Ribs-VSR Flashcards
What can lead to rib dysfunctions in hospitals?
Disease, trauma, guarding/splinting muscles, not breathing deeply, and immobilization
When during the exam should you examine rib cage?
. When examining thorax, auscultations heart/lungs, and palpating thyroid and lymph nodes
T/F examine thoracic spine before ribs
T
Where are viscerosomatic reflexes found in thoracic region?
. Paravertebral tissues at level of costotransverse joints
T/F acute and chronic viscerosomatic reflexes are opposite to acute and chronic tissue texture change
F, they are the same
T/F viscerosomatic reflexes have ambiguous end feel
T
Organs above diaphragm manifest sympathetic viscerosomatic reflexes at _____ whereas organs below diaphragm manifest at ____
. Soft tissues at or above T5
. Soft tissues at or below T5
History questions related to rib dysfunctions
. Cough, wheezing, shortness of breath
. History of bronchitis or asthma
. Trauma to chest cage
. Neck, shoulder, clavicle, or upper back pain
Observations of patient related to rib dysfunction
. 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
Rib palpation exam
. 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
Rib respiratory evaluation
. 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
How to assess pump handle motion
. 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
How to assess bucket handle motion
. Place hands on lat. sides
. Widening in frontal place w/ inhalation and recede w/ exhalation
How to assess caliper motion
. Place hands on ribs 11 and 12
. Small amt of internal and external rotation of ribs as patient breathes
Rib dysfunction nomenclature
. Named for freer motion
. Inhaled dysfunction: favor inhaled position and have restriction in exhalation (exhaled dysfunction opposite)
position of inhaled ribs
. Up in front down in back
Position of exhaled ribs
. Down in front, up in back
Inhalation dysfunction group
. Bottom rib of group is the key rib in restricting exhalation
Exhalation dysfunction group
. Top rib is key rib to restriction inhalation
Ribs w/ type I dysfunction in spine
. Ribs spread on convex side and compressed on concave side
. Crowding of ribs causes discomfort on concave side of curve
Rib dysfunctions with type II thoracic issue
. Costotransverse ribs affected
. Type II extended assoc. w/ inhaled rib
. Flexed dysfunction w/ exhaled rib
Structural rib
. 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
Counterstrain anterior rib also called _____
Depressed
Counterstrain posterior rib also called ___
Elevated
Post. Thoracic tender points are close to the ____
Midline
Ant. Thoracic tender points are close to the ___
Rib angles
Location of rib 1 tender point
Costco stern also junction inf. To sternoclavicular joint
Rib 2 tender point location
Mid-clavicular line
Rib 3-10 tender point location
Ant. Axillary line
FPR (facilitated position release) goal
Normalize hypertonic muscles by putting them in neutral position diminishing tension in all planes before adding facilitating force
FPR treats what muscles in spinal region
Deep intervertebral muscles maintaining dysfunction
Facilitating force consists of ___
Compression
Torsion
Traction
Combination
Where is force directed when treating hypertonic muscles in extremities
. Compressive force towards joint
. Fined tuned through small motions in frontal and transverse planes until muscle shortens
Viscerosomatic reflex characteristics
. Ambiguous end feel . Tenderness . Tissue texture abnormality . Generalized motion restriction . Span 2+ segments
T/F Treating the underlying visceral dysfunction is the primary treatment
T
