How do Ribs 11 and 12 move during inhalation?
They move posterior and lateral.
p.22
Somatic Dysfunction in Ribs
What indicates exhalation dysfunction?
Positive asymmetry in inhalation.
p.3
Rib Anatomy and Articulations
How does the 1st rib articulate with the vertebra?
It has a single facet on the rib head that articulates with T1.
p.4
Rib Anatomy and Articulations
What do the rib heads articulate with?
Demifacets on the vertebrae at the inferior costal facet above and the superior costal facet below.
p.24
Somatic Dysfunction in Ribs
What is the position of the key rib in inhalation dysfunction?
Stuck up, preventing ribs above from moving down.
p.4
Clinical Implications of Rib Dysfunction
What is a clinical pearl regarding rib articulations?
Ribs have multiple articulations with the thoracic spine.
p.36
Key Rib Identification and Treatment
What happens when the key rib is treated?
The ribcage returns to normal function.
p.26
Somatic Dysfunction in Ribs
What is the characteristic of exhalation dysfunction?
Positive asymmetry in inhalation, no asymmetry in exhalation.
p.22
Somatic Dysfunction in Ribs
What is observed in exhalation dysfunction?
No asymmetry in exhalation.
p.36
Key Rib Identification and Treatment
What is the purpose of identifying the key rib?
To treat inhalation/exhalation dysfunction.
p.4
Rib Anatomy and Articulations
What does the tubercle of the rib articulate with?
The transverse process of the same-numbered vertebra.
p.21
Somatic Dysfunction in Ribs
How do ribs behave in Inhalation Dysfunction?
They move fully into inhalation but are restricted in exhalation.
p.24
Somatic Dysfunction in Ribs
What is the position of the key rib in exhalation dysfunction?
Stuck down, preventing ribs below from moving up.
p.5
Rib Anatomy and Articulations
How do the 10th to 12th ribs articulate with vertebrae?
They articulate with a single vertebra, each slightly more inferior.
p.12
Somatic Dysfunction in Ribs
How can rib somatic dysfunctions affect the body?
They can impact sympathetic innervation due to proximity to sympathetic chain ganglia.
p.29
Muscles of Inhalation and Exhalation
Which muscles are used for exhalation at Rib 1?
Anterior and middle scalene.
p.33
Muscle Energy Techniques for Rib Dysfunction
What does the physician do after the patient exhales?
Increases caudad and lateral traction on the rib.
p.20
Assessment and Reassessment of Rib Function
What does caliper motion evaluation assess?
The movement and function of the ribs.
p.20
Assessment and Reassessment of Rib Function
Why is the prone position used in caliper motion evaluation?
It allows for better access to rib mechanics.
p.24
Somatic Dysfunction in Ribs
What occurs during exhalation dysfunction with the key rib?
It moves down but won't move back up during inhalation.
Why is rib 10 sometimes referred to as atypical?
It may have variations in landmarks.
p.36
Key Rib Identification and Treatment
What does the key rib indicate?
The rib causing inhalation/exhalation dysfunction.
p.25
Key Rib Identification and Treatment
What mnemonic can help remember the key rib concepts?
BITE (Bottom Inhaled, Top Exhaled).
p.15
Somatic Dysfunction in Ribs
What examination findings may indicate rib dysfunction?
Osteopathic Structural Exam findings.
p.14
Muscles of Inhalation and Exhalation
What is the primary muscle of inhalation?
Diaphragm (contracts and flattens).
p.23
Key Rib Identification and Treatment
What is the purpose of locating the key rib?
To identify the rib causing inhalation/exhalation dysfunction.
p.14
Muscles of Inhalation and Exhalation
Which muscles assist in inhalation?
External intercostal muscles, scalenes, pectoralis minor, serratus anterior & posterior, quadratus lumborum, latissimus dorsi.
p.23
Key Rib Identification and Treatment
What should treatment of the key rib achieve?
Return the ribcage to normal function.
p.12
Clinical Implications of Rib Dysfunction
What happens if the diaphragm is restricted?
It can affect lower rib motion, upper lumbar spine, sympathetic innervation, lung expansion, and gastric motility.
What are the two main types of ribs?
True ribs and false ribs.
p.20
Assessment and Reassessment of Rib Function
What is a key consideration during caliper motion evaluation?
Observing rib symmetry and mobility.
p.34
Muscle Energy Techniques for Rib Dysfunction
What is the patient's action during inhalation?
Pull the right iliac crest toward the right shoulder.
What is the significance of Bucket Handle Motion?
It refers to the motion of ribs during respiration.
p.22
Somatic Dysfunction in Ribs
What is a characteristic of inhalation dysfunction?
No asymmetry in inhalation.
What are False Ribs?
Ribs 8-10, indirectly connected to the sternum through the costal cartilage of the rib above.
p.36
Key Rib Identification and Treatment
What does BITE stand for in diagnosing key ribs?
Bottom rib for inhalation dysfunctions, Top rib for exhalation dysfunctions.
What capabilities does the body have according to osteopathic principles?
Self-regulation, self-healing, and health maintenance.
What distinguishes ribs 11 and 12?
They have no tubercle or neck.
p.15
Somatic Dysfunction in Ribs
What other respiratory complaints could indicate rib dysfunction?
Cough, wheezing, or chest tightness.
p.13
Rib Anatomy and Articulations
How are intercostal spaces numbered?
According to the rib superior to the space.
What is the first osteopathic tenet?
The body is a unit; the person is a unit of body, mind, and spirit.
p.22
Somatic Dysfunction in Ribs
What is a key sign of inhalation dysfunction?
Positive asymmetry in exhalation.
p.15
Somatic Dysfunction in Ribs
What are common patient complaints that may indicate rib dysfunction?
Pain in the head, neck, arm, or thoracic cage.
p.21
Somatic Dysfunction in Ribs
What is Exhalation Dysfunction in ribs?
Restricted inhalation; ribs move freely into exhalation but are 'stuck down' during inhalation.
Why is the 1st rib considered atypical?
It only articulates with T1.
p.5
Rib Anatomy and Articulations
Which vertebra does the 9th rib articulate with?
It articulates with the 8th and 9th vertebrae.
p.33
Muscle Energy Techniques for Rib Dysfunction
What does the physician do with the patient's arm during the technique?
Abducts it to 90 degrees.
p.14
Muscles of Inhalation and Exhalation
Which muscles are involved in forceful exhalation?
Abdominal muscles (rectus abdominus, external oblique, internal oblique, transversus abdominus) and internal intercostal muscles.
p.28
Key Rib Identification and Treatment
How do you find the key rib in exhaled rib dysfunction?
Assess the intercostal space between ribs 2 and 3.
p.6
Key Rib Identification and Treatment
What joints are located at the acromioclavicular area?
Acromioclavicular joints (A/C).
p.27
Key Rib Identification and Treatment
What role does the key rib play in rib dysfunction?
It prevents ribs above or below from completing their normal excursion.
p.18
Key Rib Identification and Treatment
Where should you screen if you have smaller hands?
Just below the nipple line and more distally.
p.26
Somatic Dysfunction in Ribs
What is the characteristic of inhalation dysfunction?
No asymmetry in inhalation, positive asymmetry in exhalation.
p.21
Somatic Dysfunction in Ribs
What does Inhalation Dysfunction in ribs indicate?
Restricted exhalation; ribs move freely into inhalation but are 'stuck up' during exhalation.
p.15
Somatic Dysfunction in Ribs
What respiratory symptom might suggest rib dysfunction?
Shortness of breath (SOB).
What is the basis for rational treatment in osteopathy?
Understanding body unity, self-regulation, and the interrelationship of structure and function.
p.21
Somatic Dysfunction in Ribs
How do ribs behave in Exhalation Dysfunction?
They move fully into exhalation but are restricted in inhalation.
p.5
Rib Anatomy and Articulations
What is unique about the articulation of the 10th to 12th ribs?
They only articulate with one vertebra each.
What does the pump handle motion of Ribs 1-5 increase?
Anterior-posterior (AP) diameter.
p.33
Muscle Energy Techniques for Rib Dysfunction
What is the physician's action on the dysfunctional rib?
Exerts caudad and lateral traction.
p.27
Somatic Dysfunction in Ribs
What does restricted inhalation feel like?
Ribs may feel like they move more during exhalation.
p.28
Somatic Dysfunction in Ribs
What holds the other ribs down in exhaled rib dysfunctions?
The uppermost rib in the group.
p.16
Assessment and Reassessment of Rib Function
What is the first step in assessing rib dysfunction?
Palpate the ribcage during deep inhalation and exhalation.
p.35
Muscle Energy Techniques for Rib Dysfunction
What does the physician do with their hand under the patient?
Grasps the superior angle of the dysfunctional rib and exerts caudad and lateral traction.
p.34
Muscle Energy Techniques for Rib Dysfunction
Where does the physician place their left hand during the procedure?
Inferior to the dysfunctional rib, applying cephalad pressure.
p.16
Key Rib Identification and Treatment
How do you locate the key rib in dysfunction?
Palpate the rib intercostal space, comparing sides.
p.32
Muscle Energy Techniques for Rib Dysfunction
What does the physician do with the patient's shoulder and elbow?
Flexes them to 90 degrees on the side of dysfunction.
p.19
Rib Anatomy and Articulations
What is unique about Ribs 11 and 12?
They don’t attach to the sternum.
What are True Ribs?
Ribs 1-7 directly connect to the sternum via costal cartilage.
What are Floating Ribs?
Ribs 11-12 that do not connect to the sternum or costal cartilage.
p.3
Rib Anatomy and Articulations
What part of the 1st rib articulates with the transverse process?
The tubercle articulates with the transverse process of T1.
How are structure and function related in osteopathy?
They are reciprocally interrelated.
p.38
Key Rib Identification and Treatment
What is the significance of identifying the 1st rib?
It is crucial for assessing rib function and potential dysfunction.
p.4
Clinical Implications of Rib Dysfunction
What is the significance of treating the axial spine?
It may help in addressing rib dysfunction.
p.28
Somatic Dysfunction in Ribs
How do you name a rib dysfunction?
Name it for what the rib prefers to do.
p.28
Somatic Dysfunction in Ribs
What is an example of naming a rib dysfunction?
Right Rib pump handle ribs exhaled.
How do ribs 6-10 affect the thoracic cavity during inhalation?
They increase the transverse diameter.
p.27
Somatic Dysfunction in Ribs
What does restricted exhalation feel like?
Ribs may feel like they move more during inhalation.
p.16
Assessment and Reassessment of Rib Function
How do you determine if ribs are stuck up or down?
Compare the movement of ribs on the left vs right side.
p.34
Muscle Energy Techniques for Rib Dysfunction
What angle should the patient's legs be positioned during the technique?
15 to 20 degrees to the left.
p.31
Muscle Energy Techniques for Rib Dysfunction
What does the patient do with their arm on the side of dysfunction?
Raises it and places the hand over their head or forehead.
p.31
Muscle Energy Techniques for Rib Dysfunction
Where does the physician place their other hand during the technique?
Over the anterior aspect of the patient's elbow or forearm on the dysfunctional side.
How do Ribs 11 and 12 move during exhalation?
They move anterior and medial.
What are the five landmarks of typical ribs?
Head, neck, tubercle, angle, and shaft/body.
How is Rib 10 connected?
Its costal cartilage attaches to the costal cartilage of Rib 9.
p.24
Somatic Dysfunction in Ribs
What happens to the key rib during inhalation dysfunction?
It moves up but won't move down during exhalation.
p.36
Key Rib Identification and Treatment
What should be palpated to locate the key rib?
The rib intercostal spaces.
p.15
Somatic Dysfunction in Ribs
What medical history might suggest rib dysfunction?
Asthma, COPD, pneumonia, or bronchitis.
p.23
Key Rib Identification and Treatment
What does BITE stand for in diagnosing key ribs?
Bottom rib for inhalation dysfunctions, Top rib for exhalation dysfunctions.
p.28
Somatic Dysfunction in Ribs
What is the first step in addressing rib somatic dysfunctions?
Identify the area of restriction.
p.33
Muscle Energy Techniques for Rib Dysfunction
What is the patient's action during the isometric contraction?
Adducts toward the iliac crest while inhaling.
p.23
Key Rib Identification and Treatment
What does a top rib indicate in the BITE mnemonic?
Exhalation dysfunctions (keeping ribs down).
What is the coupled motion exhibited by ribs?
Both pump and bucket handle motions.
What is the primary motion of ribs 6-10 during inhalation?
Bucket handle motion, moving laterally and superior.
p.33
Muscle Energy Techniques for Rib Dysfunction
How many times are steps 3 to 5 repeated?
3 to 5 times or until motion improves.
What is the primary motion of ribs 11-12 during inhalation?
Caliper motion, moving posterior and lateral.
p.35
Muscle Energy Techniques for Rib Dysfunction
What does the patient do with their arm on the side of dysfunction?
Raises it and places the hand over their head or forehead.
p.29
Muscle Energy Techniques for Rib Dysfunction
What questions are typically asked in muscle energy treatment?
What muscle is used? How to activate that muscle? Key rib?
p.27
Key Rib Identification and Treatment
How do you evaluate inhalation and exhalation in ribs?
Place fingers on each side of a pair of ribs.
p.27
Somatic Dysfunction in Ribs
What indicates an exhalation dysfunction?
Ribs that stop sooner during inhalation.
How do ribs 1-5 affect the thoracic cavity during inhalation?
They increase the anteroposterior (AP) diameter.
p.14
Muscles of Inhalation and Exhalation
What role do the intercostal muscles play in exhalation?
They assist in forceful exhalation.
p.27
Somatic Dysfunction in Ribs
What indicates an inhalation dysfunction?
Ribs that stop sooner during exhalation.
p.16
Somatic Dysfunction in Ribs
What does 'stuck up' indicate in rib dysfunction?
Inhalation Somatic Dysfunction (doesn't want to exhale).
p.34
Muscle Energy Techniques for Rib Dysfunction
What does the physician's right hand do during the technique?
Grasps the right iliac crest and pulls caudad.
p.35
Muscle Energy Techniques for Rib Dysfunction
How many times are steps 5 to 7 repeated?
3 to 5 times or until motion is maximally improved.
p.23
Key Rib Identification and Treatment
What does a bottom rib indicate in the BITE mnemonic?
Inhalation dysfunctions (keeping ribs up).
What is the primary motion of ribs 1-5 during inhalation?
Pump handle motion, moving anterior and superior.
p.2
Rib Anatomy and Articulations
What is the primary function of ribs?
To protect the thoracic cavity and support respiration.
How do ribs 11-12 affect the thoracic cavity during inhalation?
They move on the vertical axis.
p.27
Somatic Dysfunction in Ribs
In inhalation dysfunction, what does the key rib do?
Holds the ribs above it up.
p.27
Somatic Dysfunction in Ribs
In exhalation dysfunction, what does the key rib do?
Holds the ribs below it down.
p.31
Muscle Energy Techniques for Rib Dysfunction
What does the physician do with their hand under the patient?
Grasps the superior angle of the dysfunctional rib and exerts caudad and lateral traction.
p.32
Muscle Energy Techniques for Rib Dysfunction
What is the physician's action on the dysfunctional rib?
Exerts caudad and lateral traction.
p.9
Rib Anatomy and Articulations
What do rib angles refer to?
Curvature points of the ribs.
p.32
Muscle Energy Techniques for Rib Dysfunction
What does the physician do after the patient exhales?
Increases caudad and lateral traction on the rib.
p.30
Muscle Energy Techniques for Rib Dysfunction
What position should the patient be in for treating rib 1?
Supine with head straight up, looking at the ceiling.
p.30
Muscle Energy Techniques for Rib Dysfunction
What is the role of the physician's hand during the treatment?
Grasps the superior angle of the dysfunctional rib and exerts caudad and lateral traction.
p.6
Key Rib Identification and Treatment
What joints connect the sternum and clavicle?
Sternoclavicular joints (S/C).
p.6
Key Rib Identification and Treatment
What are the costosternal joints?
Joints between the ribs and the sternum.
p.6
Key Rib Identification and Treatment
What is the significance of the inferior margin of ribs?
It helps in identifying rib landmarks.
p.31
Muscle Energy Techniques for Rib Dysfunction
What action does the patient perform against the physician's counterforce?
Pushes horizontal adduction while inhaling deeply.
p.37
Muscle Energy Techniques for Rib Dysfunction
What mnemonic is associated with Ribs 3-5?
3,4,5 can I get a Hi - 5?
p.30
Muscle Energy Techniques for Rib Dysfunction
What should the physician do after the patient relaxes?
Exert increased caudad and lateral traction on the dysfunctional rib.
p.6
Key Rib Identification and Treatment
What is the manubrium?
The upper part of the sternum.
p.16
Somatic Dysfunction in Ribs
What does 'stuck down' indicate in rib dysfunction?
Exhalation Somatic Dysfunction (doesn't want to inhale).
p.35
Muscle Energy Techniques for Rib Dysfunction
What action does the patient perform against the physician's counterforce?
Pushes horizontal adduction while inhaling deeply.
p.16
Assessment and Reassessment of Rib Function
What should be done after treating the key rib?
Reassess the group for improvement.
p.32
Muscle Energy Techniques for Rib Dysfunction
What action does the patient perform during the isometric contraction?
Pushes elbow toward the ceiling while inhaling.
p.32
Muscle Energy Techniques for Rib Dysfunction
How many times are steps 3-5 repeated?
3 to 5 times or until motion improves.
p.35
Muscle Energy Techniques for Rib Dysfunction
Where does the physician place their other hand during the technique?
Over the anterior aspect of the patient's elbow or forearm on the side of dysfunction.
p.9
Key Rib Identification and Treatment
What does the T7 spinous process correspond to?
Inferior angle of the scapula.
p.34
Muscle Energy Techniques for Rib Dysfunction
What should be done at the end of the procedure?
Reassess the rib function.
p.37
Muscles of Inhalation and Exhalation
What muscles are involved in exhalation for Rib 1?
Anterior and Middle Scalenes.
p.30
Muscle Energy Techniques for Rib Dysfunction
How many times should steps 5 to 8 be repeated?
3 to 5 times or until motion is maximally improved.
p.9
Key Rib Identification and Treatment
What are the 'Rules of Threes' related to?
Landmarks of thoracic vertebrae.
p.31
Muscle Energy Techniques for Rib Dysfunction
How many times are steps 5 to 7 repeated?
3 to 5 times or until motion is maximally improved.
p.30
Muscle Energy Techniques for Rib Dysfunction
How should the patient's head be positioned when treating rib 2?
Rotated approximately 30 degrees away from the dysfunction.
p.35
Muscle Energy Techniques for Rib Dysfunction
What does the physician do after the patient exhales?
Exerts increased caudad and lateral traction on the dysfunctional rib.
p.34
Muscle Energy Techniques for Rib Dysfunction
What happens after the patient relaxes?
The physician pulls caudad and maintains cephalad pressure on the rib.
p.30
Muscle Energy Techniques for Rib Dysfunction
What action does the patient perform while the physician provides resistance?
Raises their head off the table while inhaling deeply.
p.31
Muscle Energy Techniques for Rib Dysfunction
What does the physician do after the patient exhales?
Exerts increased caudad and lateral traction on the dysfunctional rib.
What distinguishes true ribs, false ribs, and floating ribs?
<p>True ribs attach directly to the sternum, while false ribs do not <em>directly</em>. Floating ribs do not attach at all</p>
