Figures & data
Figure 1 The hands must be gently placed on the lateral sides of the costal margins to receive palpation feedback of the costal behavior during breathing.
Figure 2 The hands can be held anteriorly on the costal margins, with the thumbs being at the level of the margins and the other fingers placed across the upper ribs. This manual position can be used to assess the diaphragmatic excursion.
Figure 3 To evaluate the diaphragmatic domes, the operator’s forearm has to be held parallel to the abdomen of the patient, with the thenar and hypothenar eminences of the hand at the level of the anterior margin of the costal arch; a gentle push must be performed in the cranial direction, so as to record the elastic response of the tissue, for both right and let sides.
Figure 4 To evaluate the posterolateral area, the hand must be held as previously described for the domes, but with the forearm forming a 45° angle with the patient’s abdomen; a gentle push must be applied obliquely, following the line of the same forearm.
Figure 5 The evaluation of the xyphoid-costal area is used to assess whether there is regular elasticity of the tissue during inspiration and expiration, which is necessary for normal breathing. The hand and the forearm are positioned as in the evaluation of the domes, but in the xyphoid area; a gentle push must be applied cranially.
Figure 6 For medial ligaments, the spinal elasticity needs to be evaluated, with the patient being supine. The operator should hold the last phalanges of the fingers (of one or both hands) placed in the interspinous spaces of D11 and D12; by using a gentle push towards the ceiling, a passive extension of the vertebra is obtained, in order to deduce information on their elasticity.
Figure 7 The lateral ligaments are evaluated by actively involving the last rib. On the opposite side of the rib to be evaluated, the body of the rib must be held with one hand, and a gentle traction must be performed toward the operator.
Figure 8 Anatomical model.
