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OPP > Respiratory Mechanics of the Ribs and Diaphragm > Flashcards

Respiratory Mechanics of the Ribs and Diaphragm Flashcards

1
Q

What attaches to the diaphragm?

A

Attachments:
Lower Six Ribs bilaterally
Xiphoid process
Crura: L1-3 Left, L1-2 Right

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2
Q

What are the apertures of the diaphragm? What cord levels do they happen at?

A

Apertures:
Inferior Vena Cava at T8
Esophagus at T10
Aorta at T12

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3
Q

What pumps the most of the bodily fluid volume?

A

Diaphragm + striated muscles of body pump 75% of entire body fluid volume

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4
Q

How does the diaphragm effect venous return to the heart?

A

Increased negative intrathoracic pressure caused by diaphragm contraction promotes venous return to the heart via a “suction” mechanism

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5
Q

What loops around the esophageal hiatus?

A

Crura loops esophageal hiatus = muscle fibers surround esophagus

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6
Q

How is the aorta affected by the diaphragm?

A

Not very much:

Aorta is invested in fascia & is a thick-walled structure

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7
Q

What happens to the diaphragm with inhalation?

A

Contracts into abdomen

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8
Q

What happens to the apertures in the diaphragm with inhalation?

A

Apertures
Vena caval opening dilates - “heart of the venous system”
Esophageal hiatus contracts
Aorta remains unchanged

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9
Q

What happens to the diaphragm with exhalation?

A

Superior pull through passive recoil

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10
Q

What are some SD correlations with the diaphragm?

A

Lung efficacy

Body fluid movement (LYMPHATICS!!!)

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11
Q

What part of the diaphragm cycle ‘helps’ with gastric acid reflux? Why?

A

Inhalation

  • esophageal hiatus contracts, due to being looped by crura
  • prevents gastric acid reflux
  • GERD can possibly be helped by increasing diaphragmatic tone
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12
Q

What innervates the diaphragm? What cord levels?

A

C3, 4, 5: keep the diaphragm alive

phrenic nerves

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13
Q

What distal SD can affect diaphragmatic tone?

A

SD of cervical spine, especially at levels C3, C4, and C5

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14
Q

What is the lowest rib you’re likely to palpate?

A

rib 10

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15
Q

What should you look for as a superior landmark for rib palpation?

A

Angle of Louis - rib 2

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16
Q

What is close to the rib heads?

A

SNS ganglion chain - VERY important

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17
Q

What can affect sympathetic tone?

A

rib dysfunctions

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18
Q

What can affect sympathetic input to the viscera?

A

Treating rib SD

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19
Q

Where does the rib neurovascular bundle travel?

A

Rib neurovascular bundle travels in an inferior groove (V-A-N superior-to-inferior)

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20
Q

Could placement of a chest tube cause dysfunction? Where?

A

Yes, by affecting intercostals

Chest tubes are inserted just over the superior aspect of a rib
4th or 5th ICS @ either the anterior axillary or mid-axillary line
Aka between ribs 4-5 or 5-6

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21
Q

What is the structure of a typical rib?

A

Structure:
Round, knob-like rib head followed by neck & tubercle

A body that arcs @ rib angle & is thin/flat making internal/external surfaces

Distal concavity where cartilage attaches

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22
Q

What are the rib head facets? What vertebrae does it articulate with, generally?

A

2 facets for articulation w/ body of next superior vertebral body & same number vertebrae

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23
Q

What are the costotransverse articulations of the ribs? What do the articulate with?

A

Costotransverse Articulations

Each tubercle articulates w/ transverse process of same # vertebrae via a facet

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24
Q

What are the typical ribs? What numbers are they? How many facets do the rib head attach to?

A

Typical: #3-9
Similar in structure
Each rib head to 2 facets
Costotransverse articulation

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25
What are the atypical ribs? What numbers are they?
Atypical: #1, 2, 10, 11, 12
26
Describe rib 1. How many articulations does it have?
#1 – most curved, flat, no angle or groove, single facet with vertebral body
27
Describe rib 2. What kind of facets does it have? What is its structure like?
#2 – demifacets with T1 & T2 bodies, structure similar to #1
28
Describe rib 10. What kind of facet does it have?
#10 – single facet with T10 body
29
Describe ribs 11 and 12. What kind of articulations and facets do they have?
#11 & 12 – no tubercles, tapered ends, single facets w/ bodies (no costotransverse articulatios)
30
What are the true ribs? What do they attach to?
True: #1-7 | Attaches to sternum directly
31
What are the false ribs? What do they attach to?
False: #8-10 | Cartilage unites w/ that of rib 7 to attach to the sternum
32
What are the floating ribs? What do they attach to?
Floating: #11-12 Lack cartilage Float freely w/ muscle fibers
33
How does nomenclature for typical and atypical ribs differ from true/false/floating ribs?
Typical/atypical describes morphology of ribs | True/false/floating describes how ribs attach distally
34
What determines the major axis of the rib?
Note how there is an angle formed by the vertebral body & TP that the rib will follow This angle determines the major axis
35
What determines the major motion of the respective rib?
Major axis motion for a given rib is determined by the orientation of the axis which passes through the costovertebral joint and the costotransverse joint
36
What are the respiratory motions of the ribs?
Respiratory Motions of the Ribs Pump Handle: Ribs 1-5 Bucket Handle: Ribs 6-10 Caliper: Ribs 11 & 12
37
Explain the movements of ribs 1-5. What kind of axis do they create?
Pump Handle: Ribs 1-5 Transverse processes extend laterally Creates more of a TRANSVERSE AXIS
38
Explain the movements of ribs 6-10. What kind of axis do they create?
Bucket Handle: Ribs 6-10 Transverse processes angle back (posteriorly) Creates more of an AP AXIS
39
What do the rib head tubercles do in pump handle ribs?
Rib heads tubercles “roll” in costotransverse facets
40
What is the 'pump handle' for the pump handle ribs? Where is it palpated?
Sternum = “pump handle” | Palpated best anterior
41
What happens to pump handle ribs with inhalation?
Inhalation Increase in AP diameter Fronts rise superior & anterior Backs fall inferior & “posterior”
42
What happens to pump handle ribs with exhalation?
Decrease in AP diameter Fronts fall inferior & posterior Backs rise superior & anterior
43
Where are bucket handle ribs best palpated?
Laterally - as rib body forms 'bucket handle'
44
What happens to the rib head tubercles in bucket handle ribs?
Rib heads tubercles “roll” in costotransverse facets More severe angle changes the motion!!!
45
What happens to bucket handle ribs in inhalation?
Inhalation Increase in transverse diameter Lateral edges rise
46
What happens to bucket handle ribs in exhalation?
Exhalation Decrease in transverse diameter Lateral edges fall
47
What are the motions of the caliper ribs?
Motion: anterio-medial (exhalation) & posterio-lateral (inhalation)
48
What is the axis of the caliper ribs? What plane do the movements happen in?
Axis: mostly vertical  movement in the horizontal plane
49
How are the articulations different for the caliper ribs?
No costotransverse articulations limiting motion | TP are not large enough to provide articulations
50
How do the motions of the ribs actually change as you proceed down the spinal column?
As the articulations progressively change down the vertebral column, mixtures of motions can be seen in the ribs as a progression of pump handle - bucket handle -caliper action This is real life, for testing purposes go with the MAIN MOTION as specified before
51
How is SD named for the ribs?
Somatic Dysfunction: named for direction of ease | Inhaled vs Exhaled
52
What is the BITE mnemonic?
``` BITE Mnemonic (used to aid treatment) B – Bottom I – Inhaled T – Top E – Exhaled ```
53
How do you treat the muscles of respiration?
MET | Counterstrain
54
Describe inhaled dysfunction. Where are the ribs stuck?
Inhaled Dysfunction Prominent anteriorly Divot posterior Resists exhalation  holds up ribs above
55
Describe exhaled dysfunction. Where are the ribs stuck?
Exhaled Dysfunction Prominent posteriorly Divot anteriorly Resists inhalation  holds up ribs below
56
What are the major muscles of inspiration?
Major Diaphragm Ext. Intercostals Levator costarum - more of a stabilizer
57
What are the accessory muscles of inspiration?
``` Accessory Scalenes SCM Pectoralis Latissimus Dorsi Serratus Anterior Serratus Post. Sup. QL - stabilizes lower ribs so diaphragm has better motion ```
58
What are the major muscles of expiration?
Major Passive Recoil Int. Intercostals
59
What are the accessory muscles of expiration?
``` Accessory Transversus thoracis Rectus abdominis Internal oblique Transversus abdominis Serratus Post. Inf. ``` Abdominal mm contraction induces exhalation by multiple mechanisms
60
What are the attachments for scalenes and sternocleidomastoid?
Scalenes Anterior & Medial = to rib 1 Posterior = to rib 2 SCM Attachments to sternum & clavicle
61
What is origin and insertion of pectoralis minor?
Pec Minor Coracoid process of scapula Ribs 3-5
62
What is tripoding? What is it a sign of? What is thought to do?
“Tripoding” Def: position of leaning forward & supporting the upper body w/ hands on knees or another surface Sign of respiratory distress Often seen w/ COPD exacerbations & sprint running Thought to optimize mechanics of respiration by taking advantage of the accessory muscles of the neck & chest (esp. pec minor, scalenes, & SCM) Important in Tx of S/D for COPD pts (MET/CS)
63
What is the origin and insertion of the serratus anterior?
Medial margin of scapula | Ribs 1-8 or 9
64
How does the action of the serratus anterior contribute to breathing?
Anchors scapula, but can become fulcrum for breathing “pt’s grabbing sides of bed to breathe easier”
65
Where does serratus posterior superior insert? Serratus posterior inferior?
Superior: ribs 2-5 Inferior: ribs 9-12
66
Where does transversus thoracis insert?
internal surface on anterior aspect of chest wall ribs 2-6
67
Where is the origin and insertion for the quadratus lumborum?
Origin: Post. Iliac Crest Iliolumbar ligament Insertion: Rib 12 TP of L1-4
68
What is the action of the quadratus lumborum?
Action Fixation of rib 12 during respiration Lateral flexion (side-bending) of the trunk "take my breath away"

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