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Picture

Rib Hypomobility and Shoulder Pain

12/15/2017

1 Comment

 
Something I have been assessing more lately is rib mobility for my upper quarter patients. In the past, unless there were signs indicative of rib dysfunction, I typically only checked the 1st rib's mobility. Lately, I have been assessing ribs 2-4 (and further down if significant restriction noted) for many of my upper quarter patients and seen some interesting effects.
​Usually when we think of rib involvement, we think of pain with breathing and thoracic motions. While other tissues often have pain recreated with breathing as well, some recommend differentiating non-musculoskeletal pain from musculoskeletal by incorporating thoracic motions with holding one's breath. If the patient fully exhales ( deflating the lungs and providing less pressure on lung tissue), rotates and sidebends the thorax and pain is recreated, the pain is assumed to be coming from the ribs or thoracic spine or potentially muscles in the involved area. If pain is not present while moving the thorax with deflated lungs, the pain is assumed to be based in lung tissue. These rules may not be perfect, but can still be useful in differential diagnosis. 
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Several patients I've seen recently with scapular and/or posterior shoulder pain have presented with restricted rib 2-4 mobility (or some variation). They didn't have any pain with breathing, however, had significant reduction in pain and improved mobility following simply grade IV mobilizations to the restricted ribs. Even greater improvement was noted in the following day. Now the mechanism is not fully understood as manual therapy can have quite a few different effects. It's possible the patient would have had just as effective or more effective response to other treatments. Nonetheless, with the excellent response by my patient, I plan on regularly incorporating upper rib assessment to determine if there are some patterns for application.

​-Dr. Chris Fox, PT, DPT, OCS

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1 Comment
Barry
12/24/2017 02:39:37 pm

For as far as I know, the first 4 thoracic vertebrae are part of the shouldergirdle through their connection with their paired ribs. Clavicle is attached with the first rib through ligaments which in its turn is connected with the 2nd one and so on...
When performing anteflexion from 90 degrees the clavicle is elevating, lifting the first 4 ribs. Hereby the first 4 thoracic vertebrae need to perform a homolateral rotation.
So If rib mobility is impaired, there is almost always a impairment in shoulder mobility, probably causing pain in the long run...

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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
    • Physical Therapist Consultant Course
    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test