Thoracic (rib) Cage

Question 1

What makes up the sternum?

Answer 1

-manubrium (top portion)
-sternum (body)
-xiphoid (bottom portion)

Question 2

What is a “true” rib?

Answer 2

Rib that attaches directly to the sternum (costal cartilage of rib anchors onto the sternum)

Question 3

Which ribs are considered “true” ribs?

Answer 3

1-7

Question 4

What is a “false” rib?

Answer 4

Rib that attaches indirectly to the sternum (costal cartilage of the rib anchors onto the costal cartilage of the rib above it)

Question 5

Which ribs are considered “false” ribs?

Answer 5

8-10

Question 6

What is a “floating” rib?

Answer 6

Rib that does not attach to the sternum at all

Question 7

Which ribs are considered “floating” ribs?

Answer 7

11-12

Question 8

What is a typical rib?

Answer 8

Ribs that all share similar landmarks

Question 9

Which ribs are considered typical ribs?

Answer 9

3-9

Question 10

What is an atypical rib?

Answer 10

Ribs that do not share similar landmarks

Question 11

Which ribs are considered atypical ribs?

Answer 11

1-2, 10-12

Question 12

What are the landmarks of typical ribs (3-19)?

Answer 12

-head
-neck
-tubercle
-shaft/body
-costal angle

Question 13

How would you describe the head of a typical rib?

Answer 13

Portion of the rib that has facets which articulate with two different vertebrae to allow the rib to have some movement

Question 14

How would you describe the neck of a typical rib?

Answer 14

Narrow smooth portion of the rib distal to the head

Question 15

How would you describe the tubercle of a typical rib?

Answer 15

lateral lumps/bumps that create a surface which articulates with the transverse processes of thoracic vertebrae

Question 16

How would you describe the shaft/body of a typical rib?

Answer 16

Thin/flat portion of the rib which wraps around

Question 17

How would you describe the costal angle of a typical rib?

Answer 17

Transition point where the proximal arrangement of the rib (head/neck/tubercle) turns into the shaft/body of the rib

Question 18

What is a common site for the rib to fail/fracture?

Answer 18

The costal angle- if rib is being compressed on both sides will likely snap at this part (but can happen anywhere)

Question 19

Which vertebrae are thoracic vertebrae?

Answer 19

1-12, bony part of the back portion of the ribcage

Question 20

What is the superior aperture of the rib cage?

Answer 20

Top opening of the rib cage
-gateway for structures which need to pass to the head/upper extremities

Question 21

What does the superior aperture of the rib cage contain?

Answer 21

-esophagus
-trachea
-nerves/vessels that supply head, neck, and upper extremities

Question 22

What is the inferior aperture of the rib cage?

Answer 22

The bottom opening of the rib cage which is lined/covered by the diaphragm
-diaphragm has openings which allow structures to pass from the inferior aperture to the abdomen

Question 23

Which structures does the inferior aperture of the rib cage allow to pass below the abdominal cavity?

Answer 23

-esophagus
-IVC (inferior vena cava)
-aorta

Question 24

What is a costochondral joint?

Answer 24

Point where the rib articulates with the costal cartilage

Question 25

What is a sternocostal joint?

Answer 25

Point where the costal cartilage articulates with the sternum

Question 26

What is a manubriosternal joint?

Answer 26

AKA the sternal angle, junction between manubrium and sternal body

Question 27

What is a xiphisternal joint?

Answer 27

Junction between xiphoid (bottom of sternum) and sternal body

Question 28

What is a sternoclavicular joint?

Answer 28

Point where the clavicle articulates with the sternum

Question 29

How does the thoracic cage move during inspiration?

Answer 29

“Bucket handle” motion will pull the ribs up and out
Which increases/expands: anterior-posterior diameter & lateral diameter
**expansion should be equal on both sides in a healthy individual

Question 30

What movement highlights would you look for on a physical exam of the rib cage?

Answer 30

rate, symmetry, and quality of movement during inspiration and expiration

Question 31

What is the “accessory pattern” of movement in the rib cage? What conditions cause this pattern?

Answer 31

Accessory pattern: shrug of shoulders when breathing, work of breathing is more difficult for muscles so they recruit the accessory muscles to help out
Overuse of the accessory muscles will cause hypertrophy in this area
Common in: COPD and other pulmonary diseases

Question 32

What is the “asymmetrical pattern” of movement in the rib cage? What conditions cause this pattern?

Answer 32

Asymmetrical pattern: rib cage will not expand symmetrically when breathing
Common in: trauma/pathology to one lung (pneumothorax, etc.), scoliosis or displacement of spine

Question 33

What muscles are used during inspiration at rest?

Answer 33

-diaphragm
-external intercostals

Question 34

What muscles are used during inspiration during exertion/exercise or in pathology?

Answer 34

-diaphragm
-external intercostals
PLUS
-accessory muscles: SCM and scalenes
-pecs may also assist
(these will also be recruited in inspiration at rest in diseases like COPD)

Question 35

What muscles are used during expiration at rest?

Answer 35

Only really elastic recoil of lungs

Question 36

What muscles are used during expiration during exertion/exercise or in pathology?

Answer 36

-internal intercostals
-abdominal muscles (rectus abdominis, interior/exterior oblique)