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OPP > Respiratory Mechanics of the Ribs and Diaphragm > Flashcards

Respiratory Mechanics of the Ribs and Diaphragm Flashcards

1
Q

What attaches to the diaphragm?

A

Attachments:
Lower Six Ribs bilaterally
Xiphoid process
Crura: L1-3 Left, L1-2 Right

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2
Q

What are the apertures of the diaphragm? What cord levels do they happen at?

A

Apertures:
Inferior Vena Cava at T8
Esophagus at T10
Aorta at T12

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3
Q

What pumps the most of the bodily fluid volume?

A

Diaphragm + striated muscles of body pump 75% of entire body fluid volume

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4
Q

How does the diaphragm effect venous return to the heart?

A

Increased negative intrathoracic pressure caused by diaphragm contraction promotes venous return to the heart via a “suction” mechanism

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5
Q

What loops around the esophageal hiatus?

A

Crura loops esophageal hiatus = muscle fibers surround esophagus

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6
Q

How is the aorta affected by the diaphragm?

A

Not very much:

Aorta is invested in fascia & is a thick-walled structure

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7
Q

What happens to the diaphragm with inhalation?

A

Contracts into abdomen

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8
Q

What happens to the apertures in the diaphragm with inhalation?

A

Apertures
Vena caval opening dilates - “heart of the venous system”
Esophageal hiatus contracts
Aorta remains unchanged

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9
Q

What happens to the diaphragm with exhalation?

A

Superior pull through passive recoil

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10
Q

What are some SD correlations with the diaphragm?

A

Lung efficacy

Body fluid movement (LYMPHATICS!!!)

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11
Q

What part of the diaphragm cycle ‘helps’ with gastric acid reflux? Why?

A

Inhalation

  • esophageal hiatus contracts, due to being looped by crura
  • prevents gastric acid reflux
  • GERD can possibly be helped by increasing diaphragmatic tone
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12
Q

What innervates the diaphragm? What cord levels?

A

C3, 4, 5: keep the diaphragm alive

phrenic nerves

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13
Q

What distal SD can affect diaphragmatic tone?

A

SD of cervical spine, especially at levels C3, C4, and C5

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14
Q

What is the lowest rib you’re likely to palpate?

A

rib 10

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15
Q

What should you look for as a superior landmark for rib palpation?

A

Angle of Louis - rib 2

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16
Q

What is close to the rib heads?

A

SNS ganglion chain - VERY important

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17
Q

What can affect sympathetic tone?

A

rib dysfunctions

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18
Q

What can affect sympathetic input to the viscera?

A

Treating rib SD

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19
Q

Where does the rib neurovascular bundle travel?

A

Rib neurovascular bundle travels in an inferior groove (V-A-N superior-to-inferior)

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20
Q

Could placement of a chest tube cause dysfunction? Where?

A

Yes, by affecting intercostals

Chest tubes are inserted just over the superior aspect of a rib
4th or 5th ICS @ either the anterior axillary or mid-axillary line
Aka between ribs 4-5 or 5-6

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21
Q

What is the structure of a typical rib?

A

Structure:
Round, knob-like rib head followed by neck & tubercle

A body that arcs @ rib angle & is thin/flat making internal/external surfaces

Distal concavity where cartilage attaches

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22
Q

What are the rib head facets? What vertebrae does it articulate with, generally?

A

2 facets for articulation w/ body of next superior vertebral body & same number vertebrae

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23
Q

What are the costotransverse articulations of the ribs? What do the articulate with?

A

Costotransverse Articulations

Each tubercle articulates w/ transverse process of same # vertebrae via a facet

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24
Q

What are the typical ribs? What numbers are they? How many facets do the rib head attach to?

A

Typical: #3-9
Similar in structure
Each rib head to 2 facets
Costotransverse articulation

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25
Q

What are the atypical ribs? What numbers are they?

A

Atypical: #1, 2, 10, 11, 12

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26
Q

Describe rib 1. How many articulations does it have?

A

1 – most curved, flat, no angle or groove, single facet with vertebral body

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27
Q

Describe rib 2. What kind of facets does it have? What is its structure like?

A

2 – demifacets with T1 & T2 bodies, structure similar to #1

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28
Q

Describe rib 10. What kind of facet does it have?

A

10 – single facet with T10 body

29
Q

Describe ribs 11 and 12. What kind of articulations and facets do they have?

A

11 & 12 – no tubercles, tapered ends, single facets w/ bodies (no costotransverse articulatios)

30
Q

What are the true ribs? What do they attach to?

A

True: #1-7

Attaches to sternum directly

31
Q

What are the false ribs? What do they attach to?

A

False: #8-10

Cartilage unites w/ that of rib 7 to attach to the sternum

32
Q

What are the floating ribs? What do they attach to?

A

Floating: #11-12
Lack cartilage
Float freely w/ muscle fibers

33
Q

How does nomenclature for typical and atypical ribs differ from true/false/floating ribs?

A

Typical/atypical describes morphology of ribs

True/false/floating describes how ribs attach distally

34
Q

What determines the major axis of the rib?

A

Note how there is an angle formed by the vertebral body & TP that the rib will follow

This angle determines the major axis

35
Q

What determines the major motion of the respective rib?

A

Major axis

motion for a given rib is determined by the orientation of the axis which passes through the costovertebral joint and the costotransverse joint

36
Q

What are the respiratory motions of the ribs?

A

Respiratory Motions of the Ribs
Pump Handle: Ribs 1-5
Bucket Handle: Ribs 6-10
Caliper: Ribs 11 & 12

37
Q

Explain the movements of ribs 1-5. What kind of axis do they create?

A

Pump Handle: Ribs 1-5
Transverse processes extend laterally
Creates more of a TRANSVERSE AXIS

38
Q

Explain the movements of ribs 6-10. What kind of axis do they create?

A

Bucket Handle: Ribs 6-10
Transverse processes angle back (posteriorly)
Creates more of an AP AXIS

39
Q

What do the rib head tubercles do in pump handle ribs?

A

Rib heads tubercles “roll” in costotransverse facets

40
Q

What is the ‘pump handle’ for the pump handle ribs? Where is it palpated?

A

Sternum = “pump handle”

Palpated best anterior

41
Q

What happens to pump handle ribs with inhalation?

A

Inhalation
Increase in AP diameter
Fronts rise superior & anterior
Backs fall inferior & “posterior”

42
Q

What happens to pump handle ribs with exhalation?

A

Decrease in AP diameter
Fronts fall inferior & posterior
Backs rise superior & anterior

43
Q

Where are bucket handle ribs best palpated?

A

Laterally - as rib body forms ‘bucket handle’

44
Q

What happens to the rib head tubercles in bucket handle ribs?

A

Rib heads tubercles “roll” in costotransverse facets

More severe angle changes the motion!!!

45
Q

What happens to bucket handle ribs in inhalation?

A

Inhalation
Increase in transverse diameter
Lateral edges rise

46
Q

What happens to bucket handle ribs in exhalation?

A

Exhalation
Decrease in transverse diameter
Lateral edges fall

47
Q

What are the motions of the caliper ribs?

A

Motion: anterio-medial (exhalation) & posterio-lateral (inhalation)

48
Q

What is the axis of the caliper ribs? What plane do the movements happen in?

A

Axis: mostly vertical  movement in the horizontal plane

49
Q

How are the articulations different for the caliper ribs?

A

No costotransverse articulations limiting motion

TP are not large enough to provide articulations

50
Q

How do the motions of the ribs actually change as you proceed down the spinal column?

A

As the articulations progressively change down the vertebral column, mixtures of motions can be seen in the ribs as a progression of pump handle - bucket handle -caliper action

This is real life, for testing purposes go with the MAIN MOTION as specified before

51
Q

How is SD named for the ribs?

A

Somatic Dysfunction: named for direction of ease

Inhaled vs Exhaled

52
Q

What is the BITE mnemonic?

A 
BITE Mnemonic (used to aid treatment)
B – Bottom
I – Inhaled
T – Top
E – Exhaled
53
Q

How do you treat the muscles of respiration?

A

MET

Counterstrain

54
Q

Describe inhaled dysfunction. Where are the ribs stuck?

A

Inhaled Dysfunction
Prominent anteriorly
Divot posterior
Resists exhalation  holds up ribs above

55
Q

Describe exhaled dysfunction. Where are the ribs stuck?

A

Exhaled Dysfunction
Prominent posteriorly
Divot anteriorly
Resists inhalation  holds up ribs below

56
Q

What are the major muscles of inspiration?

A

Major
Diaphragm
Ext. Intercostals
Levator costarum - more of a stabilizer

57
Q

What are the accessory muscles of inspiration?

A 
Accessory
Scalenes
SCM
Pectoralis
Latissimus Dorsi
Serratus Anterior
Serratus Post. Sup.
QL - stabilizes lower ribs so diaphragm has better motion
58
Q

What are the major muscles of expiration?

A

Major
Passive Recoil
Int. Intercostals

59
Q

What are the accessory muscles of expiration?

A 
Accessory
Transversus thoracis
Rectus abdominis
Internal oblique
Transversus abdominis
Serratus Post. Inf.

Abdominal mm contraction induces exhalation by multiple mechanisms

60
Q

What are the attachments for scalenes and sternocleidomastoid?

A

Scalenes
Anterior & Medial = to rib 1
Posterior = to rib 2

SCM
Attachments to sternum & clavicle

61
Q

What is origin and insertion of pectoralis minor?

A

Pec Minor
Coracoid process of scapula
Ribs 3-5

62
Q

What is tripoding? What is it a sign of? What is thought to do?

A

“Tripoding”
Def: position of leaning forward & supporting the upper body w/ hands on knees or another surface

Sign of respiratory distress
Often seen w/ COPD exacerbations & sprint running

Thought to optimize mechanics of respiration by taking advantage of the accessory muscles of the neck & chest (esp. pec minor, scalenes, & SCM)
Important in Tx of S/D for COPD pts (MET/CS)

63
Q

What is the origin and insertion of the serratus anterior?

A

Medial margin of scapula

Ribs 1-8 or 9

64
Q

How does the action of the serratus anterior contribute to breathing?

A

Anchors scapula, but can become fulcrum for breathing

“pt’s grabbing sides of bed to breathe easier”

65
Q

Where does serratus posterior superior insert? Serratus posterior inferior?

A

Superior: ribs 2-5
Inferior: ribs 9-12

66
Q

Where does transversus thoracis insert?

A

internal surface on anterior aspect of chest wall

ribs 2-6

67
Q

Where is the origin and insertion for the quadratus lumborum?

A

Origin:
Post. Iliac Crest
Iliolumbar ligament

Insertion:
Rib 12
TP of L1-4

68
Q

What is the action of the quadratus lumborum?

A

Action
Fixation of rib 12 during respiration
Lateral flexion (side-bending) of the trunk

“take my breath away”

OPP (5 decks)

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