Dysfunction: Elevated second rib on the right. Posterior portion (tubercle) of right rib 2 appears elevated, with surrounding tissue texture change.
Objective: To restore physiologic range of motion to the rib 2 costotransverse joint.
Patient Position: Seated.
Physician Position: Standing behind the patient.

Procedure:
1. Place your left foot on the table, and drape the patient's left arm over a pillow on your left knee.
2. Place your left elbow in front of the patient's shoulder, with your forearm contacting the left side of the face and your hand over the top of the head.
3. Place your right hand on the patient's right shoulder, with the thumb contacting the tubercle of rib 2.
4. Slowly rotate the head and neck to the left, disengaging the rib head as T1 rotates away from it. Side bend the region to the right to the level of the rib, exerting simultaneous downward pressure on the rib with your fulcrum. Cease rotation when the rib exhibits less resistance to this downward pressure.
5. Have the patient breathe in and exhale, localizing your force on exhalation.
6. Perform a high-velocity low-amplitude thrust through the right MP joint, inferior and medial with a small posterior vector.