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OPP exam 3 > Respiratory Mechanics of the ribs and diaphragm > Flashcards

Respiratory Mechanics of the ribs and diaphragm Flashcards

1
Q

which rib do you use as a landmark for numbering ribs

A

rib 2

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2
Q

what are the main muscles for inspiration (3)

A

diaphragm
external intercostal
levator costarum

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3
Q

what are the accessory muscles of inspiration

A 
scalenes
sternocleidomastoid 
serratous posterior superior 
lat dorsi
pectoralis
serratous anterior 
quadratus lumborum
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4
Q

what are the main muscles of expiration

A

for quiet respiration the passive recoil of the lungs and diaphragm is what drives this

internal intercostals

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5
Q

what are the main accessory muscles of expiration

A 
Rectus Abdominis
External Oblique
Internal Oblique
Transversus Abdominis
Serratus Post Inferior
Transversus Thoracis
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6
Q

what does the quadratus lumborum do

A

stabilizes the lower ribs so the diaphragm has better motion

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7
Q

how do rib dysfunctions affect SNS tone?

A

find out!

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8
Q

which ribs are pump handle motion

A

1-5

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9
Q

which ribs are bucket handle motion

A

6-10

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10
Q

which ribs are caliper motion

A

11-12

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11
Q

what happens when the diaphragm contracts
what is the function of this and what spaces are changed (dimensions)
what happens to the vena caval opening and the esophageal hiatus

A

When the diaphragm contracts it drops. This Increases the vertical dimensions of the thoracic cavity and decreases pressure which brings in air but also encourages blood and lymph flow.
Also important in micturation and defecation.

The diaphragm essectially moves in two phases. First the central tendon drops down.
Second, it increases the AP and Transverse diameters of the thoracic cage.

Vena caval opening dilates
Esophageal hiatus contracts

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12
Q

what are the main structures that go through the diaphragm and spinal levels

A

Vena Cava at T8
Esophagus at T10
Aorta at T12

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13
Q

what are the attachments of the diaphragm

A

Lower Six Ribs B/L
Xiphoid
Crura: L1-3 Right, L1-2 Left

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14
Q

what are the true ribs

A

1-7

because they attach to the sternum

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15
Q

what are the false ribs

A

8-12

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16
Q

what are the typical ribs

A

3- 9

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17
Q

what are the atypical ribs

A

1,2 10, 11, 12

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18
Q

what makes ribs 3-9 typical ribs

A 
heads
necks
tubercles
angles
shafts
rib head to 2 facets 
vertebra above and below
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19
Q

what makes rib 1 atypical

A

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

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20
Q

what makes rib 2 atypical

A

demifacets with t1 and t2 bodies

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21
Q

what makes rib 10 atypical

A

single facet with T10 body

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22
Q

what makes ribs 11 and 12 atypical

A

no tubercles, tapered ends, single facets with bodies

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23
Q

what are the rib articulations to the spine

A

costotransverse

costovertebral

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24
Q

in pump handle motion what direction do the transverse processes move AND about what axis

A

Transverse processes of upper thoracics extend lateral = a largely transverse axis (the axis also angles slightly posteriorly)

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25
Q

in bucket handle motion what direction do the transverse processes move AND about which axis

A

Transverse processes of lower thoracics angle back posteriorly = a more AP axis is created

more motion in the coronal plane

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26
Q

where is pump handle motion best palpated

A

anteriorly

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27
Q

what diameter is increased with pump handle motion

what type of motion is this AND what happens to the front of the upper ribs on inhalation and exhalation

A

anteroposterior motion that increases A-P diameter

with inhalation the front of the upper ribs go up
exhalation go down

OPPosite in the back !!! so in the back on inhalation they go down and on exhalation they come up

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28
Q

where is bucket handle motion palpated best

A

laterally

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29
Q

what diameter increases with bucket handle motion

A

transverse diameter

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30
Q

what is the caliper motion

which ribs

A

antero-medial
and postero-lateral motion

ribs 11-12

31
Q

what is the sign of inhaled ribs anteriorly and posteriorly

A

up in the front (prominent)
down in the back (divot)

RESISTS exhalation

32
Q

what is the sign of exhaled ribs anteriorly and posteriorly

A

up in the back
down in the front

resists inhalation

33
Q

what is the group effect of inhalation SD

A

holds up ribs above

34
Q

what is the group effect of exhalation SD

A

holds down ribs below

35
Q

what is the pneumonic BITE

A

Bottom inhaled

Top exhaled

36
Q

what is the landmark for rib 1

A

anteriorly at the manubrium

37
Q

what is the landmark for rib 2

A

anteriorly at the sternal angle (aka angle of louis)

38
Q

what is the landmark for rib 3

A

posteriorly with T3 at the spine of the scapula

39
Q

what is the landmark for rib 7

A

Posteriorly with T7 at the inferior angle of the scapula

40
Q

what is the landmark for rib 12

A

superior to the iliac crest

41
Q

what is the landmark for T2 vertebra

A

suprasternal notch

42
Q

what is the landmark for T4 vertebra

A

sternal angle

43
Q

what is the landmark for T9 vertebra

A

Xiphoid process

44
Q

what is the landmark for L3-4 vertebra

A

umbilicus

45
Q

where does drainage of the pleural sac and lung tissues drain to?

A

right lymphatic duct

46
Q

what does increased sympathetic tone cause

A

increased thickening of secretions
vasoconstriction to lung tissue
bronchiole dilation

47
Q

what does impaired lymphatic flow cause

A

tissue congestion BAD

48
Q

what does increased parasympathetic tone cause

A

thinning of secretions
profuse secretions
relative bronchiole constriction

49
Q

when you find motion restriction/somatic Dysfunction of vertebral segments you should….

A

automatically look at the ribs b/c the ribs attach to the vertebral segments at the same level and above

50
Q

where on the ribs are TART changes frequently palpated

A

over rib angles

51
Q

how can you improve objectivity with diagnosing the rib cage

A

placing dominant eye over the patient’s midline while palpating the rib cage

also use peripheral vision

abnormalities are often felt best at the end of deep inhalation or exhalation

52
Q

what direction do the ribs take from the thoracic vertebrae

A

ribs angle inferiorly form the thoracic vertebrae so the costal attachment of each rib is inferior to the rib head

53
Q

where is rib 6 usually located

A

at the level of the inferior border of the sternum

54
Q

how do you know which rib has the somatic dysfunction?

A

the rib that has the greater amount of motion is normal while the one restricted has the SD

55
Q

during inhalation what happens to the sternal angle

A

the sternal angle moves anteriorly and superiorly

56
Q

where does the sympathetic change ganglia rest in relation the rib head

why is this important

A

rests directly anterior to the rib heads

this makes the ribs an important area to treat when addressing sympathetic balance in the entire body

57
Q

what is the proper set up for treating an anterior tenderpoint with counterstrain

A

patient is seated
physicians foot is placed on the table opposite side of the affected rib
patients arm draped over leg

Flexion, sidebending and rotation of torso towards affected side

58
Q

what muscles are involved in the counterstrain treatment of anterior tenderpoint

A

external, internal and innermost intercostals

serratous anterior

59
Q

what is the set up for treating posterior tenderpoint for rib counterstrain

A

patient seated
physicians foot up on table on the same side as the patient’s affected rib
patients arm draped over leg

slight extension, sidebending and rotation of the torso away from the affected rib
(if it is a left tenderpoint then side bend right)

60
Q

what are the muscles involvedin the counterstrain treatment of posterior tenderpoint

A

external, internal and innermost intercostals
lat dorsi
rhomboids

61
Q

where do the rib heads join the vertebral column

A

between the corresponding vertebral segment and the one above

62
Q

where do you check for function of ribs 1 and 2

what is a common diagnosis of these ribs

A

posteriorly

common to find elevated ribs 1 and 2 (exhaled)

63
Q

what is one way to check diagnosis of rib dysfunctions

A

often restricted ribs are very tender along the mid=axillary line

64
Q

what is the treatment for exhaled rib 1 on right
which muscles are used
where do you place your caudal hand

A

muscles–> anterior and middle scalene muscles ipsilaterla

physician stands on the right

place cephalad hand on patient’s right forearm
monitor posterior aspect of rib 2 with caudal hand

have patient hold deep inspiration AND flex their head and neck

65
Q

what is the treatment for exhaled rib 2 on right

what muscles
hand placement

A

muscles–> ipsilateral posterior scalene muscle

turn patient’s head to about 45 degrees opposite side of rib

place cephalad hand on their forearm (that is resting on their forehead)

instruct patient to hold their breath in inhalation and flex their head and neck

66
Q

what is the MET for ribs 3-5 Exhaled
what muscles
hand placement
patient position

A

supine patient
muscles –> ipsilateral pectoralis muscle

contact patient s elbow with cephalad hand

monitor the posterior superior aspect of the rib with caudal hand

ABDUCT the patients right arm until the feather edge of the barrier is engaged

have the patient hold their breath on inhalation and push their elbow toward their hip (try and adduct)

67
Q

what is the MET for ribs 6-10 (exhaled)

what muscles
hand placement
patient position

A

muscles –> serratous anterior muscle

contact the patients forearm with cephalad hand
monitor posterior superior aspect of the rib with caudal hand
instruct patient to hold breath inspiration
instruct patient to adduct their arm

68
Q

what muscle do you use to fix somatic dysfunction of ribs 11-12 (caliper)

A

quadratus lumborum

69
Q

what is the treatment set up (MET) for exhaled rib dysfunctions of ribs 11-12

A

patient prone with their hand reaching over their head to the opposite side of the rib dysfunction (to cause sidebending away from exhaled rib)

with cephalad hand, monitor motion over the posterior-medial aspect of rib 12

with caudal hand contact patients ASIS on the same side as the rib dysfunction

apply posterior pressure to the ASIS (liftin it off the table) AND anterior pressure to the rib

have patient hold their breath in deep inhalation

instruct patient to pull their hip toward the table

70
Q

what is the difference of hand placement for exhaled and inhaled MET for ribs 11-12

A

exhaled dysfunction –> hand is placed more medially the rib over the rib tubercle

inhaled –> hand is placed more laterally over the rib angle

71
Q

what is the MET for ribs 1-5 dysfunctions INHALED

A

used FLEXION and sidebending to the same side

patient supine
stand at the head of the table
monitor anterior aspect of rib with hand on the same side as the dysfuntion

flex patient’s head
sidebend to the same side as rib
instruct patient to hold breath in exhalation
instruct patient to extend their head and neck while providing isometric counterforce

72
Q

what is the MET for ribs 6-10 inhaled dysfunctions

A

use sidebending first
then flexion for fine tuning

patient supine
stand on the same side as rib dysfunction
with caudal hand monitor rib in question (superior and lateral aspect)

sidebend patient neck and shoulder to the same side as rib
slightly flex patient
instruct patient to hold breath in exhalation

instruct patient to return to neutral position (sidebend the other way and extend)

73
Q

what is the difference in use of flexion versus sidebending with ribs 1-5 and 6-10 for inhaled dysfucntiosn

A

for 1-5 use flexion to localize initially and then sidebending to fine-tune and rib engagement
(b/c these ribs use pump handle motion)

for 6-10 use sidebending to localize initially and flexion for fine tuning and rib engagemtn (bc these use bucket handle)

OPP exam 3 (11 decks)

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