39. OMM | Basics of Diagnosing the Ribs

A 55-year-old woman reports chronic left-sided flank pain. Exam reveals rib 12 restricted in caliper motion, failing to move posterior–inferior with inhalation. Palpation identifies tightness in the ipsilateral quadratus lumborum. Which additional dysfunction would most likely be present?

A. Lumbar shear
B. Thoracic outlet syndrome
C. Pectoralis minor syndrome
D. Cervical rib dysfunction
E. Sacral torsion

A

• Rib 12 dysfunction is most often linked to quadratus lumborum hypertonicity, which produces lumbar shear dysfunctions.

• A (Correct): Lumbar shear from rib 12 + QL tension.

• B: TOS → rib 1/pec minor.

• C: Pec minor syndrome → ribs 3–5.

• D: Cervical rib dysfunction is rare and unrelated here.

• E: Sacral torsion → lat dorsi, not rib 12.

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