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Flashcards in Respiratory Cards Deck (18)
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1

What are the typical ribs?

3rd-10th ribs

Typical ribs will always have the following
- tubercle
- head
- neck
- angle
- shaft

2

What are the atypical ribs?

1st
- articulates only with T1 and has no angle

2nd
- large tuberosity on the shaft that attaches to the serratus anterior

11th & 12th
- articulate only w/ corresponding vertebra and lack tubercles

*sometimes rib 10 is considered atypical since it articulates only T10*

3

True ribs

Ribs 1-7
- attach to the actual sternum

4

False ribs

Ribs 8-10
- has anterior articulation and posterior articulation but no costal notches on the sternum

5

Floating ribs

11th /12th
- there is no anterior articulation and only attach to the spinal segments

6

What ribs exhibit a caliper/pincer motion?

Ribs 11 and 12th

7

What is the predominant motion of ribs 1-6?

Pump handle motions
- still has some bucket handle though


*note that all ribs 1-10 have both motions, but as you go further up, pump handle motion begins to take predominance*

8

What is the predominant motion of ribs 7-10?

Bucket handle motion
- still possess some pump-handle motion

*note that all ribs 1-10 have both motions, but as you go further down, bucket handle motion begins to take predominance*

9

What is motion of pump handle motions when inhaling and exhaling?

Inhalation
- anterior portion of the rib moves anterior and superior
- posterior angle moves posterior and inferior

Exhalation
- anterior portion of the ribs moves posterior and inferiorly
- posterior angle moves anterior and superior

*motion is in a sagittal plane and costovertebral-transverse line*

*best palpated at mid-clavicle are line*

10

What is motion of bucket handle motions when inhaling and exhaling?

Inhalation
- lateral margin of the rib moves lateral and superior
- increase in transverse diameter

Exhalation
- lateral margin of the ribs moves medial and inferiorly
- decrease in transverse diameter

*motion is in a coronal plane and costovertebral-sternal line*

*best palpated at mid-axillary are line*

11

What is motion of caliper motion ribs when inhaling and exhaling?

Inhalation
- rib moves posteriorly and inferiorly

Exhalation
- rib moves anteriorly and superiorly

*motion is in a transverse plane and cephalad-pedad (vertical) line*

*best palpated at 3-5 cm lateral to transverse process*

12

Accessory muscles of inspiration

SCM

Scalenes

Pectoralis major

13

BITE phrase

Describes where the key rib is in a group of ribs based on the SOMATIC DYSFUNCTION (NOT RESTRICTION)

Bottom
Inhalation

Top
Exhalation

14

What ribs does each scalene help move?

Anterior = rib 1 only

Middle = rib 1 only

Posterior = rib 2 only

15

How do you palapate the anterior ribs 2-6

Palpate the cartilaginous attachments at the costalsternal boarder
- Rib 1= upper portion of the manubrium
- Rib 2= angle of Louis
- Rib 3-6 = attached to the lateral side of the sternum, can feel in the intercostal spaces

*make sure to assess static, passive and dynamic motions*

Patient is supine w/ physician at head of table
- place hands over ribs 2-6 OR fingertips on ribs 2-6 at parasternal region attachment

16

How do you palapate the anterior ribs 7-11

Identified by the little notches that are created when the cartilage of one rib connects to the rib above
- Rib 7 = 1st notch palpable inferior lateral to diploid process
- Rib 8 = medial 1/3rd way from proximal clavicle (roughly between R7/R9
- Rib 9 = midclavicular line
- Rib 10 = lateral 1/3rd of clavicle
- Rib 11 = free floating with tip at midaxillary line

Patient supine, physician stands at side where dominant eye is midline
- place fingertips on ribs 7-10 w/ little finger on rib 10 and index finger on rib 7

17

What are the direct effects of performing OMT on the thoracic cage?

1) improves breathing mechanics

2) modulation of the sympathetic NS
- both turn on and off

3) decreases pain

4) improves posture

18

Ribs 1 and 2 exhalation somatic dysfunction ME treatment

Uses reciprocal inhibition
- rib 1 engages the anterior and middle scalenes
- rib2 engages the posterior scalene

Physician stands on side opposite of dysfunction
- grapes superior edge of key rib between transverse process and angle w/ fingers
- exert constant anterior pressure w/ caudad hand and lateral traction
- pt face is forward (rib1) and 30 degrees rotated away (rib2), with patients wrist on forehead
- pt takes deep breath in and holds inhalation as they lift head against physcian resistance (3-5 seconds)
- pt exhales and relaxes as physician increases caudad and lateral traction
- repeat 3-5 times