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71 Cards in this Set
- Front
- Back
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What are the 3 functions of ribs?
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1. protection
2. respiration 3. circulation |
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How are ribs involved in respiration?
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By creation of negative intrathoracic pressure
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How are ribs involved in circulation?
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Venous and lymphatic return; aided by creation of negative intrathoracic pressure
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What is the relationship b/w ribs and nervous system?
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sympathetics
- mechanically moving ribs can effect sympathetic chain |
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What are the 6 postural and respiratory muscles?
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1. Scalenes (ant., post., middle)
2. SCM 3. Pectoralis minor 4. Serratus anterior 5. Latissimus dorsi 6. Thoracoabdominal diaphragm |
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What are the rib locations of anterior and posterior scalenes?
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Anterior - 1st rib
Posterior - 2nd rib |
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What is the rib location of pec. minor?
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pec minor - rib 3, 4, 5, ~6
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What is the rib location of serratus anterior?
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serratus ant - first 9 ribs (usual for 6, 7, 8, 9)
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What is the rib location of latissimus dorsi?
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lat. dorsi - lower ribs
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What plays a major role in rib dysfunction?
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Muscle attachments
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What are true ribs?
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- vertebrosternal ribs
- ribs 1-7 |
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How do true ribs attach?
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Via cartilage to sternum
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What are vertebrochondral ribs also known as?
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- false ribs
- ribs 8, 9, 10 |
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Where do false ribs (8, 9, 10) articulate?
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With costocartilage above
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Besides vertebrochondral ribs, what are the other kinds of false ribs?
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- "floating ribs"
- ribs 11, 12 |
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Floating ribs have no __________ attachments
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anterior
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What are the typical ribs?
Describe shape |
- ribs 3-10
- all have similar shapes |
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Where do the 2 demifacets on rib head articulate?
ex. |
- articulate w/ two vertebrae
ex. rib 7 articulates w/ vertebrae 7 as well as 6 (the one above) |
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What are the atypical ribs?
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- ribs 1, 2, 11-12
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Describe rib 1
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- shortest and broadest
- single facet that articulates w/ only one vertebrae, T1 |
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What allows T1, the 1st rib and the manubrium to act as a unit?
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- 1st rib's synchonrosis w/ the manubrium
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Describe rib 2's attachments
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- attached anteriorly at angle of Louis via 2 demifacets
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Describe ribs 11 and 12 articulation
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- no articulation anteriorly ("floating" ribs)
- one vertebral articulation posteriorly: Rib 11 - w/ T11 ONLY Rib 12 - w/ T12 ONLY |
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Describe the connections of ribs to vertebral bodies (costovertebral joints)
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- synovial joints
- articular capsules - head of ribs 2-10 articulate w/ 2 vertebrae each |
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Describe the connections of ribs to vertebral transverse process (costotransverse joint)
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- connection b/w facets at tip of transverse process and tubercle of rib
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Describe the connections of rib 2 to sternum
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- rib 2 has a demifacet attached to gladiolus (body) of sternum and 2nd demifacet attaching it to manubrium
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Describe the connections of ribs 3-7 to sternum
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- ribs 3-7 attach to gladiolus (bodY) of sternum via a synovial joint
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During inhalation, what diameters of the rib cage enlarge?
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- All 3:
cephalad - caudad anterior - posterior right - left (transverse) |
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What occurs anatomically, during inspiration, that allows an increase in cephalad-caudad diameter?
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Thoraco-abdominal diaphragm moves inferiorly
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Describe the A-P increase in diameter during inspiration.
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During inspiration, the sternum and those ribs attached to it elevate and move further out from the mediastinum as the lungs fill with air
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Which ribs are generally considered pump handle ribs?
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- ribs 1-5
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What is the axis of movement for pump handle ribs?
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Axis of movement is through the costovertebral and costotransverse articulations
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During inhalation, which diameter of the thorax is increased in the pump handle ribs?
What is this motion analogous to? |
- A-P diameter of the thorax
- analogous to flexion/extension |
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Describe the transverse (L-R) increase in diameter with inspiration
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During inspiration, as the lungs fill w/ air, ribs at the lateral-most location move away from the midline
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Which ribs are generally considered bucket handle ribs?
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- ribs 6-10
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What is the axis of movement for bucket hand ribs?
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Movement is on an axis through the costotransverse and costochondral articulations
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During inhalation, which diameter of the thorax is increased in the bucket handle ribs?
What is this motion analogous to? |
- transverse diameter of the thorax
- abduction/adduction |
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What are ribs 11 and 12 also known as?
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Caliper ribs
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Describe the attachment of ribs 11 and 12
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no anterior attachment
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Describe the movement of the caliper ribs
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Movement is like a "lobster claw" or ice tong
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During inhalation, what diameter of the thorax increases in the caliper ribs?
What is the motion analogous to? |
- increase in the transverse diameter (and slightly AP diameter)
- internal/external rotation |
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Describe the motion of the "in betweens" ribs
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- ribs b/w the pump handle predominant and bucket handle predominant share part of each motion, in varying degrees
- all ribs have ALL MOTIONS |
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What is the mnemonic for the ribs?
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PUMP (1-5) water into a BUCKET (6-10) and lift the bucket with CALIPERS (11-12)
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How can rib 1 be classified (type of rib)?
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50% pump
50% bucket |
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How can ribs 2-5 be classified (type of rib)?
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Predominantly pump handle
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How can ribs 6-10 be classified (type of rib)?
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Predominantly bucket handle
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How can ribs 11 and 12 be classified (type of rib)?
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Caliper
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All ribs have _____ motions; but predominantly _______
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all; one
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What are the 2 types of rib dysfunctions?
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Inhalation somatic dysfunctions
Exhalation somatic dysfunctions |
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What are 2 other ways to name an "inhalation somatic dysfunction"?
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1. exhalation restriction
2. "inhaled" rib |
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What are 2 other ways to name an "exhalation somatic dysfunction"?
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1. inhalation restriction
2. "exhaled" rib |
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Where is the assessment of rib dysfunction done?
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anterior
posterior lateral chest wall |
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What must you be careful to do when you move from the anterior to posterior wall?
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Be sure you are on the same rib
"bounce" rib on front while monitoring on back |
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In what 2 states are the assessment of rib dysfunction done?
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Statically
Dynamically |
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In inhalation somatic dysfunction, where do the ribs "live"?
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in inhalation
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In exhalation somatic dysfunction, where do the ribs "live"?
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in exhalation
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When the rib dysfunction is being assessed statically, how is it described?
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Prominent or recessed compared to contralateral side
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What physical finding can be found with the dysfunctional rib?
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Tender to palpation
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When assessing pump handle ribs, where do you want to palpate?
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Feel as close to the costosternal junction as possible
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What findings will you have during static assessment of the pump handle ribs in inhalation?
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- rib will be prominent on front of chest
- inferior border of rib wll be prominent on the front - rib will be recessed on back of chest |
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What findings will you have during static assessment of the pump handle ribs in exhalation?
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- rib will be prominent on rear of chest
- inferior border of the rib will be prominent on the back - rib will be recessed on from of chest |
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During assessment, what position will you find
1. inhaled 2. exhaled bucket handle ribs? |
1. held cephalically in position of inhalation
2. held caudally in position of exhalation |
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During dynamic assessment, what side is the side of dysfunction?
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The side that lacks rib motion infers side of dysfunction (dominance)
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Is dysfunction conclusively determined in dynamic or static assessment?
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Dynamic motion assessment
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What are the 4 things that must be mentioned every time you name a rib dysfunction?
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1. side of dysfunction (L vs. R)
2. # of the rib (3, 4, etc) 3. where the rib lives or prefers to be (inhalation or exhalation) 4. predominant type of dysfunction (pump handle or bucket handle) |
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What are the various findings of ribs 2-10, pump handle predominant, inhalation dysfunction?
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- single or multiple
- ant. end moves cephalad on inhalation - ant. end restricted on exhalation - ant. narrowing of intercostal space above and widening of intercostal space below - superior edge of post. angle is prominent - tenderness at costochondral or costotransverse junction |
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What are the various findings of ribs 2-10 pump handle predominant, exhalation dysfunction?
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- single (usually not multiple)
- ant. end moves caudal on exhalation - ant end restricted on inhalation - ant narrowing of intercostal space below and widening of intercostal space above - superior edge of ant. rib is prominent - tenderness at costochondral or costotransverse junction |
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What are the various findings of ribs 2-10, bucket handle predominant, inhalation dysfunction?
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- usually single rib, sometimes 2
- pain is prominent at mid-axillary line - pain usually deep and aching - rib at mid-axially line is closer to rib above and further apart from rib below - shaft moves upward on inhalation, does not move caudally during exhalation |
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What are the various findings of ribs 2-10, bucket handle predominant, exhalation dysfunction?
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- usually single rib, sometimes 2
- pain is prominent at mid-axillary line - pain is usually deep and aching - rib at mid-axillary line is closer to rib below and further apart from rib above - shaft moves downward on exhalation, does not move cephalically during inhalation |
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What are the various findings of inhalation somatic dysfunction in rib 1?
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- may be elevated compared to opposite side
- palpatory resistance to springing - tenderness to palpation at costotransverse junction - may move superiorly on inhalation - does not move inferiorly on exhalation |
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What are the various findings of exhalation somatic dysfunction in rib 1?
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- may be depressed compared to opposite side
- no resistance to springing - tenderness to palaption at costotransverse junction - may move inferiorly on exhalation - does not move superiorly on inhalation |
