Week 14: Lab: Osteopathic Diagnosis of the Rib Cage and Rib Raising Techniques

Question 1

What are the typical ribs?

Answer 1

Ribs 3-9

Question 2

What are the atypical ribs?

Answer 2

Ribs 1, 2, 10, 11, and 12

Question 3

What is the primary motion of rib 1?

Answer 3

Elevation and depression (pump)

Question 4

What is the primary motion of ribs 2-5?

Answer 4

Pump handle

Question 5

What is the primary motion of ribs 6-10?

Answer 5

Bucket handle

Question 6

What is the primary motion of ribs 11-12?

Answer 6

Caliper

Question 7

What are the true ribs?

Answer 7

Ribs 1-7

Question 8

What are the false ribs?

Answer 8

Ribs 8-10

Question 9

What are the floating ribs?

Answer 9

11-12

Question 10

Describe somatic dysfunction.

Answer 10

• Determined by the direction of ease.
• The ease
• The indirect side
• Where a region/segment is in space
• How the lesion is named when performing the osteopathic structural exam

Question 11

Describe restriction.

Answer 11

• The directions/positions in which motion is lacking
• Where motion is restricted from occurring
• The barrier
• The direct side
• Where a region/segment is not able to go

Question 12

Describe rib exhalation SD.

Answer 12

• A rib or group of ribs that restricts inherent movement during inhalation
• Motion towards exhalation is freer
• The key rib is the top of the group and it holds the ribs below down as an attempt is made to move through the breathing cycle
• Anterior rib remains inferior, while posterior rib head to angle remains superior
• Antero-lateral narrowing of intercostal spaces below dysfunctional rib
• Treat the uppermost rib first

Question 13

Describe rib inhalation SD.

Answer 13

• A rib or group of ribs that restricts inherent movement during exhalation
• Motion towards inhalation is freer
• The key rib is the bottom of the group as it holds the ribs below it up
• Anterior rib moves superior, while posterior rib head to angle remains inferior
• Antero-lateral intercostal space narrowing above dysfunctional rib
• Treat the lowest rib first

Question 14

Describe the diagnosing of rib inhalation SD.

Answer 14

• Ribs move easily into inhalation, but restricted in exhalation
• Pump handle ribs rise, but downward motion is limited or absent
• Bucket handle ribs move laterally, but limited or no medial motion with exhalation
• Asymmetry motion between left and right ribs

Question 15

Describe the diagnosing of rib exhalation SD.

Answer 15

• Ribs move easily into exhalation, but are restricted in inhalation
• Pump handle ribs remain down during inhalation
• Bucket handle ribs moves medial with exhalation but not laterally with inhalation

Question 16

For a group of exhaled ribs, what needs to be treated first?

Answer 16

The most superior rib

Question 17

For a group of inhaled ribs, what needs to be treated first?

Answer 17

The most inferior rib

Question 18

What will be the position of ribs that are stuck up anteriorly (inhalation dysfunction)?

Answer 18

Will be in a caudal position posteriorly and feel stuck down posteriorly

Question 19

What will be the position of ribs that are stuck down anteriorly (exhalation dysfunction)?

Answer 19

Will be in a cephalad position posteriorly and feel stuck-up posteriorly.

Question 20

During a rib examination, what must be observed?

Answer 20

Posture and breathing

Question 21

In the seated position during a rib examination, what must be palpated?

Answer 21

• Screen T-spine and posterior rib angles for TART changes and diagnosis and treat any T-spine dysfunction
• Palpate both anterior and posterior parts of ribs to assess motion with breathing in inhalation and exhalation

Question 22

In the supine position during a rib examination, what must be palpated?

Answer 22

• Anterior and posterior palpation for ribs 1 and 2
• Anterior palpation for pump handle motion (2-8)
• Anterior and anterolateral palpation for bucket handle motion/typical ribs 4-10
• Posterior palpation for pincer movements of floating ribs

Question 23

Describe the seated rib evaluation.

Answer 23

• Patient is seated with the physician standing behind
• Physician places their hands upon the trapezius bilaterally
• Grasp the anterior aspect of the trapezius muscle with finger pads and gently pull posteriorly to allow the index and middle fingers to monitor the posterior portion of 1st rib
• Have patient breath for 2-3 cycles
• Note tissue texture changes, patient complaint of pain upon palpation and/or appreciable restriction noted as patient breaths

Question 24

Describe the posterior upright rib evaluation.

Answer 24

• Patient is seated with the physician standing back
• Before starting, have patient’s cross arms across the chest - this moves the scapula out of the way to feel the ribs
• Lay the entirety of the hand on the upper back just lateral of thoracic spinous process to assess symmetry and motion along he rib angle
• Feel the posterior contour of each rib shaft and feel each rib’s inferior lip more posteriorly.
• Feel for width of intercostal space

Question 25

Describe the anterior upright rib evaluation.

Answer 25

• Patient seated and physician stands in front of the patient
• Fingers and palms are placed upon the chest wall
• As patient breaths, monitor ribs for inherent motion
• As with posterior monitoring, feel the anterior contour of the rib shaft - should feel each rib’s superior lip more anteriorly
• Feel for width of intercostal space
• While hands are along the lower torso/costal margin, can feel the diaphragm contract

Question 26

Describe the palpation of the sternum.

Answer 26

• Heel of palm on area of suprasternal notch, fingers on sternum
• Ask patient to breath deeply
• Monitor motion at fingers and palms should be synchronous

Question 27

Describe the supine evaluation of the 1st rib.