Conservative Management of Costovertebral Subluxation
Conservative Management of Costovertebral Subluxation
Conservative Management of Costovertebral Subluxation
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Conservative Management of
Costovertebral Subluxation
his fingers spread laterally across the scapula. The doctor must both maneuvers are equally painful. When the pain is primarily
keep his elbows fully extended. The patient is requested to muscular, it is not influenced by the rib maneuver.
breathe deeply and during expiration the doctor applies more
weight and gently springs the ribs, the object being to create a 3. THE RIB COMPRESSION TEST
separational stress at the costovertebral joints.
Guarding occurs a moment after pressure is applied. This test is performed with the examiner standing
If it appears before springing, then the patient is apprehensive behind the patient and placing his arms around the patient’s
and expecting the maneuver to hurt. When the contraction is chest. (Figure 3) The examiner requests the patient to take a
delayed, then the patient is attempting to create a false impres- deep breath while applying gentle pressure to the patient’s rib
sion. If the contraction is sustained without variation during cage. If the patient has a costal sprain the gentle compressive
the test, the clinician should be cognizant that either a severe force of the clinician will restrict rib expansion and the patient
continuous deep pain is present or the patient is apprehensive will experience symptomatic relief. However, if the lesion is
and is not relaxing enough for the test to be valid. present, unsupported chest expansion will create stress on the
The springing test is a valuable and sensitive test. hypomobile joint, causing the patient to experience pain at the
If the doctor determines a disproportionate response to the site of the lesion.
springing, such as excessive guarding, it should immediately When performing this test on a female patient, the ex-
arouse his suspicion of pathological changes. aminer may recommend that the patient flex both arms at the
elbows and bring them up in front of her chest to protect her
from excessive pressure being applied directly to the breast
2. THE RIB MANEUVER TEST area.
The patient lies on his right side, the doctor faces him
and grasps the patient’s left flexed elbow with his left arm
stretching the shoulder into full abduction and fixing the affected
rib in the mid-auxillary line with his right thumb and thenar emi-
nence. The thrust is inferior.
The patient lies prone with both legs flexed upward, the
doctor grasps both ankles with his right hand. He then laterally
torques the patient’s legs toward him using his left knee as a
fulcrum. This maneuver opens the rib cage on the affected side.
The doctor then places the pisiform of his left hand on the inferior
border of the affected rib. He then thrusts in a superior direction.
When managing a patient with a costal sprain, it has
been the author’s clinical experience that fitting the patient with a
supportive rib belt enhances the patient’s recovery time. The rib
support helps reinforce, protect and stabilize the involved area.
The patient wears the support during waking hours throughout
the acute period.
Summary
Bibliography