Ribs

Question 1

Movement of ribs

1 and 2

Answer 1

mainly bucket handle

Question 2

movement of ribs

3-6

Answer 2

pump handle

Question 3

Movement. of rib

7

Answer 3

pump handle

Question 4

movement of ribs

8-10

Answer 4

bucket handle

Question 5

what ribs move primarly in bucket handle motion

Answer 5

1-2

8-10

Question 6

what ribs move primarly in pump handle motion

Answer 6

3-7

Question 7

What. is the bucket handle motion?

Answer 7

Move superior & laterally

Increase transverse diameter

Question 8

What is the pump handle motion?

Answer 8

Move superior and anterior

Increase A/P diamter

Question 9

Processes of diagnosing ribs?

Answer 9

1. Screen for TART on the anterior and posterior thorax while patient is seated.
2. Palpation of ribs 1-2, 3-6, 7-10 and 11-12: Motion testing- motion asymmetry and ROM.

Question 10

Palpate ribs 1-2

Answer 10

Rib 1

1. Put thumbs fingers above clavicle
2. Put index fingers below clavicle, where first rib attaches to sternum/
3. Look statically to see if one is more anterior than the other.
4. Having pt breathe in and out for inhalation/exhalation dysfunction.

• likes to inhale but does not like to exhale: exhalation dysfunction
• likes to exhale but does not like to inhale: inhalation dysfunction

Rib 2

1. Find rib 2, located at sternal angle

2. Look at statically (see if higher on one side than the other)

3. Have patient breathe in and out and check for inhalation and exhalation dysfunction

Question 11

Palapation of ribs 3-6

Answer 11

1. Find rib 2 @ sternal angle and go one below to rib 3.
2. Place fingers lateral to sternum on the costal cartliage of each rib
3. Check static movement to see if one is more anterior than the other.
4. Have patient breathe in and out and check for exhalation and inhalation dysfunction.
5. Move onto next rib

• likes to inhale but does not like to exhale: exhalation dysfunction
• likes to exhale but does not like to inhale: inhalation dysfunction

Question 12

Palapation of ribs 7-10

Answer 12

1. Because past breast tissue, put hands on the entire rib
2. Observe static placement: check to see if one is more anterior than the other.
3. Have them breathe in and out and check for exhalation/inhalation dysfunctions

• likes to inhale but does not like to exhale: exhalation dysfunction
• likes to exhale but does not like to inhale: inhalation dysfunction

Question 13

Palpation of ribs 11-12

Answer 13

1. Pt is prone.
2. Find 12th rib: find iliac crest -> go to the middle -> go up until you find bone.
3. Place thumbs on the posterior part of rib and use 2nd and 3rd finger to monitor side of ribs.
4. Static and then have the pt breathe in and out deeply to assess for inhalation and exhalation SD.

• likes to inhale but does not like to exhale: exhalation dysfunction
• likes to exhale but does not like to inhale: inhalation dysfunction

Question 14

Mneumonic to tx ribs

Answer 14

BITE

• If group of ribs has a inhalation dysfunction: bottom of the group is KEY rib
• If a group of ribs has a exhalation dysfunction: top of the group is the KEY rib

Question 15

Naming diagnosis:

single rib

group of ribs

Answer 15

• Single rib: rib 8 inhalaled R, rib 9 exhaled L
• Group of ribs: rib 4-6 inhaled L, ribs 5-9 exhaled R

Question 16

Describe a inhalation dysfunction

Answer 16

likes to inhale

does not like to exhale

Question 17

Describe a exhalation dysfunction

Answer 17

likes to exhale

does not like to inhale

Question 18

how do we know if inhalation dysfunction or exhalation dysfunction:

Answer 18

1. Inhalation dysfunction: one rib stops moving before other rib during exhalation. Thus, likes in inhale but not exhale

2. Exhalation dysfunction: one rib stops moving moving before the other during inhalation

Question 19

Rib 1 inhalation dysfunction

MET/ART

Answer 19

1. Have pt laying prone with doc sitting at the head of the table.
2. Place same side thumb on top of rib 1
3. Opposite hand will flex head, sidebent towards, rotate away from bad rib
4. Exhalation: push rib down; inhalation: resist
5. Repeat 3-5 times

Question 20

Rib 2-6. inhalation dysfunction

MET/ART

Answer 20

1. Have pt laying prone with doc sitting at the head of the table.
2. Place same side thumb on top of rib
3. Opposite hand will flex head, sidebent towards
4. Exhalation: push rib down; inhalation: resist
5. Repeat 3-5 times

Question 21

Ribs 7-10

Inhalation Dysfunction MET/ART

Answer 21

1. Pt lies on back and you are on SS of dysfunction.
2. Put whole hand on top of the rib.
3. Have patient breathe in and out.
4. During exhalation: push and sidebend pt. towards you
   * During inhalation: resist

Question 22

Ribs 11-12 Inhalation Dysfunction

MET/ART.

Answer 22

• 1. Pt is on stomach, put in a C shape with legs away; doc is on opposite side of bad ribs
• 2. Cephalad hypothenar eminance goes on the rib; caudad hand grabs the ASIS on same side of dysfunction
• 3. Lift up ASIS
• 4. Tell pt to breathe and resist on inhalaltion and push down on exhalation

INHALATION= legs away in C shape.

Question 23

Ribs 1-2 Exhalation

MET/ART

Answer 23

1. Pt lays on back, with head rotated away. from bad rib and doc is on opp side
2. Put hand on superior surface of rib and pull inferior
3. tell pt to take a. deep inhale, hold and push up against your hand for 3-5 secconds
4. Increase lateral traction with hand

Question 24

Ribs 3-5 Exhalation

MET/ART

Answer 24

same thing as ribs 1-2, except touch ribs 3-5 (between scapula and spine. DO NOT GO BELOW SCAPULA)

-Do not rotate head, put arm off to side over head, and resist there.

Question 25

**Ribs 6-8 Exhalation** **MET/ART**

Answer 25

* 1. Doc is sits on same side of bad rib * 2. Put makes a standing up "V" with arm; flex to 90 degrees * 3. Tell pt to take a deep breathe in and tell them to push up while you resist for 3-5 seconds. * 4. When the patient relaxes, pull the affected rib down. * 5. Relax.

Question 26

**_Ribs 9-10_ Exhalation Dysunction** **MET/ART**

Answer 26

* 1. Doc is sitting down on same side as patients bad rib * 2. Pts arm is out towards side (abducted) at 90 degrees * 3. Tell take a deep breathe in and push their arm down while you resist. * 4. When patient breathes out, you will pull down.

Question 27

**Ribs 11-12 Exhalation Dysfunction** **MET/ART**

Answer 27

Pt is on stomach; doc is on opposite side of problem ribs * 1. Make C shape: SB legs towards you. * 2. Use hypothenar eminance to push up on the rib ABOVE the one that has a dysfunction. If 12th rib has the dysfunction, go to 11th rib and push up. * 3. Use caudad hand to grab iliac crests * 4. Tell patient to take a deep breath and lift hip up while you resist.