Flashcards in 20_ Respiratory Mechanics Deck (70):
What are the principle muscles of inspiration?
1. Thoracic diaphragm
2. External intercostal
3. Levator costarum
What are the accessory muscles of inspiration?
3. Serratus posterior superior
4. Pectoralis minor
5. Serratus anterior inferior fibers
6. Iliocostalis superior fibers
What are the principle muscles of expiration?
1. Passive recoil of thoracic diaphragm.
3. Internal intercostals.
What are the accessory muscles of expiration?
1. Rectus abdomminus.
2. External/internal oblique.
3. Transversus abdominis.
4.serratus posterior inferior.
5. Transversus thoracis
What are the muscular attachments of the diaphragm?
1. Lower 6 ribs bilaterally.
2. Xiphoid process.
3. Right crura: L1-L4
4. Left crura: L1-L3
What are the apertures that run through the diaphragm?
1. T8: allows inferior vena cava
2. T10: esophagus passes.
3. T12: thoracic aorta.
What does inhalation do to the diaphragm?
It will contract down towards the abdomen. Increasing the thoracic cavity (decreasing intrathoracic pressure).
What is the role of the central tendon?
Acts as a fixed point when the diaphragm meets resistance from the abdominal organs.
What provides a fixe point for the diaphragm when it meets resistance from the abdominal organs?
The role of the central tendon.
What happens to the apertures when the diaphragm contracts?
1. T10: esophageal hiatus contracts.
2. T8: vena canal opens
3. T12: aortic opening not affected.
What are the atypical ribs?
Ribs 1, 2, 10, 11, 12
What makes rib 1 atypical?
1. Highly curved, flat, no angle, and a single facet with T1 articulation only.
What makes rib 2 an atypical rib?
1. High amount of curve, flat, no angle, is longer than rib1, contains a demi-facet with T1-T2 vertebral bodies.
What makes rib 10 an atypical rib?
1. Single facet with TV10 articulation.
2. All other aspects are "normal" ribs.
What makes ribs 11 and 12 atypical ribs?
1. Neither contain tubercles, necks, tapered ends.
2. Both have a single facet with their corresponding vertebral bodies.
What are the true ribs?
1. Ribs 1-7.
2. Attach directly to the sternum via costal cartilages at the sternochondral joints.
What are the false ribs?
Technically ribs 8-12
What are the vertebrochondral false ribs?
1. Ribs 8-10.
2. Do not attach directly to the sternum
3. Attach to coastal cartilages located above the rib.
What are the floating ribs?
1. Ribs 11, 12
2. Have no anterior attachment and also lack cartilage.
What is costochondral cartilage?
1. The connection between a rib and the costal cartilage.
What is sternochondral cartilage?
1. The costal cartilage and triangular notches located in the sternum.
2. Allows for significant freedom with motion in coronal plane about an anterioposterior axis.
What is a costovertebral articulation?
1. Consists of the rib head attaching to vertebral bodies
2. Has a gliding/sliding motion
What is the motion of costovertebral articulation?
1. Consist of sliding/gliding motion.
What is a costotransverse articulation?
1. The rib tubercle connecting to the transverse process.
2. Gliding with rotational motion
What is the motion of the costotransverse articulation?
1. Motion is a gliding with some rotation.
What provides the overall rib motion?
The complex joint formed by the costovertebral and costotransverse articulations.
Which ribs move with a pump handle type of motion to increase the thoracic space?
1. Ribs 1-5.
2. Pivot about the transverse axis, increasing the anterioposterior diameter with inspiration.
Which ribs utilize the bucket-handle motion to increase the thoracic volume with inspiration?
1. Ribs 6-10.
2. Pivot about an anteroposterior axis.
3. Increases the transverse diameter during inhalation.
Which ribs utilize a caliper type motion with inspiration?
1. Ribs 11-12.
2. Pivot about the vertical axis.
3. Widens the transverse diameter during inhalation.
Where are you most likely to feel the pump handle motion of ribs 1-5?
1. Best felt on the anterior surface
Where are yo most likely to feel the bucket handle motion of ribs 6-10?
1. Best felt on the lateral aspect of ribs/
Where will you palpate the caliper motion of ribs during inspiration?
1. Best felt at ribs 11,12 at the posterior aspect of ribs.
How can you recognize an inhaled rib somatic dysfunction?
1. Dysfunctional rib will move superiorly during inhalation and will NOT move inferiorly on exhalation.
What position does an inhaled rib like?
Inhaled ribs like to be stuck in inhalation position.
How will ribs 1-5 present if they are an inhaled rib?
These ribs should protrude anteriorly. Or elevate anteriorly.
How will ribs 7-10 present if they are inhaled ribs?
1. They will protrude or be stuck with lateral expansion
How will ribs 11,12 present if they are in fact, inhaled ribs?
They will present with posterior protrusion/elevation.
How will you detect a exhaled rib on palpating?
1. Ribs 1-5: will be stuck with anterior depression.
2. Ribs 6-10: will be stuck with lateral depression.
3. Ribs 11-12: will be stuck with posterior depression.
What motion would you expect if you were to diagnose an exhaled rib?
1. Exhaled ribs will move inferiorly with exhalation but will fail to move superiorly with inhalation.
What is the "key" rib?
The rib with somatic dysfunction that will be affecting the ribs above and below it.
What does the mnemonic BITE mean?
Bottom inhaled, Top exhaled.
1. During treatment of inhaled ribs you want to treat the bottom rib.
2. During treatment of exhaled ribs you want to treat the top rib.
Should you treat SD in the vertebra before you treat the ribs?
Yes, treat vertebral SD before you treat the ribs, as vertebral manipulation may lead to resolving the ribs.
Is stuck in inhalation
Is restricted in exhalation. All refer to diagnosing what type of SD?
Refers to SD of an inhaled rib.
What is an inhaled rib?
1. stuck in inhalation
2. up in front, down in back
3. Tx most inferior rib in group
What is an exhaled rib?
1. stuck in exhalation
2. down in front, up in back
3. T the most superior rib in group
In terms of efficiency, when should ribs screening occur?
1. During the thoracic vertebral evaluation
What TART changes should you note with the rib angles?
3. Tissue texture changes
What is the best way to describe the rib attachment on the vertebra?
1. they attach to the vertebra for what they are numbered, and the one above them.
*Rib 4 attacehs at TV4, and TV3*
If a screening exam produces a "fascial" feeling, what is most likely the cause?
Upper extremity muscular problem
What should you observe globally with chest, anterior assessment?
1. chest or abdominal breathing
2. rate, rhythm, ease of motions
Which ribs utilize the pump handle motion?
1. ribs 1-5 use pump handle motion. Rotating about a transverse axis
Which ribs utilize the bucket handle motion?
Ribs 6-10, with rotation about an A-P axis
Which ribs utilize a Caliper type motion?
Ribs 11-12, rotating about a vertical axis.
What position must each of the rib sections be assessed in?
1. Ribs 1-5: supine/ant assess
2. Ribs 6-10: supine/ant assess
3. Ribs 11-12: prone/ post assess
What is the direct treatment method for inhaled ribs 1-10?
1. flex and sidebend the head until you palpate motion at ribs (thoracic for lower ribs).
2. exhale breath and hold for 3-5s.
3. apply downward force on most inferior rib of group
4. resist chest expansion with inhalation.
What muscles are you utilizing to pull ribs into the exhaled position?
internal intercostal muscles.
What is the major difference in treating ribs 1-5, versus 6-10 in terms of hand placement for an inhaled rib?
1. ribs 1-5 require more anterior placement.
2. ribs 6-10 require for lateral due to different motions.
What is the principle behind treating exhaled ribs?
1. The activaiton of muscles pulls the anterior portion of rib superiorly, while the physician pulls the posterior section inferiorly. Causes fulcrum rotation.
To treat exhaled ribs, will your patient hold their breath on inhalation or exhalation?
inhalation. pushes the ribs into the restrictive barrier.
What muscle do you use to treat an exhaled rib 1?
anterior scalene, due to its attachment on superior border of rib 1.
How will you position yourself and patient in order to treat exhaled 1st rib?
1. Place one hand on posterior rib tubercle, and pull inferiorly.
2. Pt has affected side hand laying on forehead, midline.
3. with inferior traction, pt raises head against a downward force.
4. Pt hold breath in inhalation
How will you treat an exhaled rib 2?
1. Place pt affected hand on forehead, and rotate head contralateral of the affected side.
2. This activates posterior scalene on superior aspect of rib 2.
3. Pt inhale, flexes head against downward force, and holds inhale during manuever.
4. Dr. pulls inferiorly on rib tubercle/angle.
What is the muscle utilized to treat an exhaled 2nd rib?
What muscles are used to treat an exhaled rib 3-5?
What is the set-up for treating an exhaled rib 3-5?
1. Abduct ipsilateral elbow to the feather edge.
2.Pt hold breath on inhalation and brings elbow to contralateral hip (against your counterforce)
3. Provide inferior traction during inspiration. resist superior motion during exhalation.
4. Take up slack
5. Return to neutral, re-assess
What muscles are used to treat exhaled ribs 6-10?
Latissimus dorsi and serratus anterior
What is the set up for exhaled ribs 6-10?
1. Abduct arm until palpated ribs move.
2. Have pt Adduct arm, and hold breath on inhalation.
3. Provide counterforce and pull inferiorly on the post aspect of ribs.
4. Find new feather barrier and engage.
What is the muscle energy technique for inhaled caliper ribs?
1. Caudad hand over ASIS. Cephalad hand over posterior aspect of 11-12 ribs.
2. Provide antero-lateral force with cephalad hand.
3. Caudad hand pulls hip off the table.
4. Pt holds breath on exhalation, pulls hip to table.
What is the muscle energy technique for exhaled caliper ribs?
1. same set up as for inhaled calipers. Only use anterior force, not antero-lateral.
2. Pt pulls hip toward the table and holds breath on inhalation.
3. engages quadratus lymborum.
4. Pull ASIS off of table, and apply anterior vector force to to medial aspect of the rib angle.