Biomechanics - Costal Flashcards
(71 cards)
1
Q
List atypical ribs
A
Ribs 1 & 2
2
Q
List true ribs.
A
Ribs 1-7
-attach to sternum
3
Q
List false ribs.
A
Ribs 8-12
-don’t attach to sternum
4
Q
List floating ribs.
A
Ribs 11 & 12
5
Q
What movements do costovertebral joints allow for?
A
gliding rotary motion
6
Q
What movements do costotransverse joints allow for?
A
gliding arcuate motion
most ribs have
7
Q
Where is the axis of motion for ribs?
A
through the neck of the rib
8
Q
What is rib motion influences by?
A
position and mobility of the of the thoracic vertebra due to ligamentous attachments
9
Q
What does thoracic segmental dysfunction alter?
A
the mechanics of the attached ribs
10
Q
With a rib and thoracic dysfunction, which area do you treat first?
A
thoracic
11
Q
What are the 3 types of rib motion?
A
- Bucket handle
- pump handle
- caliper motion
12
Q
How is bucket handle motion oriented?
A
- more Anterior/Posterior
- axis is more sagittal in the lower ribs
- changes the lateral diameter of the rib cage (gets wider with inhalation)
13
Q
How is pump handle motion oriented?
A
- more lateral
- axis is more coronal plane in the upper ribs
- increases anterior-posterior diameter and superior-inferior
14
Q
How is the pump handle motion used in lymphatics and venous system?
A
powerful lymphatic and venous pump
15
Q
How does the sternum move with inhalation?
A
Rises and moves forward
16
Q
What are the relative amounts of motion in the ribs?
A
Bucket handle motion - greatest at lower ribs
Pump handle motion - greatest at upper ribs
(Does not apply to rib 11 & 12)
17
Q
Describe characteristics of rib 1.
A
- borader and flatter
- attaches to sternum via synchondrosis
- subclavian artery, brachial plexus pass over its superior surface
- attached to scalene muscles and serratus anterior muscle as well as subclavius
- no attachment to iliocostalis cervicis muscle s
18
Q
Is rib 1 subject to diseases of synovial joints? Why or why not?
A
No because it is attached to sternum via synchondrosis.
- can’t get RA in the 1st joint
19
Q
How can cervical sidebending affect rib 1?
A
can elevate rib 1 when there is tension in the neck
20
Q
What are the normal mechanics for Rib 1?
A
- pump handle motion predominates
21
Q
What is an inhaled rib?
A
held in inhalation, restricted in exhalation
22
Q
What can cause inhalation of a rib?
A
- hypertonic scalene muscles (anterior and middle)
23
Q
What are the symptoms of an inhaled Rib 1?
A
- tenderness over angle of rib posteriorly (just lateral to the tp of T1 - in the back about 1 1/2 inches from midline)
- ulnar distribution of pain and paresthesias (pinch of brachial plexus)
- arm swelling (compression of subclavian vein against clavicle)
24
Q
What is an exhaled rib?
A
held in exhalation, restricted in inhalation
25
What can cause exhalation of a rib?
hypertonic serratus anterior muscle
26
What are symptoms of an exhaled rib?
- tenderness at costochondral junction anteriorly
- ulnar distribution of pain and paresthesias
- arm muscle claudication due to subclavian artery compression
27
What kind of dysfunction can exhaled ribs create?
- create sidebent and rotated dysfunction to side of dysfunctional rib
- create flexed OA dysfunction, sidebent to side of dysfunctional rib
28
Describe Rib 2.
- Atypical
- broad, flat
- attached via bicompartmental synovial joint at Manubrio-sternal junction
- muscle attachments for Posterior scalene and Serratus anterior (double attachment)
- No attachment to iliocostalis cervicis muscles
29
What mechanics predominate with rib 2?
pump handle
| very little bucket handle motion
30
What would hold rib 2 in inhalation?
hypertonic Posterior Scalene Muscle
31
What is the symptom of a rib 2 dysfunction held in inhalation?
tenderness over the angle of rib posteriorly
32
What would hold rib 2 in exhalation?
hypertonic serratus anterior muscle
33
What are the symptoms of a rib 2 dysfunction held in exhalation?
- tenderness at the costochondral junction anteriorly
| - neck pain and stiffness from passive traction on posterior scalene muscle
34
Describe ribs 3 - 7
- true ribs
- attach to sternum via synovial joint
- muscle attachment to iliocostalis cervicis and thoracis muscles posteriorly
- muscle attachment to pectoralis minor anteriorly to ribs 3,4, & 5
- muscle attachment to serratus anterior laterally
35
Where does costochondritis hurt?
costocondral junction
| if they hurt at costosternal junction, it is not costochondritis
36
How do the serratus anterior muscles pull on the ribs?
upward; due to scapular attachment
37
How do you know if you have a pec minor problem?
pain past the costochondral junction
38
What mechanics predominates in ribs 3-7?
pump handle motion predominates at superior ribs
| - progressive increase in bucket handle motion as you descend to rib 7
39
What can hold ribs 3 -5 in inhalation?
hypertonic pectoralis minor muscles
40
What can hold ribs 3 - 7 in inhalation?
hypertonic iliocostalis thoracis muscles
41
What are the symptoms for inhaled dysfunction in ribs 3-7?
- tenderness at the angle of the rib posteriorly
| - reduced thoracic sidebending due to hypertonic iliocostalis thoracis muscles
42
What can hold ribs 3 - 7 in exhalation?
hypertonic iliocostalis cervicis muscles
43
What are the symptoms for exhaled dysfunction in ribs 3 - 7?
- tenderness at costochondral junction anteriorly
- restricted cervical sidebending contralaterally due to hypertonicity of iliocostalis cervicis muscles
(can impact cervical sidebending)
44
Describe ribs 8 - 10
- false ribs
- attach to sternum via a synovial joint to costal cartilage above
- muscle attachments to diaphragm
- muscle attachments to serratus anterior
- muscles attachments to iliocostalis thoracis and lumborum
45
What can cause respiratory compromise?
- lumbar attachment of crura
46
What nerve is the diaphragm under the influence of?
```
phrenic Nerve (Sensory and Motor)
-from C3, 4, 5
```
47
What can cause referred pain from the superior or inferior surface of the diaphragm?
- referred paid goes to the neck and shoulder (C5)
- can be caused by hepatitis, gastritis, pericarditis, splenic infarction, myocardial infarction, kidneys
* *referred pain to ribs 7, 8
48
What mechanics predominate ribs 8 - 10?
- bucket handle motion (expand laterally)
| - little pump handle motion
49
What can hold ribs 8 - 10 in inhalation?
- hypertonic serratus anterior muscles
| - hypertonic iliocostalis lumborum muscles
50
What symptoms are present with an inhalation dysfunction of ribs 8 - 10?
- rib angle tenderness posteriorly
| - restricted lumbar sidebending from hypertonic iliocostalis lumborum muscles
51
What symptoms are present with an exhalation dysfunction of ribs 8 - 10?
- tenderness over costochondral junctions anterolaterally
52
Describe 11 & 12.
- atypical ribs
- floating ribs
- no sternal attachment
- no costotransverse articulation
- attached to respiratory diaphragm
- attached to quadratus lumborum (hypertonic - pulls ribs down)
53
What influences ribs 11 & 12 the most?
low back injuries
54
What is the normal motion of ribs 11 & 12?
caliper motion
55
Inhalation pulls ribs 11 & 12 in what direction?
downward & posteriorly
| quadratus lumborum anchors the ribs for more effective diaphragmatic contraction
56
Exhalation pulls ribs 11 & 12 in what direction?
upward & anteriorly
57
Inhaled ribs 11 & 12 are stuck in what direction? caused by?
- down
| - pull of quadratus lumborum overpowers the pull of the diaphragm
58
What are the symptoms for inhaled ribs 11 & 12?
- tenderness over the angle of the rib posteriorly
| - low back pain ***
59
What can cause exhaled ribs in 11 & 12?
- often traumatic in origin
| - MVA
60
What are the symptoms for exhaled ribs 11 & 12?
- tenderness over tip of rib laterally
| - flank pain
61
What is anterior sublaxation?
- whole rib moved anteriorly compared to the rest of the body
- costal end of the rib prominent anteriorly
- depression posteriorly lateral to transverse process
- usually inhaled dysfunction
- posterior tenderpoint
62
What is posterior rib sublaxation?
- whole rib moved posteriorly
- increased posterior prominence
- can cause rotation of thoracic vertebrae
- depression anteriorly
- usually exhaled dysfunction
- anterior tenderpoint
63
What is rib torsion?
- twist in rib itself
- superior border of rib is more prominent
- wider intercostal space above and narrower intercostal space below
64
What is anteroposterior compression?
- rib squeezed from front to back
- less prominence anteriorly and posteriorly
- increased prominence in mid-axillary line
- intercostal spaces above and below are tender and hypertonic
65
What is lateral compression?
- squeezed from the sides - increased prominence both anteriorly and posteriorly
- decreased prominence in the mid-axillary line
- intercostal spaces above and below are tender and hypertonic
66
What is laterally flexed rib?
- prominenece of involved rib in the mid-axillary line
- narrow intercostal space above
- wider intercostal space below
- marked tenderness in intercostal space above rib
- at rib 2
67
What neural influences are seen in the ribs?
Intercostal nerves - 3 cutaneous branches anteriorly, posteriorly, & laterally
68
Where can cause neuritis?
generated by severe or longstanding rib dysfunction
- generated by herpes zoster
- generated by thoracic dysfunction
69
Where are 3 sites of tenderness ?
- lateral to spinous process
- mid-axillary line
- next to sternum
70
How does the sympathetic chain ganglia interact with the ribs?
- bound by parietal pleura to the anterior surface of the costal heads
- each ganglion receives its blood supply and venous drainage via the intercostal vessels
- each ganglion communicates with every thoracic spinal nerve
71
What can happen to the sympathetic chain ganglia with rib dysfunction?
- can get mechanical distortion or irritation with rib distortion
- rami communicantes
- blood supply can be compressed
- autonomic responses (upset stomach, irritable bowel, asthma attack)
