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22 Cards in this Set

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  • Back
In exhalation dysfunctions ribs are _ , they are stuck _ , intercostal space is larger _
Elevated/superior ribs
Stuck in inspiration
Intercostal space is larger below rib affected
In inhalation dysfunctions ribs are _ , they are stuck_ , intercostal space is larger _
Stuck in expiration
Intercostal space is larger above affected rib
How do you differentiate chest pain due to cardiac problem from chest pain due to ribs
Pain from cardiac problem doesnt go away with inhalation or exhalation
Anterior ribs _
Ribs are pushed forward and you can feel them along costal sternal border
Posterior ribs
Ribs are pushed out toward thoracic curvature (speed bump)
Where do you palpate for posterior ribs vs anterior
Posterior - medial to scapula
Anterior - sternum
How do you assess anterior ribs for motion
Place palms facing each other on patients midline and ask patient to breath in and out while checking for pump handle motion of upper ribs
Place hands on mid-axillary line to check for bucket handle of lower ribs
How do you check for rib 11-12
Ask patient to lie prone to check for caliper motion
How do you treat inspiration restriction of first rib
Pump handle - patient is supine, place thumb on first rib and with other hand flex head until you feel motion.Have patient breath in and out. On exhalation, push rib down, as person breathes in continue pushing down on the rib, repeat 3-5 times and recheck
- Bucket handle - place hands lateral to first rib and repeat same procedure
How do you treat inspiration restriction of ribs 2-5
Pump handle - place hands near sternum in intercostal space ABOVE affected rib, bend head until you feel motion, push down on rib as patient breathes in and out
Bucket handle - same but move out laterally on the rib you are treating and side bend patient TOWARDS side that you are treating
What do you add when treating lower ribs 6-10 for inspiration restriction
Use leg to induce more flexion in thoracic spine in order to induce movement in lower ribs
If ribs 6-9 arent elevating when patient breathes in which rib do you treat
How do you treat 1st rib in exhalation dysfunctions
Which muscles used
Pump handle - patients hand on head, you grab first rib from posterior, other hand is on top of patients hand. Patient breathes in - instruct to push head up and resist, at the same time patients takes breath in and you push posteriorly on 1st rib
Bucket handle - same thing but turn head 45 degrees toward the side you are treating
PUMP - anterior scalene
BUCKET - middle scalene
Explain pump handle treatment of 1st rib in exhalation dysfunction
Inhalation is accomplished by contracting anterior scalene - attaches from cervicals down to 1st rib, so when it contracts it pulls on 1st rib
You want to raise the rib so you will contract anterior scalene that will push 1st rib in that direction
Axis for pump handle motion
Anterior to posterior
Bucket handle axis
Goes through head of the rib, neck of the rib and vertebral body at that level
2 ways in which ME works
Post contraction relaxation
Reciprocal inhibition
Why do you grab back side of 1st rib in exhalation dysfunctions
Because of the axis if you pull down posterior part it will raise anterior portion of the rib
Why do you have patient put hand on forehead in exhalation dysfunctions
Creates mechanical advantage by getting hand out of the way and avoids patient pushing themselves up on the table and also gives physician place to put their hand to add resistance
Why are you engaging anterior scalene muscle in treatment of 1st rib in exhalation dysfunction
Anterior scalene will contract and reciprocally inhibit all muscles below the first rib which will relax and allow 1st rib to go up to its normal position
Why do you use middle scalene for treatment of bucket handle exhalation dysfunction in 1st rib
It attaches laterally - you are trying to reciprocally inhibit intercostals
Why do you turn head 45 degrees in bucket handle treatment of first rib
It will inactivate anterior scalene and engage middle scalene which will reciprocally inhibit middle scalene