TEST 3: Rib Dx OSCE

Question 1

surface anatomy that is important for rib diagnosis:

Answer 1

• midclavicular line
• midaxillary line
• anterior axillary line
• midsternal line

Question 2

what is the action of the scalene muscles?

Answer 2

• contraction elevates ribs 1 and 2

- important for inhalation

Question 3

sternocleidomastoid muscle

Answer 3

accessory muscle of inhalation

Question 4

what kind of dysfunction can be caused by pectoralis muscles?

Answer 4

-contraction can cause anterior (inhalation) rib dysfunctions

Question 5

what phase of respiration is serratus anterior muscle involved in?

Answer 5

inhalation

Question 6

how is T12 able to be identified?

Answer 6

rib 12

Question 7

floating ribs

Answer 7

11-12

Question 8

typical ribs

Answer 8

3-9

Question 9

atypical ribs

Answer 9

1-2, 10-12

Question 10

explain evaluation of upper ribs 1 and 2

Answer 10

• rib 1: 50% pump handle, 50% bucket handle
• rib 2: primarily pump handle motion
• pt in supine with examiner at head of table
• to check bucket handle motion, place thumbs posteriorly on angle of rib 1 with index fingers in the supraclavicular fossa anterior to trapezius; monitor thru respiration
• to check pump handle motion, place index fingers posterior to clavicle, over superior anterior aspect of rib 1, middle and ring fingers over anterior aspect of rib 2; monitor thru respiration

Question 11

explain evaluation of middle ribs 3-6

Answer 11

• mixed pump and bucket (art of bucket handle motion inc with lower ribs)
• pt supine with examiner using thumbs or ulnar aspects of hands to palpate 3-6 bilaterally at costochondral articulations for PUMP HANDLE and midaxillary line for BUCKET HANDLE
• monitor thru respiration

Question 12

explain evaluation of lower ribs 7-10

Answer 12

• primarily bucket handle (amt of bucket handle motion inc with lower ribs)
• pt supine with examiner next to the pt
• using thumbs, palpate 7th ribs bilaterally at costochondral articulations for PUMP HANDLE and midaxillary line for BUCKET HANDLE
• monitor thru respiration

Question 13

explain evaluation of floating ribs 11-12

Answer 13

• caliper motion
• pt prone with examiner at side of table and uses thumb to palpate the posterior aspect and 2nd and 3rd fingers to palpate the lateral and anterior aspects of ribs 11 and 12 bilaterally
• monitor thru respiration
• restriction of motion is influenced by quadratus lumborum

Question 14

rib somatic dysfunctions: elevated (superior) first rib

Answer 14

• evaluated while the pt is seated, examiner behind
• examiner uses her thumbs to palpate the posterolateral shaft of each first rib immediately lateral to costotransverse articulation, and index finger to palpate anterior infraclavicular position
• examiner will alternately direct a caudad force on each rib, monitoring position
• if rib is prominent, painful, and has less spring on downward pressure, it is an elevated rib dysfunction

Question 15

rib somatic dysfunctions: inhalation

Answer 15

if one rib stops moving before the other rib during exhalation, that rib has an expiratory restriction therefore an inhalation dysfunction
-most inferior rib is the key rib to target treatment

Question 16

rib somatic dysfunctions: exhalation

Answer 16

if one rib stops moving before the other rib during inhalation, that rib has an inspiratory restriction; therefore and exhalation dysfunction
-most superior (top rib) is the key rib to target treatment