Ribs

Question 1

Typical

Answer 1

3-9 Similar in structure Each rib head to 2 facets Costotransverse articulation

Question 2

Atypical

Answer 2

1, 2, 10, 11, 12 #1 –most curved, flat, no angle or groove, single facet with vertebral body #2 –demifacetswith T1 & T2 bodies, structure similar to #1 #10 –single facet with T10 body #11 & 12 –no tubercles, tapered ends, single facets w/ bodies (no costotransversearticulatios)

Question 3

True

Answer 3

1-7 Attaches to sternum directly

Question 4

False

Answer 4

8-10 Cartilage unites w/ that of rib 7 to attach to the sternum

Question 5

Floating

Answer 5

11-12 Lack cartilage Float freely w/ muscle fibers

Question 6

Pump Handle

Answer 6

Ribs 1-5 Transverse processes extend laterally Creates more of a TRANSVERSE AXISBucket

Question 7

Bucket Handle

Answer 7

Ribs 6-10 Transverse processes angle back (posteriorly) Creates more of an AP AXIS

Question 8

Caliper

Answer 8

Ribs 11 and 12 Vertical Axis (more or less)

Question 9

Somatic Dysfunction: named for direction

Answer 9

of ease Inhaled vs Exhaled BITE Mnemonic (used to aid treatment) B –Bottom I –Inhaled T –Top E –Exhaled

Question 10

Major Muscles of Inspiration

Answer 10

Diaphragm Ext Intercostals Levator Costarum

Question 11

Accessory Muscles of Inspiration

Answer 11

Scalenes SCM Pectoralis Latissimus Dorsi Serratus Anterior Serratus Post. Sup. QL

Question 12

Major Muscles of Expiration

Answer 12

Passive Recoil Int Intercostals

Question 13

Accessory Muscles of Expiration

Answer 13

Transversus thoracis Rectus abdominis Internal oblique Transversus abdominis SerratusPost. Inf.

Question 14

“Take my breath away”

Answer 14

•QuadratusLumborum •Origin •Post. Iliac Crest •Iliolumbarligament •Insertion •Rib 12 •TP of L1-4 •Action •Fixation of rib 12 during respiration •Lateral flexion (side-bending) of the trunk

Question 15

The ribs attach to the vertebral segments at the same level and

Answer 15

above (for example, rib 3 attaches at T2 and T3).

Question 16

Anterior Rib Assessment

Answer 16

Can be in the seated or supine position (we will do supine today)  Observe global breathing patterns Chest v abdominal breathing Rate, rhythm, ease of breathing Assess motion of the following areas: Ribs 1-5 (Pump handle motion) Ribs 6-10 (Bucket handle motion) Assess for the anterior counterstrain points

Question 17

Rib Anterior Counterstrain Points

Answer 17

Question 18

Posterior Rib Assessment

Answer 18

Best done in the prone position

Assess

Ribs 11-12 (Caliper motion)

Posterior counterstrainpoints

Question 19

Rib Posterior Counterstrain Points

Answer 19

Question 21

Anterior Rib Counterstrain

Answer 21

• Found along the mid clavicular line, or along the mid axillary line
• Often associated with exhaled sd
• Treated
• Knee contralateral
• flexion and side bending towards the tender point (more flexion with anterior points and more side bending with lateral points)
• Rotation is usually towards the tender point.

Question 22

Posterior Rib Counterstrain

Answer 22

• Found along the posterior rib angles
• Often associated with inhaled sd
• Treated
• Knee ipsilateral
• slight extension, side bending away to elevate the posterior part of the rib,
• Rotation usually away from the rib tender point.

Question 23

With MET and pump handle ribs add more

Answer 23

flexion

Question 24

with MET and bucket handle ribs add more

Answer 24

side-bending

Question 25

MET for exhaled rib 1

Answer 25

anterior and middle scalenes

Question 26

MET exhaled Rib 2

Answer 26

Question 27

MET exhaled ribs 3-5

Answer 27

pec minor

Question 28

MET exhaled Ribs 6-10

Answer 28

lat dorsi

Question 29

Muscle Energy: Inhaled caliper ribs

Answer 29

• Caudadhand over ASIS
• Cephaladhand over posterior lateral aspect of ribs 11 or 12
• Anterior lateral vector

Iliopsoas?

Question 30

Muscle Energy:Exhaled ribs 11-12

Answer 30

• Caudadhand over ASIS
• Cephaladhand over posterior medial ribs 11 or 12
• Anterior vector

Question 31

Muscle Energy: Inhaled pump and bucket handle ribs

Answer 31

Question 32

Ribs and Sympathetics

Answer 32

The sympathetic chain ganglia run along the anterior aspect of rib heads

The sympathetic chain ganglia continue along the transverse processes b/l to L2

A somatic dysfunction of a rib can affect the sympathetic nervous system

So… Treating that area can “balance” the sympathetic tone

Question 33

Rib Raising

Indications

Answer 33

Hyper-sympathetic tone

Restricted respiratory excursion of ribs

Decreased lymphatic drainage

**Good for “delicate” or hospitalized patients

Question 34

Rib Raising

Contraindication

Answer 34

Rib fracture

Spinal cord injury/surgery

Malignancy (relative)

Question 35

Supine Rib Raising

Answer 35

Patient: Supine

Physician (you!!): Seated at one side of table

Technique:

Slide both hands under patient, can “roll” patient in order to position hands properly

Finger pads should contact costotransverse articulations

Lift anterior and draw fingers toward you

Use forearms as fulcrum

Constant pressure is inhibitory Decreased sympathetic tone

Kneading is stimulatory Increased sympathetic tone

OVERALL GOAL IS TO “BALANCE” AUTONOMIC TONE!!!!!!

Question 36

Seated Rib Raising

Answer 36

Patient: Sitting

Physician (you!!): Standing, facing patient

Technique:

Have patient cross arms in front of them with forearms overlapping and instruct them to lean forward so that their arms rest on you

Contact rib tubercles with fingerpads and apply anterolateral pressure

Use your body and lean back