Thoracic Spine & Rib Dysfunctions

◆Thoracic vertebrae

• •Follow Fryette's laws (Type I and II)
• •Rule of 3s for transverse process location relative to spinous process
• •T1–T3: TPs at same level as SPs
• •T4–T6: TPs one-half level below SPs
• •T7–T9: TPs one full level below SPs
• •T10: like T9 (TP one level below)
• •T11: like T6 (one-half level below)
• •T12: like T3 (same level)

◆Rib motion types

• •Pump handle: ribs 1–5; predominantly anterior-posterior (up/down) motion with inspiration
• •Bucket handle: ribs 6–10; predominantly lateral motion (sides go up/down)
• •Caliper: ribs 11–12 (floating); anterior-posterior motion at posterior attachment

◆Rib dysfunctions

• •Inhalation dysfunction: rib held UP (in inspiration); patient cannot fully exhale that rib down → tender on EXHALATION; the most cephalad rib in a group is the KEY rib
• •Exhalation dysfunction: rib held DOWN (in expiration); patient cannot fully inhale → tender on INHALATION; the most caudad rib in a group is the KEY rib
• •Treat the KEY rib first — the others often follow

◆Common rib dysfunctions (high-yield)

• •1st rib elevated (inhalation): tender at supraclavicular area; treat with muscle energy using scalene contraction
• •2nd rib: associated with shoulder/upper back pain
• •Anterior chest wall pain → assess ribs 2–5
• •Lateral chest pain → assess ribs 6–10

◆Treatment by mechanism

• •Inhalation dysfunction (held up): use EXHALATION to treat — patient exhales fully, operator holds rib down
• •Exhalation dysfunction (held down): use INHALATION to treat — patient inhales deeply, operator pulls rib up
• •Specific muscles for ME: scalenes (rib 1), pec minor (rib 2-5), serratus anterior (3-5), latissimus dorsi (rib 12), quadratus lumborum (rib 12 exhalation)

Key rib by dysfunction