Rib Evaluation and Tx Flashcards
How do evaluate ribs 1 and 2?
mostly bucket handle motion have pt inhale and exhale and monitor motion
How do you evaluate ribs 3-6?
mostly pump handle motion
place fingers just lateral to sternum on costal cartilage
monitor relative cephalad or caudal motion of
for ribs 4-6: palpate at costochondral ends w/ thumbs and midaxillary lines w/ fingertips
How do you evaluate rib 7?
primarily pump handle
pt supine
palpate rib 7 w/ thumbs at costochondral articulation for pump handle motion
How do you evaluate ribs 8-10?
mostly bucket handle
contact at midaxillary line w/ fingertips
monitor through respiration
How do you evaluate ribs 11 and 12?
Pt prone
palpate posterior aspect w/ thumbs
fingers 2 and 3 to palpate lateral and anterior aspects
monitor through respiration
*restriction of motion is influenced by quadratus lumborum
What is an inhalation dysfunction?
if one rib stops moving before the other during exhalation = exhalation restriction –> inhalation dysfunction
BITE = Bottom rib for inhalation dysfunction is the target of treatment
What is an exhalation dysfunction
if one rib stops moving before another during inhalation = inhalation restriction –> exhalation dysfunction
BITE = Top rib is target of treatment for Exhalation dyfunction
Rib 1 inhalation SD Tx
Pt supine, doc at head of table
Thumb ipsilateral to dysfunctional rib on anteromedial aspect of rib (top rib)
contralateral hand moves head into flexion, sidebent toward, rotated away from dyfunctional rib
follow rib down and fwd in exhalation
resist during inhalation
3-5x or until maximal improvement
Ribs 2-6 Inhalation SD Tx
Pt supine w/ thorax flexed up, doc uses knee to sidebend toward dysfunctional rib
web of ipsilateral thumb is on intercostal space superior to dysfunctional rib
during exhalation, exaggerate motion
resist during inhalation
3-5x or until maximal improvement
Ribs 7-10 inhalation SD Tx
Pt: supine w/ ipsilateral shoulder adducted
Doc on side of dysfunctional rib
ipsilateral thumb and index finger on superior surface of dysfunctional rib
sidebend to level of dysfunctional rib
during exhalation: exaggereate
during inhalation: resist
Ribs 11-12 inhalation SD Tx
Pt: prone w/ legs sidebent towards dysfunction
doc: on opposite side of SD
cephalad hand: hypothenar em medial and inferior to angle of dysfunctional rib
caudad hand: grasp ASIS ipsilateral to SD
Apply sustained lateral and cephalad traction to dysfunctional rib
exaggerate during exhalation
resist during inhalation
3-5x
What muscles do you utilize during exhalation SD of rib 1?
anterior, middle scalenes
What muscles do you utilize during exhalation SD of rib 2?
posterior scalene
What muscles do you utilize during exhalation SD of rib 3-5?
pectoralis minor
What muscles do you utilize during exhalation SD of ribs 6-8?
serratus anterior
