DSA 2: Ribs

Question 1

What does the head of the rib articulate with?

Answer 1

The inferior costal facet of the vertebra above and the superior costal facet of its own vertebra

(Only ribs 2-9)

Question 2

What does the tubercle of the rib articulate with?

Answer 2

The transverse process of the corresponding vertebra

(Only ribs 1-10)

Question 3

Which ribs only articulate with their own vertebra and not the one above?

Answer 3

Ribs 1, 10, 11, 12

Question 4

Which ribs do not have tubercles and cannot articulate with transverse processes of the corresponding vertebrae?

Answer 4

Ribs 11, 12

Question 5

Which ribs are atypical?

Answer 5

Ribs 1, 2, (maybe 10), 11, and 12

Question 6

Which ribs are typical?

Answer 6

Ribs 3-9

Question 7

Which ribs are true ribs?

Answer 7

Ribs 1-7

Question 8

Which ribs are false ribs?

Answer 8

Ribs 8-12

Question 9

What are the floating ribs?

Answer 9

Ribs 11-12

Question 10

What muscles insert onto the first rib and are responsible for elevating it?

Answer 10

Anterior Scalene

Middle Scalene

Question 11

What muscle inserts onto the second rib and elevates it?

Answer 11

Posterior scalene

Question 12

What is the action of the serratus anterior m.?

Answer 12

Protracts the scapula

Question 13

What is the action of the Quadratus Lumborum M.?

Answer 13

Fixes the 12th rib in inhalation

Extends and laterally flexes the vertebral column

Question 14

What is the origin and insertion of the thoracic diaphragm?

Answer 14

Xiphoid process, lower 6 ribs, L1-3 to the Central tendon of the diaphragm

Question 15

Where are the intercostal vessels found and how are they oriented?

Answer 15

Located between internal and innermost intercostal ms. in VAN orientation (sup to inf)

Question 16

Which ribs have bucket handle motion? How do they move?

Answer 16

Ribs 1-2, 8-10

Superiorly and laterally (increases horizontal/transverse diameter)

Question 17

Which ribs have pump handle motion? How do they move?

Answer 17

Ribs 3-7

Superiorly and anteriorly (increases the A/P diameter)

Question 18

What motion is performed by Ribs 11-12 during respiration?

Answer 18

Caliper

Inhalation - down and posterior

Exhalation - up and anterior

Question 19

What are the 5 motions of the ribs?

Answer 19

Bucket Handle

Pump Handle

Caliper

Torsional

Non-physiologic

Question 20

What occurs during torsional movement of the ribs?

Answer 20

Vertebrae of the rib turns towards one side, causing the anterior portion of that rib to move back and twist upwards (inferior border up) and the opposite rib to move front and twist downwards (superior border up). Side the rib cage rotates toward shrinks = less air in

Example: If T5 is rotated to the left, left R5 moves back and twists upward and right R5 moves front and twists downward

Question 21

What causes non-physiologic motion of the ribs?

Answer 21

Trauma/repetitive microtrauma

Rib becomes subluxed anterior/posterior or laterally compressed

Question 22

Describe an inhalation dysfunction

Describe an exhalation dysfunction

Answer 22

• Rib stuck upward during exhalation
• Rib stuck downward during inhalation

Question 23

What is respiratory vs structural SD?

Answer 23

Respiratory: Inhalation/Exhalation SDs ribs is unable to move in normal physiologic motion (whether it’s bucket handle, pump or caliper)

Structural: torsional and non-physiological SDs

Question 24

What does the BITE mnemonic mean?

Answer 24

BI: Treat bottom rib if inhalation SD (bottom rib preventing the other ribs from going downward_

TE: Treat top rib if exhalation SD (top rib preventing the other ribs from going upward)

Question 25

Typical causes of rib dysfunction (There’s a lot)

Answer 25

Thoracic scoliosis/kyphosis

Rib cage asymmetry (pectus excavatum/carinatum)

Osteoporosis/osteoarthritis

Increased chest wall diameter associated with illness such as COPD

Abnormal tension in cervical, rotator cuff, or shoulder girdle musculature

Lifestyle (slumping and depression)