Ribs And Reflexes

Question 1

Brachial plexus passes between what muscles?

Answer 1

Ant. And middle scalene muscles

Question 2

Sympathetic ganglia and chain location

Answer 2

Just ant. To ribs

Question 3

Sites of neuromuscular compression

Answer 3

. Btw ant. And middle scalene (ant. Scalene syndrome)
. Btw clavicle and 1st rib (costoclavicular syndrome)
. Btw. Pec minor and chest wall

Question 4

Diaphragm innervated

Answer 4

Phrenic nerve (C3-5)

Question 5

Secondary muscles of respiration

Answer 5

Scalenes

Question 6

Fluid movement in thoracic cage

Answer 6

. Neg. intrathoracic pressure and positive intra-abdominal pressure on inhalation moves fluids
. Thoracic inlet must be unrestricted (treat first when lymph obstruction is present)

Question 7

Components of thoracic cage motion

Answer 7

. Movement of thoracic cage during movement of trunk (fl/extension, sidebending, rotation)
. Movement of ribs and thoracic cage during breathing (ribs, thoracic A-P curve)

Question 8

Primary motion of ribs during inhalation/exhalation

Answer 8

. Rotation about an axis from the head of rib to angle of rib
. Axis slightly ant. To costotransverse articulation

Question 9

Pump handle motion

Answer 9

. Inc. AP diameter of chest
. Sternum moves ant. And sup. During inhalation
. Affects ribs 1-5

Question 10

Bucket handle motion

Answer 10

Inc. transverse diameter of chest

. Ribs 6-10

Question 11

Diaphragm mechanism

Answer 11

. Contraction inc. vertical diameter of chest (dome shape flattens)
. Abdominal contents pushed inf. And abdomen protrudes out on inhalation
. Intrathoracic pressure dec. while intra-abdominal pressure inc.

Question 12

How bucket handle motion can be also be described as

Answer 12

. Ribs expand laterally but not in AP axis

Question 13

Osteopathic axis of rib motion

Answer 13

. Axis from head of rib to angle of rib then exits
. Nearly horizontal in top ribs
. Axis declines more inf. From top to bottom
. 45 degrees from horizontal in bottom of rib cage
. 1st rib almost in corona plane
. Becomes more post. From head of rib as you go inf.
. Upper ribs around this axis move sternum ant. And sup.
. Owner ribs around this axis move lat.

Question 14

1st rib dysfunctions tend to be assoc. w/ ____ dysfunction

Answer 14

Elevated, reluctance to be depressed w/ downward pressure

Question 15

What ribs have the most purple handle motion

Answer 15

Ribs 1 and 2

Question 16

When a vertebrae is sidebending left what direction is rib elevated?

Answer 16

Right side (assoc. w/ bucket handle motion)

Question 17

T/E pump handle motion increases as ribs increase in size

Answer 17

. F, decreases as ribs inc. in size

Question 18

Rubs 11 and 12 motion

Answer 18

. Caliper/pincer motion
. Move post. And lat. on inhalation
. Ant. And med. on exhalation

Question 19

T/F all ribs exhibit both pump handle and bucket handle motion, one is just more prominent than the other

Answer 19

T

Question 20

Exhalation rib

Answer 20

Freer motion
Restricted in inhalation
(Inhalation rib opposite)

Question 21

Ant. Rib subluxation

Answer 21

Rib angle more prominent in post. Rib cage

Question 22

Post. Subluxation in rib

Answer 22

Rib angle less prominent in post. Rib cage

Question 23

External rib torsion

Answer 23

. Assoc. w/ extended thoracic dysfunction

Question 24

List of structural rib issues

Answer 24

. Ant. And post. Subluxation
. External rib torsion
. Sup. 1st rib subluxation
. AP rib compression
. Lat. rib compression
. Lat. flexed rib (2nd)

Question 25

Extended thoracic are assoc. w/ what kind of ribs?

Answer 25

Inhalation

Question 26

Flexed thoracic are assoc. w/ what kind. Of ribs?

Answer 26

Exhalation ribs

Question 27

What rib causing restriction of inhalation in exhalation group dysfunction

Answer 27

Top rib

Question 28

What rib causing restricted exhalation in inhalation group?

Answer 28

Bottom rib

Question 29

Principles of diagnosis of ribs

Answer 29

. Patient supine, push lat. ribs for resistance
. Pump handle: hands ant. Portion of upper ribs
. Bucket handle: fingers on lat. aspect of lower ribs
. Passively move ribs into in/exhalation w/o patient breathing
. Palpate post. For tenderness/tissue change at rib angle
. Palpate ant. For ant. Counterstrain points

Question 30

Rib position in exhalation dysfunction

Answer 30

Down in front, up in back

Question 31

Rib position in inhalation dysfunction

Answer 31

Up in front down in back

Question 32

Principles of treatment of ribs

Answer 32

. Treat spine 1st, treat structural rib before respiratory ribs
. Rib1-2, 11-12 need special techniques
. Avoid excessive pressure on cartilaginous portion of ribs ant.
. Ribs in trouble w/ extended dysfunctions and crossover points of lat. curves
. Interpret TARt for viscerosomatic or musculoskeletal
. CS, indirect and direct MFR good treatments

Question 33

What Louis burns concluded about viscerosomatic reflexes in 1907

Answer 33

. Pathway of viscerosensory impulses enters spinal cord through post. Roots
. Somatovisceral reflexes less circumscribed and less direct than viscerosomatic reflexes
. Pressure upon somato-sensory nerves is sufficient to lessen conscious sensation to bring viscera back to normal

Question 34

Result of viscerosomatic reflex neurally

Answer 34

. Activates nocicieptive, general visceral afferent neurons
. Primary somatic dysfunction results in activation of somatosensory nociceptive neurons
. Primary afferent neurons enter spinal cord and synapse w. Dorsal horn
. Ongoing afferent stimulation causes irritability (facilitation) of interneurons of that spinal segment
. Additional afferent activity causes spinal segmental response to less stimulus than normal required (if visceral afferent activity strong enough it causes pain in spinal segment)

Question 35

Degree of segmental irritability is directly proportionate to ____

Answer 35

Severity of visceral pathology
Anatomic relationship between involved organ and paravertebral soft tissues (makes reflexes consistent from person to person)

Question 36

Midline organs produce ___ reflex

Answer 36

Bilateral

Question 37

Paired organs produce ____ reflexes

Answer 37

Bilateral in general disease

Asymmetrical disease produces ipsilateral response

Question 38

Organs above diaphragm show reflexes above what spinal level

Answer 38

T5 (below diaphragm is below T5)