Ribs 11 and 12 are also known as Caliper Ribs

Locating Ribs 11 and 12

Have your patient begin laying in prone with their arms at their side. To locate ribs 11 and 12, you can begin by palpating up from iliac crest to find the 12^th rib. Remember, ribs 11 and 12 are floating ribs, you should be able to palpate both ribs laterally from their attachments to the spine outwards to their end. The ribs should be 3-5cm lateral to transverse processes. Once you have located the ribs, place your thumbs just lateral to the transverse process of spine and place your 2^nd and 3^rd fingers on the ribs.

Diagnosing Ribs 11-12

Before Diagnosing it is important to perform static motion testing, however, this may be less useful for ribs 11 and 12.

When diagnosing the ribs, what you are looking to see is if the ribs rise and fall symmetrically with one another in both inhalation and exhalation. Any changes in symmetry are VERY small changes – these differences are most often easiest to see at the beginning and end of the patients breath.

For Normal Caliper Rib Motion..

• During Inhalation: spread apart and move posterior (externally rotate)
• During Exhalation: come together and move anterior (internally rotate)

Once you believe you have found a variation in rib symmetry during the patient’s breathing, think to yourself what kind of dysfunction would this be. Recall the most common types of rib somatic dysfunctions are Inhalation somatic dysfunctions and Exhalation somatic dysfunctions

Remember Somatic Dysfunctions are named in the FREEDOM of motion 

Think of Inhalation Dysfunction meaning the rib is STUCK in inhalation and does not want to come together again

Think of Exhalation Dysfunction meaning the rib is STUCK in exhalation and does not want to rise and separate

Finding the Key Rib

Recall the BITE mnemonic . While this mnemonic is a helpful tool, in practice the “rules” are not always true in findings.

It is important to be able to identify the key rib for treatment, in order to identify the key rib you will test each individual rib by palpating a single rib at a time until you find the rib that exhibits the most dysfunction, that is the key rib.

Things to Note…

• The primary motion of Ribs 11 and 12 is in transverse plane around a vertical axis