One is apt to think that a rib is only dislocated at its vertebral
end. Although lesions of the vertebral end are generally of greater
significance as far as the etiological factors are concerned, still
the sternal end of the rib must not be overlooked. In examining the
vertebral end of a rib attention should be paid the angles of the
ribs, for at the angles a better opportunity for examination is given
on account of the prominence. It will be necessary in many cases to
find out whether or not the vertebral end of the rib is lying between
the transverse processes instead of in front of them. In many severe
lesions of the ribs the vertebral end of the rib is dislocated upward
or downward from the transverse process of the vertebra and lies
between the transverse processes of the vertebræ above and below
its attachment. This certainly requires considerable skill in the
diagnosis, for oftentimes the point to be found is barely an eighth
of an inch in diameter. It is usually best before making such a close
examination to relax the tissues well over the field of examination.
The =ribs= as a whole may be too transverse or too oblique upon one
side. This is chiefly found in pathological curves of the spine, but
still such conditions may exist where there are severely contracted
muscles, especially in some cases of paralysis. Thus the contour of
the ribs must be taken into consideration by comparing one side with
the other.
In examining the =first rib= an examination somewhat different from
the other ribs should be given. It is best to have the patient assume
a sitting posture; then place the middle fingers of each hand upon the
first ribs near their centers and compare one with the other. Also note
the difference of the spaces between the ribs and clavicles. Generally
the first rib is dislocated upward, rarely downward. Besides finding an
abnormal prominence or depression of the rib at its center considerable
tenderness will be noticed. Examinations of this region are every day
experiences with the osteopath.
When diagnosing the position of the =floating ribs= it is best to
have the patient lie flat upon the back with the thighs flexed upon
the abdomen, so that the tissues about the lower ribs may be entirely
relaxed. Then by placing the flat of the fingers carefully over the
ribs the outline and position of them can be easily discerned. The
floating ribs are oftentimes found deranged and are the source of a
great deal of suffering through the iliac regions. These ribs may
become dislocated from the vertebral ends and drop down obliquely
toward the iliac crest, or else the free end may become locked beneath
the rib above. Occasionally both ends of the rib drop down quite
perceptibly and consequently is the cause of considerable distress. In
such instances the rib is depressed inward so that the normal contour
of the lower thorax is lost.
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