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OMM M1T3E5 > Biomechanics - Costal > Flashcards

Biomechanics - Costal Flashcards

1
Q

List atypical ribs

A

Ribs 1 & 2

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2
Q

List true ribs.

A

Ribs 1-7

-attach to sternum

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3
Q

List false ribs.

A

Ribs 8-12

-don’t attach to sternum

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4
Q

List floating ribs.

A

Ribs 11 & 12

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5
Q

What movements do costovertebral joints allow for?

A

gliding rotary motion

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6
Q

What movements do costotransverse joints allow for?

A

gliding arcuate motion

most ribs have

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7
Q

Where is the axis of motion for ribs?

A

through the neck of the rib

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8
Q

What is rib motion influences by?

A

position and mobility of the of the thoracic vertebra due to ligamentous attachments

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9
Q

What does thoracic segmental dysfunction alter?

A

the mechanics of the attached ribs

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10
Q

With a rib and thoracic dysfunction, which area do you treat first?

A

thoracic

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11
Q

What are the 3 types of rib motion?

A
  • Bucket handle
  • pump handle
  • caliper motion
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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)
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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
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14
Q

How is the pump handle motion used in lymphatics and venous system?

A

powerful lymphatic and venous pump

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15
Q

How does the sternum move with inhalation?

A

Rises and moves forward

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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)

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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
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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

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19
Q

How can cervical sidebending affect rib 1?

A

can elevate rib 1 when there is tension in the neck

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20
Q

What are the normal mechanics for Rib 1?

A
  • pump handle motion predominates
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21
Q

What is an inhaled rib?

A

held in inhalation, restricted in exhalation

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22
Q

What can cause inhalation of a rib?

A
  • hypertonic scalene muscles (anterior and middle)
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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)
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24
Q

What is an exhaled rib?

A

held in exhalation, restricted in inhalation

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25
Q

What can cause exhalation of a rib?

A

hypertonic serratus anterior muscle

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26
Q

What are symptoms of an exhaled rib?

A
  • tenderness at costochondral junction anteriorly
  • ulnar distribution of pain and paresthesias
  • arm muscle claudication due to subclavian artery compression
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27
Q

What kind of dysfunction can exhaled ribs create?

A
  • create sidebent and rotated dysfunction to side of dysfunctional rib
  • create flexed OA dysfunction, sidebent to side of dysfunctional rib
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28
Q

Describe Rib 2.

A
  • 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
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29
Q

What mechanics predominate with rib 2?

A

pump handle

very little bucket handle motion

30
Q

What would hold rib 2 in inhalation?

A

hypertonic Posterior Scalene Muscle

31
Q

What is the symptom of a rib 2 dysfunction held in inhalation?

A

tenderness over the angle of rib posteriorly

32
Q

What would hold rib 2 in exhalation?

A

hypertonic serratus anterior muscle

33
Q

What are the symptoms of a rib 2 dysfunction held in exhalation?

A
  • tenderness at the costochondral junction anteriorly

- neck pain and stiffness from passive traction on posterior scalene muscle

34
Q

Describe ribs 3 - 7

A
  • 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
Q

Where does costochondritis hurt?

A

costocondral junction

if they hurt at costosternal junction, it is not costochondritis

36
Q

How do the serratus anterior muscles pull on the ribs?

A

upward; due to scapular attachment

37
Q

How do you know if you have a pec minor problem?

A

pain past the costochondral junction

38
Q

What mechanics predominates in ribs 3-7?

A

pump handle motion predominates at superior ribs

- progressive increase in bucket handle motion as you descend to rib 7

39
Q

What can hold ribs 3 -5 in inhalation?

A

hypertonic pectoralis minor muscles

40
Q

What can hold ribs 3 - 7 in inhalation?

A

hypertonic iliocostalis thoracis muscles

41
Q

What are the symptoms for inhaled dysfunction in ribs 3-7?

A
  • tenderness at the angle of the rib posteriorly

- reduced thoracic sidebending due to hypertonic iliocostalis thoracis muscles

42
Q

What can hold ribs 3 - 7 in exhalation?

A

hypertonic iliocostalis cervicis muscles

43
Q

What are the symptoms for exhaled dysfunction in ribs 3 - 7?

A
  • tenderness at costochondral junction anteriorly
  • restricted cervical sidebending contralaterally due to hypertonicity of iliocostalis cervicis muscles
    (can impact cervical sidebending)
44
Q

Describe ribs 8 - 10

A
  • 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
Q

What can cause respiratory compromise?

A
  • lumbar attachment of crura
46
Q

What nerve is the diaphragm under the influence of?

A 
phrenic Nerve (Sensory and Motor)
-from C3, 4, 5
47
Q

What can cause referred pain from the superior or inferior surface of the diaphragm?

A
  • 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
Q

What mechanics predominate ribs 8 - 10?

A
  • bucket handle motion (expand laterally)

- little pump handle motion

49
Q

What can hold ribs 8 - 10 in inhalation?

A
  • hypertonic serratus anterior muscles

- hypertonic iliocostalis lumborum muscles

50
Q

What symptoms are present with an inhalation dysfunction of ribs 8 - 10?

A
  • rib angle tenderness posteriorly

- restricted lumbar sidebending from hypertonic iliocostalis lumborum muscles

51
Q

What symptoms are present with an exhalation dysfunction of ribs 8 - 10?

A
  • tenderness over costochondral junctions anterolaterally
52
Q

Describe 11 & 12.

A
  • atypical ribs
  • floating ribs
  • no sternal attachment
  • no costotransverse articulation
  • attached to respiratory diaphragm
  • attached to quadratus lumborum (hypertonic - pulls ribs down)
53
Q

What influences ribs 11 & 12 the most?

A

low back injuries

54
Q

What is the normal motion of ribs 11 & 12?

A

caliper motion

55
Q

Inhalation pulls ribs 11 & 12 in what direction?

A

downward & posteriorly

quadratus lumborum anchors the ribs for more effective diaphragmatic contraction

56
Q

Exhalation pulls ribs 11 & 12 in what direction?

A

upward & anteriorly

57
Q

Inhaled ribs 11 & 12 are stuck in what direction? caused by?

A
  • down

- pull of quadratus lumborum overpowers the pull of the diaphragm

58
Q

What are the symptoms for inhaled ribs 11 & 12?

A
  • tenderness over the angle of the rib posteriorly

- low back pain ***

59
Q

What can cause exhaled ribs in 11 & 12?

A
  • often traumatic in origin

- MVA

60
Q

What are the symptoms for exhaled ribs 11 & 12?

A
  • tenderness over tip of rib laterally

- flank pain

61
Q

What is anterior sublaxation?

A
  • 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
Q

What is posterior rib sublaxation?

A
  • whole rib moved posteriorly
  • increased posterior prominence
  • can cause rotation of thoracic vertebrae
  • depression anteriorly
  • usually exhaled dysfunction
  • anterior tenderpoint
63
Q

What is rib torsion?

A
  • twist in rib itself
  • superior border of rib is more prominent
  • wider intercostal space above and narrower intercostal space below
64
Q

What is anteroposterior compression?

A
  • 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
Q

What is lateral compression?

A
  • 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
Q

What is laterally flexed rib?

A
  • 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
Q

What neural influences are seen in the ribs?

A

Intercostal nerves - 3 cutaneous branches anteriorly, posteriorly, & laterally

68
Q

Where can cause neuritis?

A

generated by severe or longstanding rib dysfunction

  • generated by herpes zoster
  • generated by thoracic dysfunction
69
Q

Where are 3 sites of tenderness ?

A
  • lateral to spinous process
  • mid-axillary line
  • next to sternum
70
Q

How does the sympathetic chain ganglia interact with the ribs?

A
  • 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
Q

What can happen to the sympathetic chain ganglia with rib dysfunction?

A
  • can get mechanical distortion or irritation with rib distortion
  • rami communicantes
  • blood supply can be compressed
  • autonomic responses (upset stomach, irritable bowel, asthma attack)

OMM M1T3E5 (4 decks)

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