How would you differentiate rib inhalation dysfunction from rib exhalation dysfunction on palpation?

• A. Inhalation dysfunction shows motion limitation during inhalation; exhalation dysfunction shows motion limitation during exhalation
• B. Inhalation dysfunction shows motion limitation during exhalation; exhalation dysfunction shows motion limitation during inhalation
• C. Inhalation dysfunction shows motion enhancement during inhalation; exhalation dysfunction shows motion enhancement during exhalation
• D. They cannot be differentiated palpably

Answer: (A)

Distinguishing rib dysfunctions relies on which phase of breathing shows restricted motion. During inhalation the rib normally elevates, and during exhalation it should descend. If a rib’s motion is limited when the patient inhales, that rib is an inhalation dysfunction. If its motion is limited when the patient exhales, that rib is an exhalation dysfunction. You palpate at the rib, often near the costotransverse joint or rib angle, and observe which phase shows reduced excursion. The hallmark is phase-specific restriction; the other phases typically move more normally. Motion enhancement or an inability to palpate aren’t characteristics of these findings.