Ribs And Reflexes Flashcards
Brachial plexus passes between what muscles?
Ant. And middle scalene muscles
Sympathetic ganglia and chain location
Just ant. To ribs
Sites of neuromuscular compression
. Btw ant. And middle scalene (ant. Scalene syndrome)
. Btw clavicle and 1st rib (costoclavicular syndrome)
. Btw. Pec minor and chest wall
Diaphragm innervated
Phrenic nerve (C3-5)
Secondary muscles of respiration
Scalenes
Fluid movement in thoracic cage
. Neg. intrathoracic pressure and positive intra-abdominal pressure on inhalation moves fluids
. Thoracic inlet must be unrestricted (treat first when lymph obstruction is present)
Components of thoracic cage motion
. Movement of thoracic cage during movement of trunk (fl/extension, sidebending, rotation)
. Movement of ribs and thoracic cage during breathing (ribs, thoracic A-P curve)
Primary motion of ribs during inhalation/exhalation
. Rotation about an axis from the head of rib to angle of rib
. Axis slightly ant. To costotransverse articulation
Pump handle motion
. Inc. AP diameter of chest
. Sternum moves ant. And sup. During inhalation
. Affects ribs 1-5
Bucket handle motion
Inc. transverse diameter of chest
. Ribs 6-10
Diaphragm mechanism
. Contraction inc. vertical diameter of chest (dome shape flattens)
. Abdominal contents pushed inf. And abdomen protrudes out on inhalation
. Intrathoracic pressure dec. while intra-abdominal pressure inc.
How bucket handle motion can be also be described as
. Ribs expand laterally but not in AP axis
Osteopathic axis of rib motion
. Axis from head of rib to angle of rib then exits
. Nearly horizontal in top ribs
. Axis declines more inf. From top to bottom
. 45 degrees from horizontal in bottom of rib cage
. 1st rib almost in corona plane
. Becomes more post. From head of rib as you go inf.
. Upper ribs around this axis move sternum ant. And sup.
. Owner ribs around this axis move lat.
1st rib dysfunctions tend to be assoc. w/ ____ dysfunction
Elevated, reluctance to be depressed w/ downward pressure
What ribs have the most purple handle motion
Ribs 1 and 2
When a vertebrae is sidebending left what direction is rib elevated?
Right side (assoc. w/ bucket handle motion)
T/E pump handle motion increases as ribs increase in size
. F, decreases as ribs inc. in size
Rubs 11 and 12 motion
. Caliper/pincer motion
. Move post. And lat. on inhalation
. Ant. And med. on exhalation
T/F all ribs exhibit both pump handle and bucket handle motion, one is just more prominent than the other
T
Exhalation rib
Freer motion
Restricted in inhalation
(Inhalation rib opposite)
Ant. Rib subluxation
Rib angle more prominent in post. Rib cage
Post. Subluxation in rib
Rib angle less prominent in post. Rib cage
External rib torsion
. Assoc. w/ extended thoracic dysfunction
List of structural rib issues
. Ant. And post. Subluxation . External rib torsion . Sup. 1st rib subluxation . AP rib compression . Lat. rib compression . Lat. flexed rib (2nd)
Extended thoracic are assoc. w/ what kind of ribs?
Inhalation
Flexed thoracic are assoc. w/ what kind. Of ribs?
Exhalation ribs
What rib causing restriction of inhalation in exhalation group dysfunction
Top rib
What rib causing restricted exhalation in inhalation group?
Bottom rib
Principles of diagnosis of ribs
. Patient supine, push lat. ribs for resistance
. Pump handle: hands ant. Portion of upper ribs
. Bucket handle: fingers on lat. aspect of lower ribs
. Passively move ribs into in/exhalation w/o patient breathing
. Palpate post. For tenderness/tissue change at rib angle
. Palpate ant. For ant. Counterstrain points
Rib position in exhalation dysfunction
Down in front, up in back
Rib position in inhalation dysfunction
Up in front down in back
Principles of treatment of ribs
. Treat spine 1st, treat structural rib before respiratory ribs
. Rib1-2, 11-12 need special techniques
. Avoid excessive pressure on cartilaginous portion of ribs ant.
. Ribs in trouble w/ extended dysfunctions and crossover points of lat. curves
. Interpret TARt for viscerosomatic or musculoskeletal
. CS, indirect and direct MFR good treatments
What Louis burns concluded about viscerosomatic reflexes in 1907
. Pathway of viscerosensory impulses enters spinal cord through post. Roots
. Somatovisceral reflexes less circumscribed and less direct than viscerosomatic reflexes
. Pressure upon somato-sensory nerves is sufficient to lessen conscious sensation to bring viscera back to normal
Result of viscerosomatic reflex neurally
. Activates nocicieptive, general visceral afferent neurons
. Primary somatic dysfunction results in activation of somatosensory nociceptive neurons
. Primary afferent neurons enter spinal cord and synapse w. Dorsal horn
. Ongoing afferent stimulation causes irritability (facilitation) of interneurons of that spinal segment
. Additional afferent activity causes spinal segmental response to less stimulus than normal required (if visceral afferent activity strong enough it causes pain in spinal segment)
Degree of segmental irritability is directly proportionate to ____
Severity of visceral pathology
Anatomic relationship between involved organ and paravertebral soft tissues (makes reflexes consistent from person to person)
Midline organs produce ___ reflex
Bilateral
Paired organs produce ____ reflexes
Bilateral in general disease
Asymmetrical disease produces ipsilateral response
Organs above diaphragm show reflexes above what spinal level
T5 (below diaphragm is below T5)
