Palpation of the 1st rib may be performed both posteriorly and anteriorly to determine the presence of symmetry and tenderness.
•To palpate the 1st rib posteriorly, the therapist places the index or middle finger over the fibers of the upper trapezius just prior to the transition from horizontal to the vertical position, directly across from the level of T1 spinous process. The therapists sinks their fingers inferiorly through the upper trapezius muscle mass until the first rib is felt.
•To palpate the 1st rib anteriorly, the index fingers are placed just lateral to the sternoclavicular joint and inferior to the clavicle.
Respiration Assessment for 1st Rib Mobility
The therapist stands behind the seated patient and places their index fingers over both 1st ribs and assesses the resting position. The patient is instructed to take a deep breath while the therapist assesses the entire movement of the 1st rib from inhalation through exhalation 2-3 times.
•Increased motion, especially elevation at end range inspiration, is positive for an elevated first rib.
•Decreased motion, especially depression at end range exhalation, is positive for a depressed first rib if the mechanism of injury was traumatic.
Also note asymmetries R to L in total excursion, timing of the initial movement, and onset of symptoms.
The therapist may also assess other factors with respiration which could affect the mobility of the 1st rib. Without cuing the supine patient, the therapist globally watches their natural breathing pattern, looking for one of the following dominant patterns:
•Diaphragm dominant: minimal chest rise and fall with visible abdominal rise and fall.
•Chest/intercostal dominant: chest rise and fall with minimal abdominal movement.
•Cervical accessory muscle dominance: visible/palpable scalene activation during normal inspiration.
