Diagnosis of the Ribs

00:00 Examining the ribs have to be done in both static and dynamic fashion. They are constantly in motion. So first, examining the anatomy and then examining the anatomy in motion is important.

00:12 So look, feel, move. Here we go. We want to see where the ribs start, the ribs start at T1 and usually the most prominent spinous process is T1, you always have to make sure that it's T1 and not C7 which does tend to go away with flexion and extension of the cervical spine. With T1, you know that this is where the attachment of the first rib is and 1, 10, 11 and 12 only attach to the rib and not to the transverse process. So here we're going to take T1 come around pull back the trapezius, the anterior scalene and find the rib. Got the rib? Good. Walk the rib around to the front, make sure all the attachments are in line and make sure there is symmetry. We got it. So then we want to examine him breathing and when you examine the T1 and the first rib are going to be pump handle motion. So you find the first rib, the second rib and the third rib. Take a deep breath in and you find motion bilaterally. You see what 1, 2 and 3 do, you check to see if it's moving symmetrically and fully. If it comes out and doesn't go all the way back in at the end of the inspiration, you've got an issue you have to address. Then you move down to 4, 5 and 6 and again take a deep breath in and out and you check for symmetry of motion, fullness of motion, deepness of inspiration and return at the end of expiration and make sure it is both sides. Then you want to inspect 7, 8, 9 and 10 which are mostly bucket handle motion. Deep breath in, full expansion, check bilaterality, see symmetry good and turn over. Now we check the false ribs 11 and 12 and you come to the PSIS bilaterally and you move up and the first bone you hit is going to be the 12th rib, deep breath in and you noticed as he takes a deep breath it goes posterior and inferior so you go up to the next false rib, the 11th rib, deep breath in and out. If it does not go posterior, when it's stuck, not moving that is when it takes more attention and needs to be addressed more fully and that's where what you are checking for. And that's the examination of the ribs.