Osteopathic Manipulative Medicine/Clavicle Sternum and Ribs

Osteopathic Manipulative Medicine/Clavicle, Sternum, and Ribs

Chapter 5: Clavicle, Sternum, and Ribs[edit]

Goals:

  1. Describe the bony and cartilaginous articulations of the sternum and clavicle
  2. Describe the movement of the clavicle throughout higher limb motion and the sternum throughout respiration
  3. Diagnose and deal with somatic dysfunctions of the clavicle, sternum, and ribs
  4. Clarify the muscular attachments to the sternum, clavicle, and humerus
  5. Describe kinds of motions (caliper/bucket deal with/pump deal with) seen within the ribs
  6. Describe gross rib movement in respiration and the way the anterior-posterior and lateral diameters of the thoracic cage are affected
  7. Outline typical versus atypical ribs
  8. Identify and describe the articulations of the ribs with the sternum and spinal vertebrae
  9. Identify major and secondary muscular tissues of respiration, actions and attachments to ribs

Clavicle Anatomy and Somatic Dysfunctions[edit]

The perform of the clavicle is to attach the higher extremity to the axial skeleton and to increase shoulder vary of movement. Clavicle movement is sure by the sternoclavicular joint proximally and the acromioclavicular joint distally. The acromioclavicular (AC) joint is the articulation between the acromion course of and the distal clavicle. Its major motions are abduction in addition to inside and exterior rotation. The sternoclavicular (SC) joint is the articulation between the sternum and the proximal clavicle and it’s the solely true joint attaching to the higher extremity of the thoracic cage through a saddle-shaped articular floor. Its major impact is on rib cage movement, because it connects with the manubrium in addition to offers ligamentous attachments to the costal cartilage of the ribs. Throughout flexion of the clavicle, the acromial finish of the clavicle strikes anteriorly; throughout extension, it strikes posteriorly. Somatic dysfunctions have secondary results on the higher extremity (the glenohumeral joint and the acromioclavicular joint). Motions that happen within the coronal airplane embrace abduction and adduction about an anterior-posterior axis and within the transverse airplane embrace flexion and extension a couple of superior-inferior axis. Rotation (each inside and exterior) of the clavicle happens a couple of transverse axis in a coronal airplane. The costoclavicular ligament connects the clavicle to the primary rib and enhances the general stability. The coracoclavicular ligament prevents displacement of the scapula medially beneath the clavicle.

To evaluate the clavicle, six ranges of movement needs to be assessed with the affected person within the supine place:

  1. Clavicle flexion: fold the arm throughout the chest and make the most of the proximal arm to convey the clavicle anteriorly
  2. Clavicle extension: fold the arm throughout the chest and make the most of the proximal arm to convey the clavicle posteriorly
  3. Clavicle abduction: the shoulder is shrugged superiorly
  4. Clavicle adduction: the shoulder is dropped inferiorly
  5. Clavicle inside rotation: the shoulder is kidnapped to 90o and rotated ahead in regards to the elbow
  6. Clavicle exterior rotation: the shoulder is kidnapped to 90o and rotated backward in regards to the elbow

Clavicular somatic dysfunction is predicated on reciprocal movement. Rotation of the clavicle happens alongside an anterior-posterior axis. Movement of the clavicle is crucial for respiration along with that of the ribs. First and second rib dysfunctions will usually co-exist with clavicular dysfunction.

Somatic dysfunction of the clavicle is called for ease on the distal finish (the acromioclavicular finish). The clavicle is taken into account dysfunctional when one paired movement has considerably better movement when in comparison with its counterpart (i.e. flexion vs. extension, abduction vs. adduction, inside vs. exterior rotation). Clavicle somatic dysfunction could contain multiple airplane of movement concurrently. On this case, every part of the somatic dysfunction needs to be handled individually.

To diagnose clavicle somatic dysfunctions:

  • Adducted: the distal finish is discovered to be inferior and immune to springing together with having poor vary of movement. The sternoclavicular joint can be displaced anteriorly and superiorly. (Typically coupled with clavicle extension dysfunction.)
  • Kidnapped: the distal finish is discovered to be superior. The clavicle will seem elevated, there can be painful articulation, and restriction and ache at each the AC and SC joints. (Typically coupled with clavicle flexion dysfunction.)
  • Exterior rotation: the superior ridge of the clavicle can be barely posterior.
  • Inner rotation: the superior ridge of the clavicle can be barely anterior.
Instance: Clavicle somatic dysfunctions
If the left proximal clavicle is discovered to be extra caudad and posterior on palpation. What’s the somatic dysfunction primarily based on these findings? For the reason that palpatory findings point out restriction with adduction and extension for the proximal clavicle, and the somatic dysfunction is called for the distal clavicle, the somatic dysfunction is left clavicle abduction and flexion dysfunction.

As talked about earlier, the clavicle is concerned in scapular and glenohumeral movement. For instance, if a affected person is discovered to have a decrease proper shoulder in comparison with the left, has bother extending the suitable shoulder, and has bother externally rotating the suitable shoulder, a clavicle somatic dysfunction will be identified. What’s the somatic dysfunction of the clavicle primarily based on these findings? It is a proper clavicle adduction, flexion, and inside rotation dysfunction. This somatic dysfunction will be handled with muscle vitality by putting the affected person within the restrictive barrier and utilizing post-isometric rest.

Instance: Clavicle somatic dysfunction therapy with post-isometric muscle vitality
How would a clavicular adduction dysfunction be handled using post-isometric muscle vitality? By shrugging the shoulders for 3-5 seconds in opposition to resistance 3-5 instances.

Within the absence of another dysfunction, a shoulder top discrepancy can be defined by an ipsilateral hypertonic trapezius muscle which can trigger elevation of the scapula and will not essentially be attributed to a clavicular dysfunction.

Origin Insertion Motion Innervation Schematic (from Thieme)
Trapezius muscle
  • Descending portion: superior nuchal line; occipital protuberance
  • Transverse portion: T1-T4 spinous processes
  • Ascending portion: T5-T12 spinous processes
  • Descending portion: lateral third of clavicle
  • Transverse portion: acromion
  • Ascending portion: scapular backbone
  • Descending portion: sidebend to identical facet; rotate to reverse facet
  • Transverse portion: draw scapula medially
  • Ascending portion: draw scapula medially
CN XI, cervical plexus (C2-C4)

Trapezius: 1 – descending; 2 – transverse; 3 – ascending

Therapy of clavicle somatic dysfunctions with post-isometric muscle vitality strategies:

Clavicle flexion dysfunction Affected person is supine and in the direction of the sting of the desk. Contact the dysfunctional clavicle in the direction of the distal finish. Prolong the clavicle to the restrictive barrier, taking care to stabilize the affected person. Ask affected person to flex their clavicle, and meet the affected person pressure to create an isometric contraction. After 3-5 seconds, have affected person calm down, and reposition the clavicle to its new restrictive barrier.

Clavicle flexion somatic dysfunction therapy
Clavicle extension dysfunction Affected person is supine. Contact the dysfunctional clavicle in the direction of the distal finish. Flex the clavicle to the restrictive barrier, taking care to stabilize the affected person. Could use the higher extremity as a lever. Ask affected person to increase their clavicle, and meet the affected person pressure to create an isometric contraction. After 3-5 seconds, have affected person calm down, and reposition the clavicle to its new restrictive barrier.

Clavicle extension somatic dysfunction therapy
Clavicle abduction dysfunction Affected person is supine. Contact the dysfunctional clavicle in the direction of the distal finish. Adduct the clavicle to the restrictive barrier, taking care to stabilize the affected person. Could use the higher extremity as a lever. Ask affected person to abduct their clavicle, and meet the affected person pressure to create an isometric contraction. After 3-5 seconds, have affected person calm down, and reposition the clavicle to its new restrictive barrier.

Clavicle abduction somatic dysfunction therapy
Clavicle adduction dysfunction Affected person is supine. Contact the dysfunctional clavicle in the direction of the distal finish. Abduct the clavicle to the restrictive barrier, taking care to stabilize the affected person. Could use the higher extremity as a lever. Ask affected person to adduct their clavicle, and meet the affected person pressure to create an isometric contraction. After 3-5 seconds, have affected person calm down, and reposition the clavicle to its new restrictive barrier.

Clavicle adduction somatic dysfunction therapy
Clavicle inside rotation dysfunction Affected person is supine. Abduct dysfunctional shoulder to 90 levels. Contact the dysfunctional clavicle in the direction of the distal finish. Externally rotate the higher extremity till the clavicle externally rotates to the restrictive barrier, taking care to stabilize the shoulder. Ask affected person to internally rotate their higher extremity, and meet the affected person pressure to create an isometric con traction. After 3-5 seconds, have affected person calm down, and reposition the higher extremity to its new restrictive barrier.

Clavice inside rotation somatic dysfunction therapy
Clavicle exterior rotation dysfunction Affected person is supine. Abduct dysfunctional shoulder to 90 levels. Contact the dysfunctional clavicle in the direction of the distal finish. Internally rotate the higher extremity till the clavicle internally rotates to the restrictive barrier, taking care to stabilize the shoulder. Ask affected person to externally rotate their higher extremity, and meet the affected person pressure to create an isometric contraction. After 3-5 seconds, have affected person calm down, and reposition the higher extremity to its new restrictive barrier.

Clavicle exterior rotation dysfunction therapy

Sternum Anatomy and Somatic Dysfunctions[edit]

The sternum has three components:

  1. the pinnacle, or manubrium
  2. the physique, or gladiolus;
  3. the tail, or xiphoid course of.

The angle of Louis is the location of the second rib attachment. Upon deep inhalation, all the sternum glides superiorly, and the inferior finish strikes anterior. Upon exhalation, all the sternum glides inferiorly, and the inferior finish strikes posteriorly. Movement on the sternal angle permits for anterior and posterior movement.

Movement happens on the sternum in 4 planes:

  • flexion/extension (a couple of transverse axis)
  • rotation (a couple of vertical axis)
  • sidebending (about an anterior-posterior axis)
  • superior/inferior glide of all the sternum

Assessing the manubrium: To evaluate flexion/extension, place one thumb on the superior border of the manubrium and place the opposite thumb simply above the angle of Louis. Assess springing movement. To evaluate sidebending, place fingers on superior and inferior lateral borders on reverse sides of manubrium springing medially. To evaluate rotation, place thumb on every lateral border of the manubrium. Assess spring.

Assessing the gladiolus: To evaluate flexion/extension, place one thumb slightly below the angle of Louis and place different thumb on inferior border of gladiolus simply above the xiphoid course of. Assess springing. To evaluate sidebending, place thumb on every lateral border of the gladiolus. Spring. To evaluate rotation, place fingers on superior and inferior lateral borders on reverse sides of gladiolus. Spring medially.

To evaluate the sternum, place one thumb on superior border of manubrium, different on angle of Louis. Spring. If the superior border springs higher, that is an extension somatic dysfunction of the manubrium. If the inferior border springs higher, this can be a flexion somatic dysfunction of the manubrium. Repeat this take a look at on superior and inferior borders of physique of gladiolus. Subsequent, examine the angle of the sternum for facet bending choice. Spring the lateral margins to evaluate rotational somatic dysfunction. Final, transfer all the sternum in round movement; examine for “drag” within the superior, inferior, and lateral instructions. Don’t spring the xiphoid! To call somatic dysfunction of the sternum, use the identical ideas used to call vertebral somatic dysfunction; somatic dysfunction is called by the motion of an imaginary dot on the anterosuperior floor of the bone of reference and named for the popular path of movement. Somatic dysfunction of the gladiolus, if current, will often be reverse of manubrium.

Instance: Sternum somatic dysfunction analysis and therapy

1. If a affected person presents following an altercation with a outstanding sternal angle and demonstrates an absence of spring when palpating simply inferior to the angle of the sternal physique, with no different restrictions considerable in both sidebending or rotation, the somatic dysfunctions related to the manubrium and the gladiolus are extension dysfunction of the manubrium and flexion dysfunction of the gladiolus.

2. If a affected person is discovered to have extension and rightward rotation dysfunction of the manubrium, the gladiolus can be discovered to be flexion and leftward rotation dysfunction. Therapy of somatic dysfunction of the sternum will be performed using direct or oblique myofascial launch of the affected part.

Ribs Anatomy and Somatic Dysfunctions[edit]

The ribs will be categorized as true ribs, false ribs, and floating ribs. The true ribs are ribs 1-7 and named as such as a result of they connect to the sternum. The false ribs are ribs 8-10 that are connected through cartilage to one another after which to the cartilage of rib 7 and the floating ribs. The floating ribs are ribs 11 and 12, which don’t hook up with both cartilage or the sternum. The bottom rib attachment connects superiorly to the xiphoid course of (rib 10 by way of costal cartilage).

The typical ribs embrace ribs 3-9. Current on the standard ribs is the knob-like rib head, the rib neck, the tubercle, the rib physique, the angle of the rib, and the costal groove. Every typical rib has two sides which type costovertebral articulations. One articulates with the vertebral physique above and the opposite with the vertebral physique on the identical degree. A 3rd aspect, on the tubercle, articulates with the transverse technique of the vertebra on the identical degree forming the costotransverse articulation. For instance, rib Three would articulate with T2 (inferior aspect) and T3 (superior aspect). The costochondral articulations join the ribs to the costal cartilage, and the sternochondral articulations join the costal cartilage to the sternum (with out direct connection to the ribs).

The atypical ribs are ribs 1, 2, 10, 11, and 12:

  • Rib 1 is flat, has the best curvature, the shortest size, no angle, no costal groove, and has one aspect at its rib head that articulates solely with the physique of T1
  • Rib 2 is just like rib 1 however it’s longer and never as flat. It has two demifacets on its rib head that articulate with the physique of T1 and T2.
  • Rib 10 is analogous in construction to the standard ribs besides that it solely has one aspect on the rib head which articulates with the physique of T10.
  • Ribs 11 and 12 haven’t any neck, no tubercles, and just one aspect on the rib head articulating with the corresponding vertebral physique.

Rib movement is influenced by the angle between the vertebral physique and the transverse course of in addition to the space between the costal articulations with the vertebrae. Rib movement is characterised by considered one of three motions. Pump deal with (ribs 1-5) movement describes movement like an old school water pump that in inhalation enhance the anterior-posterior diameter. Bucket deal with movement (ribs 6-10) describes movement the place each ends are mounted, and the transverse diameter will increase with inhalation. Combined pump deal with and bucket deal with motions happen from ribs 1-10, however the major movement is as described above. Caliper movement (ribs 11 and 12) happens when each anterior/posterior and transverse dimensions change with respiratory cycles; these ribs wouldn’t have connections with the sternum. Motion is like calipers opening and shutting.

Muscular tissues concerned within the respiratory cycle are listed under:

Muscular tissues of inspiration
  • diaphragm+
  • exterior intercostals
  • interchondral portion of the inner intercostals

+ used for therapy of inhalation dysfunctions with respiratory-assisted muscle vitality

Accent muscular tissues of inspiration
  • sternocleidomastoid
  • subclavius
  • serratus posterior superior
  • levatores costarum
  • scalene muscular tissues (ribs 1-2)++
  • pectoralis minor (ribs 3-5)++
  • serratus anterior (ribs 6-9)++
  • latissimus dorsi (ribs 9-10)++
  • quadratus lumborum (ribs 11-12)++

++ used for therapy of exhalation dysfunctions with respiratory-assisted muscle vitality

Muscular tissues of exhalation
  • inside intercostals
  • rectus abdominus
  • exterior obliques
  • inside obliques
  • serratus posterior inferior
  • transversus thoracis
  • transversus abdominus

Rib somatic dysfunctions could trigger chest, again, shoulder, arm, or neck ache; they could be major dysfunctions however all the time accompany a thoracic dysfunction. At all times deal with thoracic dysfunctions previous to treating any rib dysfunctions. Rib somatic dysfunctions could also be categorized as an exhalation dysfunction or an inhalation dysfunction. Each exhalation and inhalation dysfunctions sometimes have an effect on a gaggle of ribs.

Exhalation dysfunctions (i.e. inhalation restrictions; “caught down”) could also be handled with muscle vitality utilizing the important thing rib, which is probably the most cephalad (the “high”) rib. Utilizing respiratory effort and accent muscular tissues of inhalation, muscle vitality strategies can be utilized to deal with these dysfunctions.

For treating inhalation dysfunctions, the important thing rib is probably the most caudad (the “backside”) rib. Utilizing respiratory effort and the muscular tissues of exhalation, muscle vitality strategies can be utilized to deal with these dysfunctions. The quadratus lumborum muscle is used to deal with exhalation dysfunctions of ribs 11-12. The latissimus dorsi is the “cough” muscle; dysfunctions from acute sickness which have a considerable amount of coughing can have rib dysfunctions related to this muscle.

Respiratory-assisted muscle vitality remedies of rib somatic dysfunctions:

Inhalation dysfunction key ribs 1-10 (respiratory diaphragm) Affected person is supine. Doctor sits/stands both on the head of the desk or to the facet of the desk. Contact the lateral portion of the important thing rib with agency strain, utilizing as broad contact as attainable. Remember to keep away from any delicate areas (i.e. breast tissue). Apply a caudad pressure on the important thing rib, exerting simply sufficient strain to really feel stress over the dysfunctional ribs. Supporting the affected person’s head and higher physique, sidebend the affected person to the identical facet as the important thing rib, utilizing the important thing rib as a fulcrum. Ask the affected person to carry out a cycle of pressured maximal inhalation and exhalation. Throughout the exhalation part, enhance caudad strain on the important thing rib and sidebending round the important thing rib.

Higher ribs inhalation dysfunction

Decrease ribs inhalation dysfunction
Inhalation dysfunction key ribs 11-12 (respiratory diaphragm) Affected person is inclined. Doctor is standing on the facet of the desk reverse the important thing rib. Contact the important thing rib with agency anterior strain over the lateral fringe of the rib. Ask the affected person to carry out a cycle of pressured max- imal inhalation and exhalation. Throughout the exhalation part, enhance anterior/medial strain on the lateral fringe of the important thing rib.

Ribs 11-12 inhalation dysfunction
Exhalation dysfunction key rib 1 (anterior/center scalenes) Affected person is supine. Ask affected person to put the dorsum of their dysfunction-side hand on their brow. Contact the important thing rib as near the costotransverse junction as attainable with one hand, and stabilize the affected person’s head/hand with the opposite hand. Ask the affected person to carry out a pressured maximal inhalation and concurrently attempt to raise their head off the desk. Resist their head movement, and through the inhalation part apply a caudad pressure on the important thing rib on the costotransverse junction.

Rib 1 exhalation dysfunction
Exhalation dysfunction key rib 2 (posterior scalene) Affected person is supine. Ask affected person to put the dorsum of their dysfunction-side hand on their brow, after which rotate their head away from the facet of the important thing rib. Contact the important thing rib as near the costotransverse junction as attainable with one hand, and stabilize the affected person’s head/hand with the opposite hand. Ask the affected person to carry out a pressured maximal inhalation and concurrently attempt to raise their head off the desk. Resist their head movement, and through the inhalation part apply a caudad pressure on the important thing rib on the costotransverse junction.

Rib 2 exhalation dysfunction
Exhalation dysfunction key ribs 3-5 (pectoralis minor) Affected person is supine. Ask the affected person to put their dysfunction-side arm in abduction to 90 levels. The elbow could also be flexed to permit for higher positioning. Contact the important thing rib as shut the costotransverse junction as attainable with one hand, and stabilize the affected person’s elbow with the opposite hand. Ask the affected person to carry out a pressured maximal inhalation and concurrently attempt to raise their elbow straight off the desk. Resist their elbow movement, and through the inha- lation part apply a caudad pressure on the important thing rib on the costotransverse junction.

Ribs 3-5 exhalation dysfunction
Exhalation dysfunction key ribs 6-8 (serratus anterior) Affected person is supine. Ask the affected person to put their dysfunction-side arm in abduction to 90 levels. The elbow could also be flexed to permit for higher positioning. Contact the important thing rib as shut the costotransverse junction as attainable with one hand, and stabilize the affected person’s elbow with the opposite hand. Ask the affected person to carry out a pressured maximal inhalation and concurrently attempt to convey their elbow throughout their physique in the direction of the contralateral ASIS. Resist their elbow movement, and through the inhalation part apply a caudad pressure on the important thing rib on the costotransverse junction.

Ribs 6-Eight exhalation dysfunction
Exhalation dysfunction key ribs 9-10 (latissimus dorsi) Affected person is supine. Ask the affected person to put their dysfunction-side arm in abduction to 90 levels. The elbow could also be flexed to permit for higher positioning. Contact the important thing rib as shut the costotransverse junction as attainable with one hand, and stabilize the affected person’s elbow with the opposite hand. Ask the affected person to carry out a pressured maximal inhalation and concurrently attempt to adduct their elbow. Resist their elbow movement, and through the inhalation part apply a caudad pressure on the important thing rib on the costotransverse junction.

Ribs 9-10 exhalation dysfunction
Exhalation dysfunction key ribs 11-12 (quadratus lumborum) Affected person is inclined. Doctor is standing on the facet of the desk reverse the important thing rib. Contact the important thing rib with agency anterior strain over the costotransverse junction of rib with one hand, and maintain onto the ASIS on the dysfunctional facet with the opposite hand. Ask the affected person to carry out a cycle of pressured maximal inhalation and exhalation. Throughout the inhalation part, enhance anterior/lateral strain on the costotransverse junction of the important thing rib, whereas pulling posteriorly barely on the ASIS to stabilize the pelvis.

Ribs 11-12 exhalation dysfunction

Anterior rib tenderpoints are related to exhalation dysfunctions. Posterior rib tenderpoints are related to inhalation dysfunctions and are related to spasm of the levatores costarum muscle. Rib dysfunctions can be handled with counterstrain.

Rib counterstrain tenderpoints

Rib counterstrain tenderpoints

Determine 5.1 – Tenderpoints of the Anterior and Posterior Ribs1

Reference: 1. Nicholas AS, Nicholas EA. Atlas of Osteopathic Strategies. Philadelphia, PA: Lippincott Williams and Wilkins, 2016. Web page 179.

Anterior and posterior rib tenderpoint location and therapy place

Tenderpoint Location Acronym
AR1 Beneath clavicle at first chondrosternal articulation Supine, F STRT
AR2 On second rib at midclavicular line Supine, F, STRT
AR3-AR10 Anterior axillary line on dysfunctional rib Seated, F STRT
PR1 Cervicothoracic angle simply anterior to trapezius Seated, E, SART
PR2-PR10 Superior floor of respective rib angles Seated, F SARA

Evaluate Questions[edit]

1. Which of the next appropriately characterizes extension of the clavicle?

A. The acromial finish of the clavicle strikes anteriorly
B. The acromial finish of the clavicle strikes posteriorly
C. The sternal finish of the clavicle strikes inferiorly
D. The sternal finish of the clavicle strikes superiorly

2. A affected person is examined and located to have a sternoclavicular joint that glides inferiorly on the left with shoulder shrug and has no considerable movement on the suitable. What’s the somatic dysfunction analysis?

A. Proper clavicle adducted
B. Left clavicle adducted
C. Proper clavicle kidnapped
D. Left clavicle kidnapped

3. A affected person presents with the findings that reveal the left proximal clavicle is extra caudad and posterior. What’s the somatic dysfunction analysis?

A. Left clavicular abduction and extension dysfunction
B. Left clavicular abduction and flexion dysfunction
C. Left clavicular adduction and extension dysfunction
D. Left clavicular adduction and flexion dysfunction

4. A affected person is discovered to have a decrease proper shoulder in comparison with the left, has bother extending the suitable shoulder, and has bother externally rotating the suitable shoulder. A clavicle somatic dysfunction will be identified. What’s the somatic dysfunction of the clavicle primarily based on these findings?

A. Proper clavicle abduction, flexion, exterior rotation dysfunction
B. Proper clavicle adduction, flexion, inside rotation dysfunction
C. Proper clavicle adduction, extension, inside rotation dysfunction
D. Proper clavicle abduction, extension, exterior rotation dysfunction
E. Proper clavicle abduction, flexion, inside rotation dysfunction

5. A affected person is identified with a left clavicle adduction, extension, and inside rotation dysfunction. Which of the next is true relating to using post-isometric muscle vitality strategies to deal with somatic dysfunctions of the clavicle?

A. The somatic dysfunctions in every respective airplane of movement needs to be handled unexpectedly.
B. The somatic dysfunctions in every respective airplane of movement needs to be handled individually.
C. Decrease extremity somatic dysfunctions needs to be addressed previous to addressing clavicle somatic dysfunctions.
D. Put up-isometric muscle vitality just isn’t an acceptable method to handle this somatic dysfunction.

6. Which of the next statements is true relating to the atypical ribs?

A. Rib 10 is flat, has the best curvature, the shortest size, no angle, no costal groove, and has one aspect at its rib head that articulates solely with the physique of T1
B. Rib 2 is just like rib 1 however it’s longer and never as flat. It has two demifacets on its rib head that articulate with the physique of T1 and T2
C. Rib 2 is analogous in construction to the standard ribs besides that it has just one aspect on the rib head which articulates with the physique of T10
D. Ribs 11 and 12 haven’t any neck, no tubercles, and just one aspect on the rib head articulating with the corresponding vertebral physique

Questions 7-11: Match the next descriptions with the listed therapy method.

7. Ribs 1-2
8. Ribs 3-5
9. Ribs 6-9
10. Ribs 9-10
11. Ribs 11-12

A. Anterior and center scalenes
B. Serratus anterior
C. Quadratus lumborum
D. Pectoralis minor
E. Latissimus dorsi

12. Contemplate a proper ribs 3-6 exhalation dysfunction. What’s the key rib in treating this dysfunction with muscle vitality and what’s the major movement of those ribs?

A. Rib 3; Pump deal with
B. Rib 3; Bucket deal with
C. Rib 3; Caliper
D. Rib 6; Pump deal with
E. Rib 6; Bucket deal with
F. Rib 6; Caliper

13. To which of the next buildings does rib Four articulate?

A. T2, T3, and T4
B. T3 and T4
C. T3 solely
D. T4 solely
E. T4 and T5

14. Which of the next accurately describes sternal movement throughout a respiratory cycle?

A. Upon deep inhalation, all the sternum glides inferiorly.
B. Upon deep inhalation, the inferior finish of the sternum strikes anteriorly.
C. Upon exhalation, all the sternum glides superiorly.
D. Upon exhalation, the inferior finish of the sternum strikes caudad.

15. A 30-year-old feminine presents for comply with up of reactive airway illness. She notes that her bronchial asthma has been nicely managed with inhaled corticosteroids. She notes a current bronchial asthma assault within the final week throughout which she has had residual left-sided rib ache. Important indicators are steady. On bodily examination, her breath sounds are clear to auscultation bilaterally with out rales, wheezing, rhonchi, or accent muscle use. Muscle power testing, deep tendon reflexes, and sensation testing are unremarkable. T3-T6 are famous to have paraspinal hypertonicity on the suitable. Ribs 3-6 are famous to be caught down on the left. She has restriction of the suitable hemidiaphragm. Which of the next is correct with regard to this rib dysfunction?

A. Binding or immobilization of the ribs is really useful to enhance rib ache.
B. Thoracic backbone somatic dysfunctions needs to be handled previous to treating the ribs.
C. The affected ribs are atypical ribs.
D. The affected ribs are false ribs.
E. Muscle vitality strategies are contraindicated on this affected person.

16. Which of the next statements relating to somatic dysfunctions of the ribs is appropriate?

A. Anterior rib tenderpoints are related to spasm of the levatores costarum muscle.
B. Anterior rib tenderpoints are related to ribs that choose to stay cephalad.
C. Posterior rib tenderpoints are related to inhalation dysfunctions.
D. Dysfunctional ribs 1-6 will present a bucket deal with movement.
E. The preliminary setup for a counterstrain therapy of a posterior rib dysfunction Is with the affected person supine, prolonged, sidebent towards the tenderpoint, and rotated away.

Solutions to Evaluate Questions[edit]

  1. B
  2. A
  3. B
  4. B
  5. B
  6. D
  7. A
  8. D
  9. B
  10. E
  11. C
  12. A
  13. B
  14. B
  15. B
  16. C

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