that if bilateral ribs 1‐2 move into inhalation equally and the left side of the rib delays moving (does not move) into their exhalation position while the right side moves into exhalation position easily then a Left Ribs 1‐2 Inhalation Group, Pump Handle Somatic Dysfunction is diagnosed.
• Student states the most inferior (bottom) rib in a group inhalation dysfunction is the key rib to address with treatment.
• Student notes that if ribs 1‐2 on the left delays moving (does not move) into their inhalation position while the right side moves into inhalation position easily and bilaterally the ribs move into exhalation position equally, then a Left Ribs 1‐ 2 Exhalation Group, Pump Handle Somatic Dysfunction is diagnosed.
• Student states the most superior (top) rib in a group exhalation dysfunction is the key rib to address with treatment.

Question 2

b. Performs the evaluation of the middle ribs (3‐6) for somatic dysfunction and documents appropriately.

Answer 2

• Student states these ribs have mixed pump & bucket handle respiratory motion, with the more inferior ribs having less pump handle and more bucket handle motion (Rib 6 is approximately 50% pump, 50% bucket).

PATIENT SUPINE
- Examiner uses thumbs or ulnar aspects of hands to palpate ribs 3‐6 bilaterally at their costochondral articulations for pump handle motion and at the midaxillary line with the fingertips for bucket handle motion.

• Monitor through respiration.
• Student notes that while monitoring at the costochondral junction, if bilateral ribs 3‐6 move into inhalation equally and the left side of the ribs delays moving (does not move) into their exhalation position while the right side moves into exhalation position easily, then a Left Ribs 3‐6 Inhalation Group, Pump Handle Somatic Dysfunction is diagnosed.
• Student notes that while monitoring at the midaxillary line, bilateral ribs 3‐6 move into inhalation equally and the left side of the ribs delays moving (does not move) into their exhalation position while the right side moves into exhalation position easily then a Left Ribs 3‐6 Inhalation Group, Bucket Handle Somatic Dysfunction is diagnosed.
• Student states the most inferior (bottom) rib in a group inhalation dysfunction is the key rib to address with treatment.
• Student notes that while monitoring at the costochondral junction, ribs 3‐6 on the left delays moving (does not move) into their inhalation position while the right side moves into inhalation position easily and bilaterally the ribs move into exhalation position equally, then a Left Ribs 3‐6 Exhalation Group, Pump Handle Somatic Dysfunction is diagnosed.
• Student notes that while monitoring at the midaxillary line, ribs 3‐6 on the left delays moving (does not move) into their inhalation position while the right side moves into inhalation position easily and bilaterally the ribs move into exhalation position equally, then a Left Ribs 3‐6 Exhalation Group, Bucket Handle Somatic Dysfunction is diagnosed.
• Student states the most superior (top) rib in a group exhalation dysfunction is the key rib to address with treatment.

Question 3

c. Performs the evaluation of the lower ribs (7‐10) for somatic dysfunction and documents appropriately.

Answer 3

• Student states these ribs have primarily bucket handle respiratory motion but may have pump handle dysfunctions.

Examiner places PATIENT SUPINE.
- Using thumbs or ulnar aspects of hands, the examiner will palpate the 7‐10 ribs bilaterally at their costochondral articulations for pump handle motion and will contact at midaxillary line with the fingertips for bucket handle motion.

• Monitor through respiration.
• Student notes that while monitoring at the costochondral junction, bilateral ribs 7‐10 move into inhalation equally and the left side of the ribs delays moving (does not move) into their exhalation position while the right side moves into exhalation position easily then a Left Ribs 7‐10 Inhalation Group, Pump Handle Somatic Dysfunction is diagnosed.
• Student notes that while monitoring at the midaxillary line, bilateral ribs 7‐10 move into inhalation equally and the left side of the ribs delays moving (does not move) into their exhalation position while the right side moves into exhalation position easily then a Left Ribs 7‐10 Inhalation Group, Bucket Handle Somatic Dysfunction is diagnosed.
• Student states the most inferior (bottom) rib in a group inhalation dysfunction is the key rib to address with treatment.
• Student notes that while monitoring at the costochondral junction, ribs 7‐10 on the left delays moving (does not move) into their inhalation position while the right side moves into inhalation position easily and bilaterally the ribs move into exhalation position equally, then a Left Ribs 7‐10 Exhalation Group, Pump Handle Somatic Dysfunction is diagnosed.
• Student notes that while monitoring at the midaxillary line, ribs 7‐10 on the left delays moving (does not move) into their inhalation position while the right side moves into inhalation position easily and bilaterally the ribs move into exhalation position equally, then a Left Ribs 7‐10 Exhalation Group, Bucket Handle Somatic Dysfunction is diagnosed.
• Student states the most superior (top) rib in a group exhalation dysfunction is the key rib to address with treatment.

Question 4

d. Performs the evaluation of the floater ribs for somatic dysfunction and documents appropriately.

Answer 4

• Student states ribs 11 and 12 have caliper respiratory motion.

PATIENT PRONE
- Examiner at side of table.

• Examiner uses thumb to palpate the posterior aspect and 2nd and 3rd fingers to palpate the lateral and anterior aspects of ribs 11 and 12 bilaterally.
• Monitor through respiration.
• Student notes that if bilateral ribs 11‐12 move into inhalation equally and the left side of the ribs delays moving (does not move) into their exhalation position while the right side moves into exhalation position easily then a Left Ribs 11‐12 Inhalation Group, Caliper Somatic Dysfunction is diagnosed.
• Student states the most inferior (bottom) rib in a group inhalation dysfunction is the key rib to address with treatment.
• Student notes that if ribs 11‐12 on the left delays moving (does not move) into their inhalation position while the right side moves into inhalation position easily and bilaterally the ribs move into exhalation position equally, then a Left Ribs 11‐12 Exhalation Group, Caliper Somatic Dysfunction is diagnosed.
• Student states the most superior (top) rib in a group exhalation dysfunction is the key rib to address with treatment.
• Student notes that restriction of motion is influenced by quadratus lumborum.