How do Ribs 11 and 12 move during inhalation?
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They move posterior and lateral.
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How do Ribs 11 and 12 move during inhalation?
They move posterior and lateral.
What indicates exhalation dysfunction?
Positive asymmetry in inhalation.
Which ribs are classified as typical ribs?
Ribs 3 to 10.
How does the 1st rib articulate with the vertebra?
It has a single facet on the rib head that articulates with T1.
What do the rib heads articulate with?
Demifacets on the vertebrae at the inferior costal facet above and the superior costal facet below.
What is the characteristic of the intercostal space below the bottom rib?
Wider intercostal space.
What is the position of the key rib in inhalation dysfunction?
Stuck up, preventing ribs above from moving down.
What is a clinical pearl regarding rib articulations?
Ribs have multiple articulations with the thoracic spine.
What happens when the key rib is treated?
The ribcage returns to normal function.
What may treatment with OMM need to address?
Both thoracics and ribs.
What is the characteristic of exhalation dysfunction?
Positive asymmetry in inhalation, no asymmetry in exhalation.
What is observed in exhalation dysfunction?
No asymmetry in exhalation.
What is the bottom rib associated with in terms of dysfunction?
Inhaled dysfunction.
What is unique about rib 1?
It has no angle.
What is the purpose of identifying the key rib?
To treat inhalation/exhalation dysfunction.
What does the tubercle of the rib articulate with?
The transverse process of the same-numbered vertebra.
How do ribs behave in Inhalation Dysfunction?
They move fully into inhalation but are restricted in exhalation.
What is the position of the key rib in exhalation dysfunction?
Stuck down, preventing ribs below from moving up.
How do the 10th to 12th ribs articulate with vertebrae?
They articulate with a single vertebra, each slightly more inferior.
How can rib somatic dysfunctions affect the body?
They can impact sympathetic innervation due to proximity to sympathetic chain ganglia.
What does it indicate if the right upper ribs are not rising during inhalation?
They prefer exhalation.
What other structure does the diaphragm attach to?
The xyphoid process.
How long is the isometric contraction held?
3 to 5 seconds.
Which muscles are used for exhalation at Rib 1?
Anterior and middle scalene.
What does the physician do after the patient exhales?
Increases caudad and lateral traction on the rib.
What does caliper motion evaluation assess?
The movement and function of the ribs.
Why is the prone position used in caliper motion evaluation?
It allows for better access to rib mechanics.
Which rib is considered the key rib in exhalation dysfunction?
The top rib.
What muscle does the physician move to locate the 1st rib in the left picture?
The trapezius muscle.
In the right picture, what structure is moved to find the 1st rib?
The clavicle.
What is the top rib associated with in terms of dysfunction?
Exhaled dysfunction.
What occurs during exhalation dysfunction with the key rib?
It moves down but won't move back up during inhalation.
How do the articular facets of ribs shift as you move down the spine?
They shift inferiorly.
Why is rib 10 sometimes referred to as atypical?
It may have variations in landmarks.
What does the key rib indicate?
The rib causing inhalation/exhalation dysfunction.
What mnemonic can help remember the key rib concepts?
BITE (Bottom Inhaled, Top Exhaled).
What examination findings may indicate rib dysfunction?
Osteopathic Structural Exam findings.
What is the primary muscle of inhalation?
Diaphragm (contracts and flattens).
What is the purpose of locating the key rib?
To identify the rib causing inhalation/exhalation dysfunction.
Which muscles assist in inhalation?
External intercostal muscles, scalenes, pectoralis minor, serratus anterior & posterior, quadratus lumborum, latissimus dorsi.
What should treatment of the key rib achieve?
Return the ribcage to normal function.
What happens if the diaphragm is restricted?
It can affect lower rib motion, upper lumbar spine, sympathetic innervation, lung expansion, and gastric motility.
What is the primary position for evaluating caliper motion?
Prone position.
What are the two main types of ribs?
True ribs and false ribs.
What is a key consideration during caliper motion evaluation?
Observing rib symmetry and mobility.
What position does the patient assume for Muscle Energy technique on ribs 11 & 12?
The patient lies prone.
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.
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.
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.
How many tubercles does rib 2 have?
Two tubercles.
What distinguishes ribs 11 and 12?
They have no tubercle or neck.
What other respiratory complaints could indicate rib dysfunction?
Cough, wheezing, or chest tightness.
What type of motion do Ribs 1-5 primarily exhibit?
Pump handle motion.
Which rib articulates with the T10 facet?
The 10th rib.
How are intercostal spaces numbered?
According to the rib superior to the space.
What ribs are screened in the Bucket Handle Motion?
Ribs 6 to 10.
What type of motion do Ribs 11 and 12 exhibit?
Caliper motion.
What is the first osteopathic tenet?
The body is a unit; the person is a unit of body, mind, and spirit.
What is a key sign of inhalation dysfunction?
Positive asymmetry in exhalation.
What are common patient complaints that may indicate rib dysfunction?
Pain in the head, neck, arm, or thoracic cage.
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.
Which vertebra does the 9th rib articulate with?
It articulates with the 8th and 9th vertebrae.
What does the physician do with the patient's arm during the technique?
Abducts it to 90 degrees.
Which muscles are involved in forceful exhalation?
Abdominal muscles (rectus abdominus, external oblique, internal oblique, transversus abdominus) and internal intercostal muscles.
How do you find the key rib in exhaled rib dysfunction?
Assess the intercostal space between ribs 2 and 3.
Which rib is associated with the sternal angle?
Rib 2.
What is the lowest part of the sternum called?
Xiphoid process.
Which muscles are involved in exhalation for Ribs 3-5?
Pectoralis minor.
What joints are located at the acromioclavicular area?
Acromioclavicular joints (A/C).
What role does the key rib play in rib dysfunction?
It prevents ribs above or below from completing their normal excursion.
Where should you screen if you have smaller hands?
Just below the nipple line and more distally.
What is the characteristic of inhalation dysfunction?
No asymmetry in inhalation, positive asymmetry in exhalation.
Which rib is considered the key rib in inhalation dysfunction?
The bottom rib.
What does Inhalation Dysfunction in ribs indicate?
Restricted exhalation; ribs move freely into inhalation but are 'stuck up' during exhalation.
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.
How do ribs behave in Exhalation Dysfunction?
They move fully into exhalation but are restricted in inhalation.
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.
What is the physician's action on the dysfunctional rib?
Exerts caudad and lateral traction.
What type of motion do Ribs 6-10 primarily exhibit?
Bucket handle motion.
What is the location of the 1st intercostal space?
Between rib 1 and rib 2.
What does restricted inhalation feel like?
Ribs may feel like they move more during exhalation.
What holds the other ribs down in exhaled rib dysfunctions?
The uppermost rib in the group.
What is the key rib in the example provided?
Right Rib 3.
What muscle acts on Ribs 6-8 during exhalation?
Serratus anterior.
Which muscle is used for exhalation at Ribs 9-10?
Latissimus dorsi.
What is the first step in assessing rib dysfunction?
Palpate the ribcage during deep inhalation and exhalation.
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.
Where does the physician place their left hand during the procedure?
Inferior to the dysfunctional rib, applying cephalad pressure.
How do you locate the key rib in dysfunction?
Palpate the rib intercostal space, comparing sides.
What position does the patient assume for Muscle Energy Technique for ribs 6-8?
The patient lies supine.
What does the physician do with the patient's shoulder and elbow?
Flexes them to 90 degrees on the side of dysfunction.
What are the two options for screening ribs 2-5?
Option 1 and Option 2.
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.
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.
What is the significance of identifying the 1st rib?
It is crucial for assessing rib function and potential dysfunction.
What is the significance of treating the axial spine?
It may help in addressing rib dysfunction.
What position does the patient assume for Muscle Energy technique for exhalation dysfunctions?
Supine.
How do you name a rib dysfunction?
Name it for what the rib prefers to do.
What lumbar vertebrae does the diaphragm attach to?
L1 to L3.
What type of motion do Ribs 11-12 primarily exhibit?
Caliper motion.
What is an example of naming a rib dysfunction?
Right Rib pump handle ribs exhaled.
How many pairs of ribs are there in the human body?
12 pairs.
What muscle is associated with Rib 2 during exhalation?
Posterior scalene.
How do ribs 6-10 affect the thoracic cavity during inhalation?
They increase the transverse diameter.
What does restricted exhalation feel like?
Ribs may feel like they move more during inhalation.
What is the initial position of the patient for Muscle Energy technique for ribs 3-5?
The patient lies supine.
How do you determine if ribs are stuck up or down?
Compare the movement of ribs on the left vs right side.
What angle should the patient's legs be positioned during the technique?
15 to 20 degrees to the left.
What does the patient do with their arm on the side of dysfunction?
Raises it and places the hand over their head or forehead.
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.
What is the motion associated with ribs 2-5?
Pump handle motion.
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.
What happens to the key rib during inhalation dysfunction?
It moves up but won't move down during exhalation.
What should be palpated to locate the key rib?
The rib intercostal spaces.
What is the purpose of moving the trapezius muscle?
To locate the 1st rib.
What is the characteristic of the intercostal space above the top rib?
Wider intercostal space.
What medical history might suggest rib dysfunction?
Asthma, COPD, pneumonia, or bronchitis.
What does BITE stand for in diagnosing key ribs?
Bottom rib for inhalation dysfunctions, Top rib for exhalation dysfunctions.
What is the first step in addressing rib somatic dysfunctions?
Identify the area of restriction.
Which ribs does the diaphragm attach to?
Ribs 6 to 12.
What is the patient's action during the isometric contraction?
Adducts toward the iliac crest while inhaling.
What is the suprasternal notch also known as?
Jugular notch.
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.
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.
What does the patient do with their arm on the side of dysfunction?
Raises it and places the hand over their head or forehead.
What questions are typically asked in muscle energy treatment?
What muscle is used? How to activate that muscle? Key rib?
What happens to the diaphragm during exhalation?
It relaxes and domes.
How do you evaluate inhalation and exhalation in ribs?
Place fingers on each side of a pair of 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.
What role do the intercostal muscles play in exhalation?
They assist in forceful exhalation.
What indicates an inhalation dysfunction?
Ribs that stop sooner during exhalation.
What muscle is associated with Ribs 11-12 during exhalation?
Quadratus lumborum.
What is the key rib in muscle energy treatment?
The top of the group.
What does 'stuck up' indicate in rib dysfunction?
Inhalation Somatic Dysfunction (doesn't want to exhale).
What does the physician's right hand do during the technique?
Grasps the right iliac crest and pulls caudad.
How many times are steps 5 to 7 repeated?
3 to 5 times or until motion is maximally improved.
What should be reassessed after the technique?
Pec minor.
What is the classification of Rib 2?
Atypical.
What is the motion type for Ribs 3-5?
Pump Handle.
What should be done after completing the treatment?
Reassess the Scalenes.
What does a bottom rib indicate in the BITE mnemonic?
Inhalation dysfunctions (keeping ribs up).
What are the primary muscles involved in quiet exhalation?
Diaphragm.
What is the primary motion of ribs 1-5 during inhalation?
Pump handle motion, moving anterior and superior.
What landmark is referred to as the Angle of Louis?
Sternal angle.
What is the primary function of ribs?
To protect the thoracic cavity and support respiration.
What should be reassessed after the technique?
Latissimus Dorsi.
How do ribs 11-12 affect the thoracic cavity during inhalation?
They move on the vertical axis.
In inhalation dysfunction, what does the key rib do?
Holds the ribs above it up.
In exhalation dysfunction, what does the key rib do?
Holds the ribs below it down.
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.
Which rib is treated for exhaled dysfunction?
The top rib (BITE).
What technique is discussed for treating the key rib?
Muscle energy.
What is the physician's action on the dysfunctional rib?
Exerts caudad and lateral traction.
What do rib angles refer to?
Curvature points of the ribs.
What does the physician do after the patient exhales?
Increases caudad and lateral traction on the rib.
What position should the patient be in for treating rib 1?
Supine with head straight up, looking at the ceiling.
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.
What is the motion type for Ribs 6-7?
Bucket Handle.
What is the motion type for Rib 9?
Bucket Handle.
What joints connect the sternum and clavicle?
Sternoclavicular joints (S/C).
What are the costosternal joints?
Joints between the ribs and the sternum.
What is the significance of the inferior margin of ribs?
It helps in identifying rib landmarks.
What position does the patient assume for Muscle Energy techniques for ribs 3-5?
The patient lies supine.
What is the prominent vertebra at C7 known as?
C7 vertebra prominens.
How long is the isometric contraction held?
For 3 to 5 seconds.
What action does the patient perform against the physician's counterforce?
Pushes horizontal adduction while inhaling deeply.
How long is the isometric contraction held?
3 to 5 seconds.
What mnemonic is associated with Ribs 3-5?
3,4,5 can I get a Hi - 5?
What should the physician do after the patient relaxes?
Exert increased caudad and lateral traction on the dysfunctional rib.
What is the classification of Rib 8?
Typical.
What is the manubrium?
The upper part of the sternum.
What does 'stuck down' indicate in rib dysfunction?
Exhalation Somatic Dysfunction (doesn't want to inhale).
What action does the patient perform against the physician's counterforce?
Pushes horizontal adduction while inhaling deeply.
What should be done after treating the key rib?
Reassess the group for improvement.
What action does the patient perform during the isometric contraction?
Pushes elbow toward the ceiling while inhaling.
How many times are steps 3-5 repeated?
3 to 5 times or until motion improves.
What is the classification of Ribs 11 & 12?
Atypical and Floating.
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.
Which rib is treated for inhaled dysfunction?
The bottom rib.
Which spinous process corresponds to the spine of the scapula?
T3 spinous process.
What does the T7 spinous process correspond to?
Inferior angle of the scapula.
What should be done at the end of the procedure?
Reassess the rib function.
What muscles are involved in exhalation for Rib 1?
Anterior and Middle Scalenes.
Is Rib 1 typical or atypical?
Atypical.
How many times should steps 5 to 8 be repeated?
3 to 5 times or until motion is maximally improved.
How long is the isometric contraction maintained?
3 to 5 seconds.
What are the 'Rules of Threes' related to?
Landmarks of thoracic vertebrae.
How many times are steps 5 to 7 repeated?
3 to 5 times or until motion is maximally improved.
What should the physician reassess after the technique?
Serratus Anterior.
How should the patient's head be positioned when treating rib 2?
Rotated approximately 30 degrees away from the dysfunction.
What muscles are involved in exhalation for Ribs 6-7?
Serratus Anterior.
What does the physician do after the patient exhales?
Exerts increased caudad and lateral traction on the dysfunctional rib.
What happens after the patient relaxes?
The physician pulls caudad and maintains cephalad pressure on the rib.
How many times are steps 5 to 7 repeated?
Three to five times.
What do rib heads articulate with?
The thoracic spine.
What mnemonic is associated with Rib 1?
1 Hand on head.
What action does the patient perform while the physician provides resistance?
Raises their head off the table while inhaling deeply.
What muscles are involved in exhalation for Ribs 11 & 12?
Quadratus Lumborum.
How long is the isometric contraction held?
3 to 5 seconds.
What does the physician do after the patient exhales?
Exerts increased caudad and lateral traction on the dysfunctional rib.
What should be reassessed after the technique?
Pectoralis minor.
What is the motion type for Rib 1?
Pump Handle.
How long should the isometric contraction be maintained?
For 3 to 5 seconds.
What type of facets are mentioned for ribs 9-12?
True facets.
What distinguishes true ribs, false ribs, and floating ribs?
True ribs attach directly to the sternum, while false ribs do not directly. Floating ribs do not attach at all
