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OPP Respiratory Block > Rib Diagnosis > Flashcards

Rib Diagnosis Flashcards

1
Q

What are the typical ribs ??

A

Ribs 3-10

Typical ribs have all of the following

  • tubercle
  • head
  • neck
  • angle
  • shaft
  • articulate with the sternum
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2
Q

What ribs are atypical?

A

1st
2nd
11th and 12th
sometimes rib 10 since it only articulates with T10

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3
Q

Why is rib 1 atypical?

A

Articulates with only T1 and has no angle

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4
Q

Why is rib 2 atypical?

A

Possess a large tuberosity on the shaft for attachment of serrates anterior

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5
Q

Why are ribs 11 and 12th atypical?

A

Articulate only with T11 and T12 respectively and lack tubercles

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6
Q

Which ribs are true

A

1-7

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7
Q

Which ribs are false?

A

8-10

technically 11 and 12 also but they are defined as floating ribs

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8
Q

What ribs have vertebrosternal attachments?

A

1-7

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9
Q

What ribs have vertebrochondral attachments

A

8-10

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10
Q

Where is the cervical pleura located with respect to the ribs?

A

Above rib 1

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11
Q

Where does the diaphragmatic cartilage begin with respect to the ribs?

A

6th-11/12th

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12
Q

Physiological/respiratory motion of the ribs

A

All ribs 1-10 exhibit both pump-handle AND bucket-handle motion

  • Ribs 1-6 primary = pump handle (superior/anterior -inferior/posterior)
  • ribs 7-10 primary = bucket handle (superior/medial - interior/lateral)

Ribs 11-12 exhibit caliper/pincer motions

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13
Q

Pump-handle motion specifics

A

predominant motion of ribs 1-6

Inhalation:

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

Exhalation

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

1) best palpated at the mid-claviicular level
2) plane of motion is in the sagittal plane
3) axis of motion is in the costovertebral-costtransverse line

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14
Q

Bucket handle motion specifics

A

predominant motion of ribs 7-10

Inhalation:

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

Exhalation

  • lateral margin of the rib moves inferior/lateral
  • decrease in transverse diameter

1) best palpated at the mid-axillary level
2) plane of motion is in the coronal plane
3) axis of motion is in the costovertebral-costosternal line

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15
Q

Caliper motion specifics

A

predominant movement for ribs 11-12

Inhalation:
- ribs move posterior/inferior

Exhalation
- ribs move anterior/superior

1) best palpated 3-5 cm lateral to the transverse process
2) plane of motion = transverse
3) axis of motion = vertical (cephalad-pedad )

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16
Q

Quiet breathing muscles

A

Diaphragm

External and internal intercostals

Rectus abdominis

External and internal obliques

During inspiration:

1) external intercostal = tonic contraction
2) internal intercostal = resists negative pressure

During expiration:

1) abdominis = tonic contraction
2) external and internal obliques = tonic contraction and maintain intra-abdominal pressures

17
Q

Forced breathing muscles

A

SCM
- elevates sternum

Trapezius

Pectoralis minor

Scalenes
- elevates upper ribs

Rectus abdominis

Serratus posterior

Levatores costarum

External and internal obliques

Quadratics lumborum
- pulls ribs down during expiration

Internal intercostals
- pulls down on ribs during expiration

External intercostals
- elevates ribs during inspiration

During inspiration:
1) SCM/trapezius/pectoralis minor/scalenes = elevates the rib cage

During expiration:

1) abdominis = tonic contraction
2) external and internal obliques = tonic contraction and maintain intra-abdominal pressures

18
Q

Prime muscles in both inhalation and exhalation

A

Inhalation

  • diaphragm
  • intercostal muscles
  • scalenes

Exhalation

  • intercostal muscles
  • abdominal muscles
  • quadrates lumborum
  • note diaphragm is not prime mover in exhalation technically since it just relaxes
19
Q

Inhalation somatic dysfunctions

A

TREAT BOTTOM RIB AND GO UP

Pump handle inhalation rib dysfunctions:

1) anterior portion of dysfunctional rib will stay anterior and not move inferior when patient exhales
2) posterior rib angle moves easier in posterior direction
3) AP diameter of rib cage at level of dysfunction is larger

Bucket handle inhalation rib:

1) lateral portion of dysfunctional rib will not move inferiormedial during exhalation (stays superiorlateral)
2) transverse diameter of the rib cage at the level of dysfunction is larger

20
Q

Exhalation somatic dysfunctions

A

TREAT TOP FIRST AND MOVE DOWN

Pump handle exhalation rib dysfunctions:

1) anterior portion of dysfunctional rib will stay posterior and not move superior when patient inhales
2) posterior rib angle moves easier in anterior direction
3) AP diameter of rib cage at level of dysfunction is smaller

Bucket handle exhalation rib:

1) lateral portion of dysfunctional rib will not move superiorlateral during exhalation (stays inferiormedial)
2) transverse diameter of the rib cage at the level of dysfunction is smaller

21
Q

Diagnosis of the 1st rib

A

Index finger is superior on the head of 1st rib

Middle finer is inferior on the head of the 1st rib

Thumb is on the anterior shaft

Assess the following
- static positions: are they equal in the anterior-posterior direction

  • passive movement: gently spring the anterior rib posterior and assess movement of both sides (does one resist more than the other?)
  • active movement: have patient inhale and exhale and assess pump handle motion by monitoring
22
Q

Rib 1-6 costal-sternal boarder locations

A

this is the location of ribs 2-6 to assess diagnosis

Rib 1: upper portion of manubrium

Rib 2: attachment at the angle of Louis

Rib 3-6 each respective level below rib 2 cartilage at the levels of the respective vertebral segments

Inhalation somatic dysfunction & exhalation restriction
- rib stays superior/anterior, doesnt move inferior/posterior during exhalation

Exhalation somatic dysfunction & inhalation restriction
- rib stays inferior/posterior, doesn’t move superior/anterior during exhalation

23
Q

BITE

A

The acronym for remembering which rib to treat first in rib treat emend based on exhalation on inhalation somatic dysfunctions

B: bottom
I: Inhalation
T: Top
E: Exhalation

24
Q

Patient position of rib diagnosis based on section of ribs

A

1-10 = supine

11-12 = prone

25
Q

Location of anterior ribs 7-11

A

Note: all are on the costal margin bilaterally except R11

Rib 7 = 1st notch palpable inferio-lateral to the xiphoid

Rib 8 = medial 1/3rd of the clavicle, halfway between R7 and 9

Rib 9 = midclavicular line on the costal margin

Rib 10 = lateral 1/3 of clavicle on the costal margin

Rib 11 = free floating tip in the mid axillary line just inferior to R10

26
Q

Ribs 7-10 testing

A

Place fingertips on ribs 7-10 w/ pinky on rib 10 and index on rib 7

Inhalation somatic dysfunction & exhalation restriction
- rib stays superior/lateral, doesnt move inferior/medial during exhalation

Exhalation somatic dysfunction & inhalation restriction
- rib stays inferior/medial, doesn’t move superior/lateral during exhalation

27
Q

Effects of OMT on thoracic cage

A

Improves breathing mechanics

Increases venous/lymphatic return to heart

Helps modulate the sympathetic nervous system

Decreases pain

Improves posture

OPP Respiratory Block (6 decks)

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