So now we're going to assessment, looking in the first rib, the cervical-thoracic junction. We're looking at the thoracic and linden. One thing I think we've tried to teach and work with things is to try to find the simplest way to present a concept in doing it. I think so many things in medicine just seem so complex, even if they're not, and that's maybe the definition of expert. They take a complex thing, they make it very understandable. I think so many times a barrier to learning is people feel like things are intimidating. I can't, I don't understand this concept. So in this next section, I want to try to utilize some simple kind of a concept to doing it. So we're kind of diagnosing this first rib, cervical-thoracic area, think about driving a car. And you say, well, what's he talking about? Well, I'll kind of explain it. So we're driving a couple, you think of a few things. We think of a wheel driving a car, we think of gas pedals, we think of brake pedals and how we're doing that. And so sometimes using a conceptual model when you're describing it to people is putting very tangible things that make sense with that. So as I go through, I'll explain that. So when we're doing it, the first thing is you want to make sure when someone's doing any kind of assessment, their hands are in the right place to evaluate someone. Because if they're not, for a structural exam, they're not going to get an accurate diagnosis. So at the beginning, it's kind of that neutral position where they're assessing it, again, so that number one thing is good hand placement. So there are different ways to do this. I'd recommend one way to evaluate this in the supine position is looking at the patient's thumbs on the posterior and the first rib and the fingers anteriorly over the clavicles. So again, you're working with the learners themselves. You want to find these models, you want to have them demonstrate this. This is a fundamental technique that people are learning when they're going to learn kind of myofascial release and going through it. But they have to be able to figure out, you know, which area is the barrier, which direction it's going, and to get a feel for it. So again, when you're beginning, if you see here the kind of pictures we have of the patient, and try to show a clear picture so they can see what's going on, and describe something they find, describing in a picture first and then showing to in person kind of reinforces that. So the key thing, I have the thumbs kind of posterior on that first rib and anteriorly over the clavicle. By doing that, what happens is, you can explain, learner, you can get a feel. You can feel which direction things are going. You can see if it's, you know, when we're looking at that self, I can get in that position. So that's how that driving is. So when you're looking at motion and saying, well, if I kind of turn my hands and rotate one over to the other, I can see which way is easier, which way it wants to go. You know, if I have the ideas of, you know, my foot's in the middle, now I'm going to put my foot over. I'm going to feel how it goes when it's on the gas. So I'm pushing down the right. How it's when I push on the brakes, it's going down left. I'm checking that side bending, so whichever way that pedal goes. So again, keeping that hands over the area, and from there, saying, okay, think of these models. I have two things I'm looking at. I'm looking at kind of the side bending and rotation. So that wheel helps with rotation, and the pedals help us with side bending. So I'd like to now go to the table and kind of show you this and how we can look and assess the cervical-thoracic junction. So now what we're going through here is the assessment of the cervical-thoracic junction. The basic concept here, again, if you can drive a car, or know how to drive a car, you can evaluate this area. The key motion to look at is rotation and side bending. We try to get the right placement of our hands when we're doing this because we want to feel the motions of that cervical-thoracic junction. We're impacting that upper ribs themselves, posterior ribs. We're also looking at that first rib itself, posteriorly, the transverse process. We're looking at that whole junction and going through it. So what we're doing, to make sure I do it, I try to get my thumbs so my thumbs are posteriorly, can be on that first rib. If you're not certain, feel where the spine of T1 is, move it laterally, but you can feel the promise of the first ribs posteriorly. Then find the clavicles. Put your other hands right in front of the clavicles. One advantage of this approach is that I get a good feel for whole motion in the area. So the key motions I'm thinking about, this is where I guess the driving analogy works, is I'm rotating. So I'm moving the wheel, rotating the right. If I press on the gas, I'm side-bending right. If then if I press on the brakes, I'm side-bending left. So when you're teaching someone, again, use that model. Give some simple idea they can understand in the components because then you say all these, you know, side-bending rotation, but say, hey, it's like driving a car, and put a tangible thing. So, okay, so that rotation is like turning the wheel. Like, oh, okay, I can see that, you know, hands at, oh, the side-bending. And then right away I say, well, if it goes right, think we're pressing on the gas, side-bending left, think we're stepping on the brakes. Oh. And see, those models help get people a better idea, and also the intimidation, I can't feel anything. You say, just put your hands and just see where things are at. So when they assess that themselves, make sure you get the right hand position, again, the thumbs over that first rib and anteriorly right over the clavicle. So again, say, take one motion at a time, we'll rotate. See which way it seems to go a little bit easier to. Then again, pressing the gas, the side-bend right, side-bend left. See it just go easier one direction than the other. See, well, if I'm pressing on the right, it seems to go easier, that means I'm side-bend to the right. If I try to turn the wheel, it seems to want to turn to the right more. So we're side-bend and we rotate it to the right because the gas wants to go down and the wheel wants to turn to the right. If you use that, then they get a better idea what's going on. So those are the key things. So again, when you're doing it, make sure that you work on that hand placement and make sure that you're also working on those two motions of rotation and side-bending. So now we've gone through assessing the cervical-thoracic junction. We're going to now go to the tables so we can look at this motion. Again, we're going to use our analogy of driving a car, checking for rotation and for side-bending. So we'll do that. Again, hands in a place that we're going to go through and to make sure we have our thumbs on the first rib and our other hands right above the clavicle, checking rotation and side-bending. You want to make sure you're in a good position and look at that cervical-thoracic junction and say, well, how can I assess that? Well, one thing, get their thumbs so their thumbs are on that first rib until you find the clavicle and your hands right below the clavicle. When you look at driving a car, there's two components. One is rotation. So you talk about that steering wheel. The steering wheel itself checks rotation. Now, side-bending, there's two major motions, is step on the gas, which is side-bending to the right. Step on the brakes, that's side-bending to the left. So learners, two things. Again, get a good position. Understand just the idea of rotation, side-bending, and I think people can get those concepts with it. The other thing you're going to try to do is give them a feel to see, can they tell which way it's easier to go, and getting a feel for it. So again, right position, make sure they have it. Check their hands when they have it to make sure their thumb's in the right position, they find that clavicle, the hands in front of it, getting a feel for the area. And say, well, gee, I'm going to check on rotation, see which way it seems to want to rotate. Okay, it seems to go easier here to the right. Okay. So say, okay, well, then we're rotating to the right. You can put your hands on top of those if you need to to say, let me feel it with you. Some days that makes it easier for them. I got these big hands, so it's easy for me, you know. But the other thing is side-bending, say, okay, I'll compress on the right, compress on the left. Say, okay, step on the gas, step on the brakes. And all of a sudden they say, okay, oh, it seems to go more on this gas thing than it does on the brakes. Oh, that's right. Oh, yeah, so side-bend right, it's rotated right, you know, and going through it. And also, the other thing is they're having difficulty feeling it, you know, and they're doing it saying, well, let's, you know, remember, they have someone else who can help you. That's the patient, you know, and tell them it's no ego. Just say, now tell me, if I turn this, which way does it feel easy? People can feel that, you know, and it's hard. You got to take it for granted. We've been at it for a while. And you feel this. They don't feel stuff. So you got to do things that make them feel less intimidated with it. So when you're teaching it, think of those things in mind, and I think it'll be real effective. Okay. So, Ryan, today we're going to talk about assessing the first rib and the motion. And a good way to do this is to think about driving a car. And so the first things first, though, is hand placement. So you're going to use your hands, and then you put your thumbs on the first rib behind, and then your fingertips go ahead and reach forward, almost like clasping the actual wheel and onto the clavicle. And then from there, we're going to talk about rotation, like driving the car, and just like turning the wheel, and then pushing on the gas or pushing on the brake, and to determine the side bending, okay? Sure. So is it okay if I go ahead? Of course. And demonstrate? Okay. So first, my thumbs will come behind, feeling for the first rib, and then my fingertips are coming forward, feeling for the clavicle, and I'm in a good position. And then now I'm going to start feeling for rotation by using the turning. I feel like towards the right, you rotate better? Yes, I do. Okay. And then now we're going to go ahead and do for the gas versus the brake to feel which side you side bend better to. And then which side do you feel is easier for you? I feel like the left. I agree. So then in that situation, you would be rotated right and side bent left. Okay? So an interesting point with this is vast majority of people, most commonly, it's rotating side bent to the same side on those areas. The exception is if a trauma or acute injury. Okay. And Ryan's had recently acute injury, and it throws it off because normally it follows, you know, of course, you wouldn't get into this level with kind of novice learners, but there's type two mechanics, type one mechanics, and, you know, you lose all of them with that. That's the next phase. The guy, you get people's hands doing things, and then once they get that, then you bring the next level. And then they get it. They understand. But you throw on so much, it makes it kind of challenging. But just as a side note for yourself, because they may find this, well, you told me it's either going to go this way or that way. You know, we do rules in generalities. Because you teach novice learners, you take the most general thing that you get, the most common, because you throw out every scenario. They're going to be like, forget it. I can't do this, you know. But the exception, when they see it steps out, is there's a reason. And the reason there is because, you know, it's a trauma or something happened. You know, and I know Ryan, you know, just a recent injury, so all of a sudden he has this muscle spasm. And he's off. So he's not going to get a normal finding with that, doing it. So just for the sake of them, say the vast majority of people are going to rotate in the same direction we've seen here. But it's not always that case. And if it's not, you should ask the next question, why? And that's usually because of, again, trauma or acute injury that's occurred. All right. Hi, Neha. It's me again, Shanshan. Hi. Today I'm just going to assess you to see if you have any typical thoracic junction. But to assess this, I will have my hands placed onto the back of your first rib, as well as over the clavicles. Essentially, I'm feeling for all the structures that is involved in a typical thoracic junction. Okay? So first I'm going to feel for your T1. Thank you for lifting your head up. Okay. And go lateral to that to feel for the first rib. And then the rest of my fingers will be over the clavicle. Okay. And like driving a car, if I turn right, that's rotating you right. If I turn left, that's rotating you left. I'm trying to assess where you have the greatest ease of movement. Okay. And then sometimes if you close your eyes, you can feel the ease of movement greater. So for you, it's easier for you to turn left. Next, I'm going to push on your left, push down to the left, which is the brake, and push you on the right, push down, which is the gas. And in doing this, I'm inducing side bending to the left or to the right. Again, assessing for the greatest ease of movement. It's easier for you to side bend to the right. Okay. And that's it. Do you have any questions? I have no questions. Thank you. You're welcome. All right. Thanks. All right. Let's kind of go over the thing. In a professional environment, when you introduce yourself, always introduce yourself as doctor. Okay. Because that credentials you. And just kind of get in the habit of doing that. You don't have to apologize for being a doctor. You earned it. So just say, I'm Dr. So and So. All right. This part was wonderful. Very clear. You did what you did. And then you showed the patient to it. You know, you described it. And then you actually did it. And I'm sure that the camera picked up the fact that you are rotating right. So that means that this is there. And you did it a couple of times. And you could actually see the results of your exam based on where your hands went. At least I could. Same thing with the gas and the brake. You figured that out. And you said, oh, yeah, you go easier this side than this side. And I could see your exam from the way that you did it. You know, at the end, have a summary statement even if it's only one sentence to say. So we talked about, you know, using the model of rotation where rotating, driving the car to the right, means you have side bend or you have rotational process to the right side. Gas and brake, you know, with side bending. And we found this and that. And then some statement about the clinical use of that. Now we have a diagnosis for what we found. And the next step is to go and treat it. Okay? So. So it would be like the diagnosis is naming for the freedom. Yeah. It's rotated to the side of ease, which means conversely that the bad side, we use that term a lot, is actually the other side. Okay. So it's too far to the right. I want to get it more to the left because the left is actually stuck. So she was rotated left and side bent right. Okay. Yeah. Now. Yes. That was the diagnosis. So if you're going to treat it, that over rotation, you've got to bring back to normal. And that more side bend, you've got to bring that back to normal. Yeah. And then reassess. Okay? Does that make sense? Yeah. All right. Let's switch and. You can use the analogy of driving the car, which is great. So hand position is important. It's like, you know, they say 10 and 2. Okay. But this is a little different. What you want to do is find the clavicles. And that is going to be where your fingers are. And your thumb will be on the first rib, which is just behind the clavicle. So you can just tell whoever you're teaching just to kind of. This will be the steering wheel. As you can kind of see, the clavicles kind of form the steering wheel. You see that? And then when you. So that's your hand position. And then when you go to evaluate for rotation, you'd actually. That's how you steer. So you get your hands into position. And you just. Palpate. Just kind of go through the range of motion and try to find what side is. Moves easier. So. So for her. It's easier for me to turn right. Okay. So in. When we. When we diagnose issues. Somatic issues. So that would be rotated right. Okay. And then the other part is side bending. And side bending you have. You have the. The brakes on the left. And the gas on the right. And you just kind of see which side has freer motion. So for her. I think it's. I feel that it's. It's easier for me to push down on the left. So the diagnosis would be. Rotated right. Side bend left. For the thoracic. Okay. And that's pretty much all you need to really tell the person that you're teaching. Do a steering wheel motion with my hand placement. In front of the clavicle. And also on the first rib. So. I'm going to start by. Turning my steering wheel. To the right. Left. Right. Left. I feel freedom of motion to the right. So she's rotated right. Okay. And then I'm going to do. My gas pedal. And my brake pedal. Yes. I was trying to think of my feet position and which is which. Okay. So I think. Okay. Okay. I think my brake pedal goes down farther. So that would be. Side bend to the left. Correct. So that was rotated right. Side bend left. Yeah. Okay. Perfect.

cervical-thoracic junction

first rib movement

driving analogy

anatomical assessments

learner accessibility