Sternum/Clavicle 11/4

Question 1

Sibson’s Fascia

Answer 1

originates from deep cervical fascia surrounding the longus muscles of the anterior cervical spine, may also attach to transverse processes of C7.

connects to superomedial border of 1st rib, and is contiguous with the axillary sheath and endothoracic fascia covering the cupola of lungs

changes in one side can influence changes on the other side

Clinical implications: tension of this tissue leading to relative stenosis or altered neurologic impulses of any of these structures can have the potential for broad spread alterations to neurologic, organic, and cellular homeostasis. One such example is the effect of compression on the thoracic duct. The thoracic duct creates a loop that necessitates piercing Sibson’s fascia twice and is responsible for the majority of the lymphatic drainage of the body. The right lymphatic duct drains lymph from the upper right quadrant (dark blue) of the body into the right subclavian vein. The thoracic duct drains lymph from the rest of the body (green) into the left jugulovenous angle. The lymphatic fluid is thus returned to the systemic blood just before entering the heart. Blockage of this duct can result in lymphatic stasis and diminshment of cellular, tissue and organ system health

Question 2

Important structures passing through sibson’s fascia

Answer 2

1. Recurrent Laryngeal Nerve
2. Vagus Nerve
3. Stellate Ganglion
4. Phrenic Nerve
5. Brachial Plexus
6. Common Carotid Artery
7. Vertebral Artery
8. Thyrocervical Trunk
9. Internal Thoracic Artery (especially cardiothoracic surgeons)
10. Internal Jugular Vein
11. Subclavian Artery and Vein
12. Thoracic Duct and Right Lymphatic Duct
13. Anterior Cervical Lymph Nodes

Question 3

Abduction of arm, what does clavicle do?

Answer 3

distal end of clavicle moves superirly, proximal end moves inferiorly

physician tests motion in abuction by patient shrugging their shoulders

Question 4

What does clavicle do in flexion of the arm/

Answer 4

in flexion, distal end of clavicle moves anteriorly and proximal end moves posteriorly on the sternum. The phsician tests motion in flexion by having the patient do the zombie move

Question 5

Pectus excavatum, pectus carnii, psuedoarthrosis

Answer 5

• sunken chest
• pigeon breast
• multiple joints

Question 6

Where does abdominal diaphragm attach?

Answer 6

first three lumbar vertebrae, lower six ribs and xiphoid process of sternum. during inspiration diameters of the inferior portion of the chest cage change much more dramatically.

• deep inhalation, the entire sternum glides supiorly; distal end of sternum moves anteriorly
• exhalation: entire sternum glides inferiorly and inferior end moves posteriorly

Question 7

somatic dysfunction of the sternum

Answer 7

both manubrium of sternum and body of sternum have motions of FB/BB, and Sr/SL, and Rr/Rl

furthermore, the entire sternum can prefer to move superiorly or inferiorly

For sidebending/rotation it is useful to use indirect method to treat, and to stack all of the motions that the patient prefers in one direction

Question 8

Strongest ligament between the clavicle and scapula?

Answer 8

Coracoclavicular joint

Question 9

anatomic boundaries of thoracic inlet

Answer 9

The thoracic inlet is essentially a hole surrounded by a bony ring, through which several vital structures pass.
The superior thoracic aperture is bounded by: the first thoracic vertebra (T1) posteriorly, the first pair of ribs laterally (more specifically, the first ribs form lateral C-shaped curves posterior to anterior), the costal cartilage of the first rib and the superior border of the manubrium anteriorly.

Structures passing through:

trachea
oesophagus
thoracic duct
apexes of the lungs
phrenic nerve
vagus nerve
Recurrent laryngeal nerves
sympathetic trunks
left and right common carotid arteries
left and right subclavian arteries
internal jugular veins
brachiocephalic veins
subclavian veins
lymph nodes and lymphatic vessels

Question 10

Thoracic Outlet

Answer 10

Thoracic outlet syndrome (TOS) is a syndrome involving compression at the superior thoracic outlet[1] resulting from excess pressure placed on a neurovascular bundle passing between the anterior scalene and middle scalene muscles.[2] It can affect one or more of the nerves that innervate the upper limb and/or blood vessels as they pass between the chest and upper extremity, specifically in the brachial plexus, the subclavian artery, and, rarely, the subclavian vein, which does not normally pass through the scalene hiatus.

Question 11

Thoracic Inlet MFR: “steering wheel technique”

Answer 11

Dx: restricted right thoracic inlet

• place hands overlying thoracic inlet… apply compression to sibson’s fascia dn move hands to find restriction or ease. use MFR.

Question 12

MET for anterior clavicular head

Answer 12

for anterior clavicular head (i.e. the zombie test) instruct patient to drape their right hand over your neck, straighten your back until their scapula lifts of ground, have them try to pull down -

Question 13

MET for superior clavicular head

Answer 13

Tested via the shrug test

• have patient place shoulder at edge of table, extend and internally rotate the right shoulder, inducing inferior motion of the clavicular head
• instruct patient to flex shoulder while providing an isometric counterforce