Ribs Flashcards
Typical
3-9 Similar in structure Each rib head to 2 facets Costotransverse articulation
Atypical
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)
True
1-7 Attaches to sternum directly
False
8-10 Cartilage unites w/ that of rib 7 to attach to the sternum
Floating
11-12 Lack cartilage Float freely w/ muscle fibers
Pump Handle
Ribs 1-5 Transverse processes extend laterally Creates more of a TRANSVERSE AXISBucket
Bucket Handle
Ribs 6-10 Transverse processes angle back (posteriorly) Creates more of an AP AXIS
Caliper
Ribs 11 and 12 Vertical Axis (more or less)
Somatic Dysfunction: named for direction
of ease Inhaled vs Exhaled BITE Mnemonic (used to aid treatment) B –Bottom I –Inhaled T –Top E –Exhaled
Major Muscles of Inspiration
Diaphragm Ext Intercostals Levator Costarum
Accessory Muscles of Inspiration
Scalenes SCM Pectoralis Latissimus Dorsi Serratus Anterior Serratus Post. Sup. QL
Major Muscles of Expiration
Passive Recoil Int Intercostals
Accessory Muscles of Expiration
Transversus thoracis Rectus abdominis Internal oblique Transversus abdominis SerratusPost. Inf.
“Take my breath away”
•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
The ribs attach to the vertebral segments at the same level and
above (for example, rib 3 attaches at T2 and T3).
Anterior Rib Assessment
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
Rib Anterior Counterstrain Points
Posterior Rib Assessment
Best done in the prone position
Assess
Ribs 11-12 (Caliper motion)
Posterior counterstrainpoints
Rib Posterior Counterstrain Points
Anterior Rib Counterstrain
- 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.
Posterior Rib Counterstrain
- 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.
With MET and pump handle ribs add more
flexion
with MET and bucket handle ribs add more
side-bending
MET for exhaled rib 1
anterior and middle scalenes
MET exhaled Rib 2
MET exhaled ribs 3-5
pec minor
MET exhaled Ribs 6-10
lat dorsi
Muscle Energy: Inhaled caliper ribs
- Caudadhand over ASIS
- Cephaladhand over posterior lateral aspect of ribs 11 or 12
- Anterior lateral vector
Iliopsoas?
Muscle Energy:Exhaled ribs 11-12
- Caudadhand over ASIS
- Cephaladhand over posterior medial ribs 11 or 12
- Anterior vector
Muscle Energy: Inhaled pump and bucket handle ribs
Ribs and Sympathetics
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
Rib Raising
Indications
Hyper-sympathetic tone
Restricted respiratory excursion of ribs
Decreased lymphatic drainage
**Good for “delicate” or hospitalized patients
Rib Raising
Contraindication
Rib fracture
Spinal cord injury/surgery
Malignancy (relative)
Supine Rib Raising
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!!!!!!
Seated Rib Raising
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
