{"id":12704,"date":"2022-11-11T15:29:51","date_gmt":"2022-11-11T14:29:51","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=wiki&amp;p=12704"},"modified":"2022-11-11T15:29:51","modified_gmt":"2022-11-11T14:29:51","slug":"first-rib-assessment","status":"publish","type":"wiki","link":"https:\/\/www.physiotutors.com\/wiki\/first-rib-assessment\/","title":{"rendered":"First Rib Assessment"},"featured_media":12705,"template":"","class_list":["post-12704","wiki","type-wiki","status-publish","has-post-thumbnail","hentry"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":12705,"background_image_alt_text":"First Rib Assessment"},"heading":"First Rib Assessment | 1st Rib Hypomobility Examination","subheading":"Thoracic Spine Assessment","content_editor":"","button_type":"internal_link","button_label":"Check our shop","button_style":"button-five","button_internal_link":4646,"button_anchor":"","button_url":"","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Learn","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Assessment E-Book","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Reviews","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":16662,"button_anchor":"","button_url":"","button_file":""},"button_description":"Find this wiki on the Physiotutors platform"},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>Learn<\/h4>"},"column_right":{"content_editor":"<h6>First Rib Assessment | 1st Rib Hypomobility Examination<\/h2>\nAssessing the first rib can be useful when evaluating thoracic outlet symptoms or pain in the region of the cervicothoracic junction.\n<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/10543580\/\" target=\"_blank\" rel=\"noopener\">Fjellner et al. (1999)<\/a> report low reliability for range of motion assessment of the first rib with a weighted kappa of .06 only.\nThere are several ways to assess the first rib:\n\n<strong>Sitting position<\/strong>\n\nThe patient sits on the bench while you will stand behind them. The patient can rest against your thigh. Locate T1 for orientation and rotate the patient's head towards the side you want to examine, which will bring the first rib backward and make it more accessible. Add lateral flexion to slacken the trapezius muscle and fixate this position by placing your elbow on the patient\u2019s sternum. Then place your MCP 1 on the first rib and assess mobility by gently pushing into caudal, ventral, and medial direction. Or in other words: pushing towards the contralateral Anterior superior iliac spine. Assess end-feel, possible reproduction of symptoms, and compare with the other side.\n<div class=\"embed-container\">\n\n[embed]https:\/\/www.youtube.com\/watch?v=TTMQh4dZqeg[\/embed]\n\n<\/div>\n<strong>Supine Position<\/strong>\n\nThe patient lies in supine position slightly diagonal on the treatment table. Rotate the head towards the side you want to evaluate as this will bring the first rib posteriorly and thus more accessible for palpation. Brace the cervical spine with one hand applying slight traction at the occiput.\n\nThen place your MCP 1 flat on the rib and lock your hand against your pelvis. Then initiate a ventral, caudal and medial force with your body to assess movement of the first rib including end-feel and possible reproduction of symptoms.\n\nSimilarly, this same technique can be done with a cross grip.\n\n[embed]https:\/\/www.youtube.com\/watch?v=dPexFNjZB0Q[\/embed]\n\n<strong>Prone position<\/strong>\n\nThe patient lies in prone position slightly diagonal on the treatment table. Rotate the head towards the side you want to evaluate as this will bring the first rib posteriorly and thus more accessible for palpation. Brace the cervical spine with one hand applying slight traction at the occiput.\n\nThen place your MCP 1 flat on the rib and lock your hand against your pelvis. Then initiate a ventral, caudal and medial force with your body to assess movement of the first rib including end-feel and possible reproduction of symptoms.\n\nSimilarly, this same technique can be done with a cross grip.\n\n[embed]https:\/\/www.youtube.com\/watch?v=gfIy_SZ1KMc[\/embed]\n\n&nbsp;\n\n[cta]\n\nAnother way to assess for hypomobility of the first rib is the <a href=\"https:\/\/www.physiotutors.com\/nl\/wiki\/cervical-rotation-lateral-flexion-test\/\">cervical rotation lateral flexion test<\/a>.\n\nIf you are curious to learn more about joint play assessment &amp;\u00a0 treatment of the costotransversal joints, click <a href=\"https:\/\/www.physiotutors.com\/nl\/wiki\/rib-joint-play\/\">here<\/a>.\n\n&nbsp;\n"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>References<\/h4>"},"column_right":{"content_editor":"<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/10543580\/\" target=\"_blank\" rel=\"noopener\">Fjellner, A., Bexander, C., Faleij, R., &amp; Strender, L. E. (1999). Interexaminer reliability in physical examination of the cervical spine.\u00a0Journal of manipulative and physiological therapeutics,\u00a022(8), 511-516.<\/a>"}},{"acf_fc_layout":"cta-image-v2","layout":"","background":"transparent","heading":"","content_editor":"<p class=\"subheading\">Like what you\u2019re learning?<\/p>\n<p class=\"heading-two\">BUY THE FULL PHYSIOTUTORS <strong>ASSESSMENT BOOK<\/strong><\/p>\n\n<ul>\n \t<li>600+ Pages e-Book<\/li>\n \t<li>Interactive Content (Direct Video Demonstration, PubMed articles)<\/li>\n \t<li>Statistical Values for all Special Tests from the latest research<\/li>\n \t<li>Available in \ud83c\uddec\ud83c\udde7 \ud83c\udde9\ud83c\uddea \ud83c\uddeb\ud83c\uddf7 \ud83c\uddea\ud83c\uddf8 \ud83c\uddee\ud83c\uddf9 \ud83c\uddf5\ud83c\uddf9 \ud83c\uddf9\ud83c\uddf7<\/li>\n \t<li>And much more!<\/li>\n<\/ul>","button_type":"internal_link","button_label":"Check out our 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