Ribs

Question 1

where are the anterior rib TPs?

Answer 1

• rib 1: first rib mid clavicular
• rib 2: second rib mid clavicular
• ribs 3-6: mid axillary line on rib or intercostal space

Question 2

how are anterior rib TPs treated?

Answer 2

1. patient seated
2. physician puts foot on table on side OPPOSITE of TP
3. forearm on thigh
4. bring arm ipsilateral to TP off back of table
5. monitor TP
6. translate AWAY (sidebend toward) side of TP until movement
7. rotate toward side of TP until movement
8. hand on head, flex patient forward by pulling them back toward you until rib starts to move
9. 70-100% better? (fine tune)
10. follow S/CS

Question 3

where are the posterior rib TPs?

Answer 3

located along rib angle bilaterally

Question 4

how are posterior rib TPs treated?

Answer 4

1. patient seated
2. physician puts foot on table on SAME side of TP
3. bring contralateral arm off table
4. monitor TP
5. translate toward (sidebend away) side of TP until movement
6. rotate away from side of TP until movement
7. hand on head, flex patient forward by pulling them back toward you until rib moves
8. 70-100% better? (fine tune)
9. follow S/CS

Question 5

what is the most common rib dysfunction?

Answer 5

locked up on the left

Question 6

ME for locked up pump handle ribs 1-5

Answer 6

1. patient seated at end of table with arm on side of SD hanging off table
2. physician behind patient and monitors locked up rib with thumb / fingers
3. physician guides patient’s head, neck, and upper thoracic spine into FLEXION until a downward motion is felt at key rib
4. patient takes small breath in while the physician holds down the rib and then exhales fully WITHOUT forcing breath out
5. during exhalation, physician follows inferior motion of rib and uses more flexion of head / neck / t spine
6. repeat 3x to barrier
7. re check

Question 7

ME for locked up bucket handle ribs 6-10

Answer 7

1. patient seated end of table with arm of SD handing off
2. physician stands behind and monitors superior aspect of locked up rib with thumb / fingers
3. physician guides patient’s head / neck / t spine into FLEXION and SIDEBENDING until a downward motion is felt at the key rib
4. patient takes small breath in while the physician holds down the rib and then exhales fully WITHOUT forcing breath out
5. during exhalation, physician follows inferior motion of rib and uses more flexion of head / neck / t spine
6. repeat 3x to barrier
7. re check

Question 8

ME for locked up caliper ribs 11-12

Answer 8

1. patient prone with physician on opposite side of SD
2. patient’s involved arm is placed at their side and feet moved away from side of SD (taco - sidebend AWAY from SD) - engages QL to facilitate movement of rib downward
3. physician stands on side of SD
4. place one hand on ipsilateral ASIS and rotate pelvis posteriorly while heel of your hand is placed over involved ribs
5. patient inhales then exhales deeply. during exhalation physician pushes laterally on rib, separating it from its articulation
6. patient exhales fully and holds breath out while they push against the hand on their ASIS as physician resists isometrically
7. repeat 3x
8. recheck

Question 9

ME for locked down rib 1

Answer 9

1. patient seated at end of table
2. physician standing on side of SD
3. grasp posterior-superior surface of rib to be treated by grasping top of trapezius muscle and pulling down until rib is felt
4. patient places forearm on side of SD on forehead and you place your hand on top of the patient’s forearm
5. anterior and middle scalene muscles move 1st rib - turn patient’s head 5-10 degrees AWAY from dysfunctional rib to engage them
6. patient inhales as you pull caudally on rib angle to a barrier
7. patient holds breath in and pushes their head against their forearm as you resist and maintain caudal rib traction
8. repeat 3x
9. recheck

Question 10

ME for locked down rib 2

Answer 10

1. patient seated end of table with physician on side of SD
2. grasp posterior-superior surface of rib
3. patient places forearm on side of SD on forehead and you place your hand on top of the patient’s forearm
4. posterior scalene moves rib 2 - patient’s head should be turned 20-30 degrees AWAY from SD to engage
5. patient inhales as you pull caudally on rib angle to a barrier
6. patient holds breath IN and pushes against forearm as you resist and maintain traction
7. repeat 3x
8. recheck

Question 11

ME for locked down ribs 3-5

Answer 11

1. patient at end of table with physician on side of SD
2. grasp posterior-superior surface of rib to be treated
3. patient brings arm on side of SD to side of head with hand by ear
4. place hand on patient’s elbow
5. as patient inhales, pull caudally on rib angle to barrier
6. as patient holds breath IN, ask them to bring elbow toward opposite ASIS as you resist and maintain traction
7. repeat x3
8. recheck

Question 12

ME for locked down ribs 6-9

Answer 12

1. patient seated end of table with physician on side of SD
2. grasp posterior-superior surface of rib to be treated
3. patient brings arm on side of SD to 90 degree angle
4. place hand on patient’s elbow
5. as patient inhales, pull caudally on rib angle to a barrier
6. as patient holds breath IN, ask them to push their elbow ANTERIORLY as you resist isometrically and maintain traction
7. repeat x3
8. recheck

Question 13

ME for locked down caliper ribs 10-12

Answer 13

1. patient prone with physician on opposite side
2. patient’s involved arm above head and feet moved away from SD in order to sidebend AWAY from SD - uses lat to facilitate movement of rib upward and outward
3. place caudad hand on patient’s ipsilateral ASIS and rotate pelvis posteriorly while heel of cephalad hand is placed over involved ribs
4. patient inhales deeply as physician pushes laterally on rib, separating it from its articulation to allow the breath to carry it into inhalation
5. ask patient to hold their breath IN and then while they push against the hand on their ASIS as physician resists
6. repeat x3
7. recheck