Ribs-VSR

Question 1

What can lead to rib dysfunctions in hospitals?

Answer 1

Disease, trauma, guarding/splinting muscles, not breathing deeply, and immobilization

Question 2

When during the exam should you examine rib cage?

Answer 2

. When examining thorax, auscultations heart/lungs, and palpating thyroid and lymph nodes

Question 3

T/F examine thoracic spine before ribs

Answer 3

T

Question 4

Where are viscerosomatic reflexes found in thoracic region?

Answer 4

. Paravertebral tissues at level of costotransverse joints

Question 5

T/F acute and chronic viscerosomatic reflexes are opposite to acute and chronic tissue texture change

Answer 5

F, they are the same

Question 6

T/F viscerosomatic reflexes have ambiguous end feel

Answer 6

T

Question 7

Organs above diaphragm manifest sympathetic viscerosomatic reflexes at _____ whereas organs below diaphragm manifest at ____

Answer 7

. Soft tissues at or above T5

. Soft tissues at or below T5

Question 8

History questions related to rib dysfunctions

Answer 8

. Cough, wheezing, shortness of breath
. History of bronchitis or asthma
. Trauma to chest cage
. Neck, shoulder, clavicle, or upper back pain

Question 9

Observations of patient related to rib dysfunction

Answer 9

. Slumped posture (inhibits fully respiratory effort)
. Thoracic humping
. Using accessory muscles to breathe
. Pain in rib cage during breathing
. Patient can point to where pain is with one finger

Question 10

Rib palpation exam

Answer 10

. Start at sup. Rib cage then move inf.
. Palpate ribs 1 and 2 (most tender ribs)
. Palpate sternum and when ribs join it
. Palpate clavicles and have patient shrug shoulders
. Palpate post. Rib angles and lat. ribs
. Note tenderness and asymmetries

Question 11

Rib respiratory evaluation

Answer 11

. Upper ribs pump handle, lower ribs bucket handle
. Ribs 1 and 2 most pump handle motion in normal breathing (forced respiration has more bucket handle from accessory muscles)
. 6-10 bucket handle
. 11 and 12 caliper motion
. Dysfunctional ribs exhibit incorrect motion or tenderness

Question 12

How to assess pump handle motion

Answer 12

. 1 hand on patient ant. Thoracic cage and other on post. Thoracic cage
. Should perceive widening from front to back w/ inhalation
. Expansion recedes during exhalation

Question 13

How to assess bucket handle motion

Answer 13

. Place hands on lat. sides

. Widening in frontal place w/ inhalation and recede w/ exhalation

Question 14

How to assess caliper motion

Answer 14

. Place hands on ribs 11 and 12

. Small amt of internal and external rotation of ribs as patient breathes

Question 15

Rib dysfunction nomenclature

Answer 15

. Named for freer motion

. Inhaled dysfunction: favor inhaled position and have restriction in exhalation (exhaled dysfunction opposite)

Question 16

position of inhaled ribs

Answer 16

. Up in front down in back

Question 17

Position of exhaled ribs

Answer 17

. Down in front, up in back

Question 18

Inhalation dysfunction group

Answer 18

. Bottom rib of group is the key rib in restricting exhalation

Question 19

Exhalation dysfunction group

Answer 19

. Top rib is key rib to restriction inhalation

Question 20

Ribs w/ type I dysfunction in spine

Answer 20

. Ribs spread on convex side and compressed on concave side

. Crowding of ribs causes discomfort on concave side of curve

Question 21

Rib dysfunctions with type II thoracic issue

Answer 21

. Costotransverse ribs affected
. Type II extended assoc. w/ inhaled rib
. Flexed dysfunction w/ exhaled rib

Question 22

Structural rib

Answer 22

. Motion is restricted in both inhalation and exhalation
. Diagnostic criteria mostly positional
. Assoc. w/ handed Ess. And poor posture, scoliosis curves, and pectus excavatum or pectus carinatum

Question 23

Counterstrain anterior rib also called _____

Answer 23

Depressed

Question 24

Counterstrain posterior rib also called ___

Answer 24

Elevated

Question 25

Post. Thoracic tender points are close to the ____

Answer 25

Midline

Question 26

Ant. Thoracic tender points are close to the ___

Answer 26

Rib angles

Question 27

Location of rib 1 tender point

Answer 27

Costco stern also junction inf. To sternoclavicular joint

Question 28

Rib 2 tender point location

Answer 28

Mid-clavicular line

Question 29

Rib 3-10 tender point location

Answer 29

Ant. Axillary line

Question 30

FPR (facilitated position release) goal

Answer 30

Normalize hypertonic muscles by putting them in neutral position diminishing tension in all planes before adding facilitating force

Question 31

FPR treats what muscles in spinal region

Answer 31

Deep intervertebral muscles maintaining dysfunction

Question 32

Facilitating force consists of ___

Answer 32

Compression
Torsion
Traction
Combination

Question 33

Where is force directed when treating hypertonic muscles in extremities

Answer 33

. Compressive force towards joint

. Fined tuned through small motions in frontal and transverse planes until muscle shortens

Question 34

Viscerosomatic reflex characteristics

Answer 34

. Ambiguous end feel 
. Tenderness
. Tissue texture abnormality
. Generalized motion restriction
. Span 2+ segments

Question 35

T/F Treating the underlying visceral dysfunction is the primary treatment

Answer 35

T