Rib Counterstrain

Question 1

How long is rib counterstrain held for?

Answer 1

120 seconds checking every 30 seconds for deviation of the treatment position.

(All other counterstrain = 90 seconds)

Question 2

4 functions of ribs and sternum

Answer 2

Protection of vital organs

Respiration

Pump for venous and lymphatic return

Platform for upper extremities

Question 3

How is the sympathetic chain oriented with respect to the ribs?

Answer 3

Immediately anterior to rib heads just anterior to the costerovertebral joints
- runs along T1-L2

Question 4

Specific areas of sympathetic innervation from the sympathetic chain

Answer 4

T1-4 = bronchi/esophagus/thyroid/heart

T1-T6 = lungs

T2-T6 = upper extremities

Question 5

Which area on the body is a chapman point located for an acute MI?

Answer 5

Left T2 rib head

Question 6

Borders of the thoracic outlet

Answer 6

Middle and anterior scalene

1st rib

Clavicle

Cervical rib (if present which it is not in everyone)

Question 7

Common locations of impingement for thoracic outlet syndrome and the corresponding parts impinged

Answer 7

Anterior /middle scalenes

• brachial plexus
• subclavian artery

Clavicle and anterior 1st rib

• brachial plexus
• subclavian artery
• subclavian vein

Costo-pectoral-coracoid-region

• brachial plexus
• subclavian artery
• subclavian vein

Question 8

Roos/adsons/wrights/halstead

Answer 8

Roos = General thoracic impingement

Adsons = scalenes impingement

Wrights = pectoral minor impingement

Halstead = cervical rib impingement

Question 9

Nerve vs artery vs vein impingement

Answer 9

Nerve:

• paresthesia
• weakness
• muscle atrophy
• seen in overhand athletes and patients who sleep with arms above head*

Artery:

• pallor
• coolness
• weakened distal pulse/BP
• often shows arm fatigue*

Vein:

• edema
• discoloration
• venous engorgement distal to impingement

Question 10

Scalene muscle origin and insertion

Answer 10

Anterior and middle scalenes

• origin = transverse process of cervical vertebrae
• insertion = rib 1

Posterior scalene

• origin = transverse process of cervical vertebrae
• insertion = rib 2

Question 11

Pectoralis minor origin/insertion/function

Answer 11

Origin = ribs 3/4/5

Insertion = coracoid process of scapula

Actions:

• depresses scapula
• inferior rotation of scapula
• elevates ribs of origin if scapula is fixed

Question 12

Serratus anterior origin/insertion/function

Answer 12

Origin: ribs 1-8

Insertion = medial border and inferior angle of scapula

Functions:

• accessory muscle of respiration
• protraction of scapula
• elevation of the ribs of origin if scapula is fixed