Rib ME

Question 1

1 Dx

Answer 1

thumb on rib head (anterior to trapezius)
index finger on sternal end (just posterior to clavicle)
check static
check spring
check active motion

Question 2

1 Exhalation Tx

Answer 2

superior rib is stuck inferior
pt supine with dorsum of ipsilateral hand on forehead (looking straight ahead)
ph standing contralateral with caudad hand on rib angle (pulling caudad, and lateral) pt inhales and ph ipsilateral hand resisting pt HEAD movement anteriorly (5-10 lbs)

Question 3

2-6 Dx

Answer 3

pt supine, ph with fingertips on ribs (at least 2-3 anteriorly, on female may do 4-6 laterally)
pt inhales and holds
pt exhales and holds

note: 2 is at sternal angle and 10 is most inferior attached rib

Question 4

7-10 Dx

Answer 4

pt supine, ph with fingers on ribs 7-10 bilaterally (follow rib curves poteriosuperiorly)
pt inhales and holds
pt exhales and holds

note: 10 is most inferior connected rib

Question 5

2 Exhalation Tx

Answer 5

superior rib is stuck inferior
pt supine with dorsum of ipsilateral hand on forehead (rotated away 30°)
ph standing contralateral with caudad hand on rib angle (pulling caudad, and lateral) pt inhales and ph ipsilateral hand resisting pt HEAD movement anteriorly (5-10 lbs)

Question 6

1 muscle

Answer 6

anterior and middle scalene

from TP of cervical spine

Question 7

2 muscle

Answer 7

posterior scalene

from TP of cervical spine

Question 8

3-5 muscle

Answer 8

Pectoralis minor

from coracoid process

Question 9

3-5 Exhalation Tx

Answer 9

superior rib is stuck inferior
pt supine with dorsum of ipsilateral hand on forehead (looking straight ahead)
ph standing contralateral with caudad hand on superior edge of key rib between angle and mid-axillary line (pushing anterior and pulling caudad, and lateral) pt inhales and ph ipsilateral hand resisting pt ELBOW movement towards contralateral hip (5-10 lbs)

Question 10

6-10 muscle

Answer 10

Serratus anterior?
at least to 8 or 9
from the costal aspect of the medial margin of the scapula

Question 11

6-10 Exhalation Tx

Answer 11

superior rib is stuck inferior
pt supine and ph on ipsilateral side
abduct pt arm until motion at key rib and then place against your leg.
caudad hand on superior edge of key rib between angle and mid-axillary line (pushing anterior and pulling caudad, and lateral) pt inhales and adducts arm against ph leg

Question 12

1 Inhalation Tx

Answer 12

inferior rib is stuck superiorly
pt seated with ph behind
pt contralateral armpit on ph leg and relaxed.
FSTRA
ph uses index MP joint on rib (just lateral to costotransverse articulation, maybe put tip on sternal end?) to resist superior motion while pt inhales and then holds and exerts pressure (caudad and anterior) when exhaling
increase FSTRA to new barrier

Question 13

2-6 Inhalation Tx

Answer 13

inferior rib is stuck superior
Pt supine F (2-3) ST (4-6)
Ph at head of table with webbing of hand on superior anterior surface or Key rib..
resist superior motion while pt inhales and then holds and exerts pressure (caudad and anterior) when exhaling..
increase F/ST to new barrier

Question 14

7-10 Inhalation Tx

Answer 14

inferior rib is stuck superior
Pt supine ST until tension is taken off rib
Ph is on side of bed and web of hand in on the superior surface along the lateral aspect of the Key rib. Resist elevation during inhalation and as Pt exhales exert inferior force as well as exaggerate sidbending. Pt CAN ASSIST by reaching for their foot.