Ribs 2-5 are also known as Pump Handle Ribs

Locating Ribs 2-5

In males:

Can palpate from below or above Midclavicular line 

In females:

Can palpate the chondral portion of ribs with side of hand OR you can have female patients cover their chest and you palpate the midclavicular line like on the male

Diagnosing Ribs 2-5

Remember before diagnosing it is important to perform static motion testing

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.

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 lower back down

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

Findings of Inhalation Dysfunction of Pump Handle Ribs

• Anteriorly elevated rib
• Anterior part of rib moves cephalad on inhalation and is restricted on exhalation
• Anterior narrowing of intercostal space above dysfunctional rib
• Superior edge of posterior rib angle is prominent

Findings of Exhalation Dysfunction of Pump Handle Ribs

• Anteriorly depressed rib
• Anterior part of rib moves caudad on exhalation and is restricted on inhalation
• Anterior narrowing of intercostal space below dysfunctional rib
• Inferior edge of posterior rib angle is prominent

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 2-5 is in the Sagittal plane / midclavicular line (with a horizontal axis)
• Ribs move anterior and superior with inhalation