Rib Counterstrain

Question 1

5 functions of the ribs and sternum

Answer 1

Protect vital organs

Aid in respiration

Serve as pump for venous/lymphatic return

Platform for upper extremities

Protect the sympathetic chain ganglia that’s re anterior to the rib heads and costovertebral joints

Question 2

Sympathetic innervation areas and their correlated organs

Answer 2

T1-4 = bronchi/esophagus/thyroid/heart/head/neck

T1-T6 = lungs

T2-T6 = upper extremities

Question 3

What is the sympathetic innervation for an acute myocardial infarction?

Answer 3

T2 on the left side

Question 4

Thoracic outlet syndrome

Answer 4

Impingement of neurovascular structures by a tightened thoracic outlet

Impingement includes the following:

1) anterior/middle scalenes
- impinge branchial plexus and subclavian arteries

2) clavicle and anterior 1st rib
- impinges brachial plexuses, subclavian artery and vein

3) Costco-pectoral/coracoid region
- impinges the same as 2

Question 5

Borders of the thoracic outlet

Answer 5

Middle/anterior scalenes

1st rib

Clavicle

Cervical rib

Question 6

Tests for thoracic outlet syndrome

Answer 6

Roos
- + = numbness and tingling

Adsons

• • weakened radial pulse
• tests for scalene entrapment

Wrights

• • = weakened radial pulse
• tests pectoralis entrapment

Question 7

Symptoms of nerve/artery and vein impingement

Answer 7

Nerve

• paresthesia/weakness
• common in overhand athletes and patients who sleep with arms above their head

Artery

• pallor/coolness/weak pulses
• common in arm fatigue and repetitive overhead activity

Vein

• edema/discoloration/venous engorgment
• same as artery

Question 8

AR 1 point location

Answer 8

Inferior to the clavicle on the 1st chondrosternal articulation

Question 9

AR 2 point location

Answer 9

Superior aspect of rib 2 on mid clavicle line

Question 10

AR 3-6

Answer 10

Anterior axillary line on the corresponding rib

Question 11

Anterior ribs 1 & 2 treatment

Answer 11

FSTRT

Patient supine, with physician at the head of the table

Use the patients head to place them in position

Question 12

AR 3-6 treatment

Answer 12

FSTRT

Patient is seated with the physician standing behind them

Physician foot and knee is contralateral to the side being treated

Patient can place feet on table ipsilaterally to further induce sidebending

Question 13

PR 1 point location

Answer 13

Posterior superior aspect of rib 1 just lateral to costotransverse articulation

Question 14

PR 2-6 point locations

Answer 14

Superior aspect of corresponding rib angles

rib angles are more lateral the further down you go

Question 15

PR1 treatment position

Answer 15

ESART

Patient seated with physician behind

Physician uses head to place into position

greatest variability in position of all tenderpoints

Question 16

PR 2-6 tenderpoint treatment

Answer 16

FSARA

Patient seated with physician behind them

Physician places leg under ipsilateral axilla

Patient can place their legs on the table contralaterally to induce more side being
- not needed for PR2