Ribs 6-10 are also known as Bucket Handle Ribs

Locating Ribs 6-10

Ribs 6-10 in males and females can generally be located in the same area below the nipple line. To palpate these ribs place your thumbs by xiphoid process, take the rest of your hand laterally and try to spread fingers (one finger per rib if you can).

Diagnosing Ribs 6-10

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 Bucket Handle Ribs

• Laterally Elevated Rib
• Lateral Part of Rib moves slightly upward on Inhalation and is restricted on Exhalation
• Lateral Narrowing of Intercostal Space Above dysfunctional rib
• Lower Edge of Rib Shaft (Lateral Aspect of the Rib) is Prominent

Findings of Exhalation Dysfunction of Bucket Handle Ribs

• Laterally Depressed Rib
• Lateral Part of Rib moves slightly downward on Exhalation and is restricted on Inhalation
• Lateral Narrowing of Intercostal Space Below dysfunctional rib

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 6-10 is in coronal plane / axillary line (AP axis)
• Ribs move laterally and increase transverse diameter with inhalation