DSA Ribs Flashcards
What does the rib head articulate with?
its own vertebra - superior costal facet
vertebra above - inferior costal facet
What is the neck of the rib?
the area between the head and the tubercle
What does the tubercle articulate with?
articulates with the transverse process of the corresponding vertebra
What is the angle of the rib?
abrupt change in rib curvature
What is the body?
Shaft of the rib
What is the costochondral joint?
cartilage to body of rib
What is the sternochostal joint?
cartilate to sternum
What ribs only articulate with their own vertebrae?
1, 10, 11, 12
What ribs do not have tubercles (and therefore do not articulate with transverse processes)?
11, 12
What ribs are atypical?
1, 2, 11, 12, and sometimes 10
What ribs are typical ribs?
3-9 and sometimes 10
What are the true ribs?
1-7
cartilage attaches to sternum
What are false ribs?
8-12
cartilage attaches to the costal cartilage of the rib above
What are floating ribs?
11-12
no anterior attachment
What are the parts of the sternum?
manubrium
sternal angle - angle of louis - rib 2 costal cartilage
body (gladiolus)
xiphoid process
Anterior scalene
- origin
- insertion*
- innervation
- action*
* = bolded in powerpoint
- anterior tubercles of transverse processes of C3-6
- superior surface of 1st rib*
- cervical spinal nerves C4-6
- Elevates 1st rib*, side bends and rotates neck (unilateral), flexes neck (bilateral)
Middle scalene
- origin
- insertion*
- innervation
- action*
* = bolded in powerpoint
- posterior tubercles of teh transverse processes C2-7
- superior surface of 1st rib*
- cervical spinal nerves C3-8
- elevates 1st rib*, lateral flexion of neck
Posterior scalene
- origin
- insertion*
- innervation
- action*
* = bolded in powerpoint
- posterior tubercles of the transverse processes C5-7
- 2nd rib*
- cervical spinal nerves C6-8
- elevates 2nd rib*, lateral flexion of the neck
Pectoralis minor
- origin*
- insertion
- innervation
- action
* = bolded in powerpoint
- anterior superior surface of ribs 3, 4, 5*
- coracoid process of the scapula
- medial pectoral nerve (C8, T1)
- stabilizes the scapula, drawing it inferiorly and anteriorly
Serratus anterior
- origin
- insertion*
- innervation
- action
* = bolded in powerpoint
- anterior surface of the medial border of the scapula
- superior lateral surface of ribs 2-8*
- long thoracic nerve (C5-7)
- protracts the scapula
Latissimus dorsi
- origin*
- insertion
- innervation
- action
* = bolded in powerpoint
- spinous processes of T7-S3, thoracolumbar fascia, inferior angle of the scapula, lower 4 ribs*, iliac crest
- intertubercular (bicipital) groove of the humerus
- thoracodorsal nerve (C6-8)
- extends, adducts, medially rotates the humerus
Quadratus lumborum
- origin
- insertion*
- innervation
- action*
* = bolded in powerpoint
- iliac crest and iliolumbar ligament
- inferior aspect of rib 12*, transverse processes of L1-4
- T12-L4
- Extends and laterally flexes the vertebral column; flexes the 12th rib in inhalation*
External intercostals
- origin
- insertion
- innervation
- action
- orientation
- circumference
- inferior border of ribs
- superior border of ribs
- intercostal nerves
- elevate ribs during forced inspiration
- like putting hands in the front pockets
- starts from spine around to costal cartilage
Internal intercostals
- origin
- insertion
- innervation
- action
- orientation
- circumference
- inferior border of ribs
- superior border of ribs
- intercostal nerves
- depression of ribs
- like putting hands in back pockets
- starts from rib angle to sternum
Innermost intercostals
- origin
- insertion
- innervation
- action
- orientation
- circumference
- inferior border of ribs
- superior border of ribs
- intercostal nerves
- depression of ribs
- like putting hands in back pockets
- starts from rib angle to costal cartilage
Diaphragm
- origin
- insertion
- innervation
- action
- xiphoid process, lower 6 ribs, L1-3
- central tendon
- C3-5 (phrenic N)
- descends during inspiration
What runs along the costal groove on the inferior side of the rib? Where? (superior to inferior)
vein
artery
nerve
-between the internal intercostal muscle and the innermost intercostal muscle
Describe respiratory motion
Ribs 1-2, 8-10
- move superioly and laterally
- increase transverse diameter
ribs 3-7
- move superiorly and anteriorly
- increase anterior/posterior (A/P) diameter
What are the rib motions?
bucket handle pump handle caliper torsional non-physiologic
What is caliper or pincer motion?
downward and posteriorly with inhalation; upward and anteriorly with exhalation
ribs 11-12
What is subluxation?
incomplete or partial dislocation of a joint or organ
Describe torsional movement
When T5 is rotated to the right on T6
- posterior aspect of the right 6th rib turns externally
- posterior aspect of the left sixth rib turns internally
- anterior extremity of the right sixth rib becomes more flat with its inferior border sharp
- anterior extremity of the left sixth rib having its superior margin accentuated
Describe non-physiologic movement
- due to trauma or repetative micro-trauma
- rib becomes subluxed anteriorly or posteriorly
- create abnormal, hypermobile ribs with the rib being carried more either anteriorly or posteriorly along the axis of motion between the costovertebral and the costotransverse articulations
- one or more ribs lose the usual plasticity and become restricted in a deformed state
What causes torsional movement?
due to the rotation of the thoracic spine
What are respiratory rib dysfunctions?
- inhalation restriction
- exhalation restriction
What are structural rib dysfunctions?
- torsion
- anterior and posterior subluxation
- superior subluxation of the first rib
- anteroposterior compression
- lateral compression
What is inhalation dysfunction?
rib being held in a position of inhalation such that motion toward inhalation is more free and motion toward exhalation is restricted
What is exhalation dysfunction?
rib being held in a position of exhalation such that motion toward exhalation is more free and motion toward inhalation is restricted
What is the key rib?
rib that maintains a group of ribs in dysfunctional motion
-treat this rib FIRST
What is the mnemonic for finding the key rib?
BITE
Bottom Inhalation
-if a group of ribs is found to have Inhalation dysfunction, the Bottom of the group is the key rib
Top Exhalation
-if a group of ribs is found to have Exhalation dysfunction, the Top of the group is the key rib
What is exhalation restriction (inhalation dysfunction)?
- a rib or group of ribs that ceases movement first during exhalation effort
- key rib is bottom
- assessment made as to whether the pump handle or bucket handle component is most restricted
What is inhalation restriction (exhalation dysfunction)?
- rib or group of ribs that ceases movement first during inhalation effort
- key rib at top
- assessment is made as to whether the pump handle or bucket handle component is most restricted
Treatment for exhalation restriction (inhalation dysfunction)
ribs 1-10
-depress key rib with exhalation
ribs 11-12
-quadratus lumborum
Treatment for inhalation restriction (exhalation dysfunction)
rib 1 - ant/med scalene rib 2 - post scalene ribs 3-5 - pectoralis minor ribs 6-8 - serratus anterior ribs 9-10 - latissimus dorsi ribs 11-12 - quadratus lumborum
Causes of rib dysfunction
- thoracic scoliosis or kyphosis
- rib cage asymmetries, such as pectus excavatum or pectus carinatum
- effects of bony diseases such as osteoporosis or osteoarthritis
- increased chest wall diameter associated with illnesses such as COPD
- effects of abnormal tensions in cervical rotator cuff or shoulder girdle muscles
- effects of trauma to rib cage
- effects of lifestyle and affective states such as slumping with depression
