Respiratory Cards

Question 1

What are the typical ribs?

Answer 1

3rd-10th ribs

Typical ribs will always have the following

• tubercle
• head
• neck
• angle
• shaft

Question 2

What are the atypical ribs?

Answer 2

1st
- articulates only with T1 and has no angle

2nd
- large tuberosity on the shaft that attaches to the serratus anterior

11th & 12th
- articulate only w/ corresponding vertebra and lack tubercles

sometimes rib 10 is considered atypical since it articulates only T10

Question 3

True ribs

Answer 3

Ribs 1-7

- attach to the actual sternum

Question 4

False ribs

Answer 4

Ribs 8-10

- has anterior articulation and posterior articulation but no costal notches on the sternum

Question 5

Floating ribs

Answer 5

11th /12th

- there is no anterior articulation and only attach to the spinal segments

Question 6

What ribs exhibit a caliper/pincer motion?

Answer 6

Ribs 11 and 12th

Question 7

What is the predominant motion of ribs 1-6?

Answer 7

Pump handle motions
- still has some bucket handle though

note that all ribs 1-10 have both motions, but as you go further up, pump handle motion begins to take predominance

Question 8

What is the predominant motion of ribs 7-10?

Answer 8

Bucket handle motion
- still possess some pump-handle motion

note that all ribs 1-10 have both motions, but as you go further down, bucket handle motion begins to take predominance

Question 9

What is motion of pump handle motions when inhaling and exhaling?

Answer 9

Inhalation

• anterior portion of the rib moves anterior and superior
• posterior angle moves posterior and inferior

Exhalation

• anterior portion of the ribs moves posterior and inferiorly
• posterior angle moves anterior and superior
• motion is in a sagittal plane and costovertebral-transverse line*
• best palpated at mid-clavicle are line*

Question 10

What is motion of bucket handle motions when inhaling and exhaling?

Answer 10

Inhalation

• lateral margin of the rib moves lateral and superior
• increase in transverse diameter

Exhalation

• lateral margin of the ribs moves medial and inferiorly
• decrease in transverse diameter
• motion is in a coronal plane and costovertebral-sternal line*
• best palpated at mid-axillary are line*

Question 11

What is motion of caliper motion ribs when inhaling and exhaling?

Answer 11

Inhalation
- rib moves posteriorly and inferiorly

Exhalation
- rib moves anteriorly and superiorly

• motion is in a transverse plane and cephalad-pedad (vertical) line*
• best palpated at 3-5 cm lateral to transverse process*

Question 12

Accessory muscles of inspiration

Answer 12

SCM

Scalenes

Pectoralis major

Question 13

BITE phrase

Answer 13

Describes where the key rib is in a group of ribs based on the SOMATIC DYSFUNCTION (NOT RESTRICTION)

Bottom
Inhalation

Top
Exhalation

Question 14

What ribs does each scalene help move?

Answer 14

Anterior = rib 1 only

Middle = rib 1 only

Posterior = rib 2 only

Question 15

How do you palapate the anterior ribs 2-6

Answer 15

Palpate the cartilaginous attachments at the costalsternal boarder

• Rib 1= upper portion of the manubrium
• Rib 2= angle of Louis
• Rib 3-6 = attached to the lateral side of the sternum, can feel in the intercostal spaces

make sure to assess static, passive and dynamic motions

Patient is supine w/ physician at head of table
- place hands over ribs 2-6 OR fingertips on ribs 2-6 at parasternal region attachment

Question 16

How do you palapate the anterior ribs 7-11

Answer 16

Identified by the little notches that are created when the cartilage of one rib connects to the rib above

• Rib 7 = 1st notch palpable inferior lateral to diploid process
• Rib 8 = medial 1/3rd way from proximal clavicle (roughly between R7/R9
• Rib 9 = midclavicular line
• Rib 10 = lateral 1/3rd of clavicle
• Rib 11 = free floating with tip at midaxillary line

Patient supine, physician stands at side where dominant eye is midline
- place fingertips on ribs 7-10 w/ little finger on rib 10 and index finger on rib 7

Question 17

What are the direct effects of performing OMT on the thoracic cage?

Answer 17

1) improves breathing mechanics

2) modulation of the sympathetic NS
- both turn on and off

3) decreases pain
4) improves posture

Question 18

Ribs 1 and 2 exhalation somatic dysfunction ME treatment

Answer 18

Uses reciprocal inhibition

• rib 1 engages the anterior and middle scalenes
• rib2 engages the posterior scalene

Physician stands on side opposite of dysfunction

• grapes superior edge of key rib between transverse process and angle w/ fingers
• exert constant anterior pressure w/ caudad hand and lateral traction
• pt face is forward (rib1) and 30 degrees rotated away (rib2), with patients wrist on forehead
• pt takes deep breath in and holds inhalation as they lift head against physcian resistance (3-5 seconds)
• pt exhales and relaxes as physician increases caudad and lateral traction
• repeat 3-5 times