Weston SlideShow Content

True ribs

Refers to ribs that connect to the sternum. Ribs 1-7 fall into this category

False ribs

Refers to ribs that do not directly connect to the sternum. Ribs 8-12 fall into this category

Vertebrochondral ribs

Ribs 8-10 are _______. That means ribs 8-10 attaches to the cartilage of the rib above it.  This connection  terminates where the 7^th ribs attaches to the sternum.

Floating ribs

Ribs XI and XII have no anterior connection with other ribs or with the sternum and are often called ______.  They do not attach to the sternum. 

Typical ribs

_____ have a head with two articular facets: a superior rib head facet and an inferior rib head facet. They also have a neck, tubercle, shaft or body, and costal groove

superior facet and inferior facet

The vertebra has two facets to articulate with the rib head: a…..

Costovertebral joint

the articulation between the vertebra and rib. Consist of the two facets on the head of the rib articulate with the superior facet on the body of its own vertebra and with the inferior facet on the body of the vertebra above

Costotransverse joints

_______ are synovial joints between the tubercle of a rib and the transverse process of the related vertebra. The capsule surrounding each joint is thin. The joint is stabilized by two strong extracapsular ligaments that span the space between the transverse process and the rib on the medial and lateral sides of the joint.

costal groove

The _____ is a protective groove that allows the intercostal vein, artery and nerve (VAN) to run protected by the rib.

above

A thoracostomy tube is usually placed between the mid to anterior axillary line in the fourth or fifth intercostal space tracking [above/below] the rib so as not to injure the intercostal bundle (artery, vein, nerve).

3-9

The typical ribs are……

1,2,10,11,12

The atypical ribs are……

fibrocartilaginous

1st rib sternocostal joint is ______, the rest are synovial

Rib 2

Which rib has a two-compartment synovial joint at the sternal angle (angle of louis).

volume and pressure of the thorax

One of the principal functions of the thoracic wall and the diaphragm is to alter the……

air, blood and lymph

The change in volume changes the the pressure in thorax and causes the movement of _______ in and out of the thorax

vertical, lateral, and anteroposterior.

During breathing, the dimensions of the thorax change in the ________ directions

vertical

Elevation and depression of the diaphragm significantly alter the _____ dimensions of the thorax

Depression

results when the muscle fibers of the diaphragm contract.

Elevation

occurs when the diaphragm relaxes

diaphragm

The _______ is a thin musculotendinous structure that fills the inferior thoracic aperture and separates the thoracic cavity from the abdominal cavity

Diaphragm attachment points

xiphoid process, first 3 lumbar vertebrae, costal margin of the thoracic wall, ends of ribs XI  and XII, ligaments that span across structures of the posterior abdominal wall

phrenic nerve (C3-5)

The respiratory or thoracic diaphragm is innervated by the…..

vertically

During breathing, the dimensions of the thorax change…..

inferior thoracic aperture

The musculotendinous diaphragm seals the _______, separating the contents or the thorax from the abdomen.  

large central tendon

Generally, muscle fibers of the diaphragm arise radially, from the margins of the inferior thoracic aperture, and converge into a……

inferiorly

During inspiration or inhalation, the diaphragm contracts, moving _____.  This movement increasing the volume of the thorax.  As the volume increases, the pressure in the thorax decreases.

inferior

Because of the oblique angle of the inferior thoracic aperture, the posterior attachment of the diaphragm is [inferior/superior] to the anterior attachment.

superiorly

The diaphragm is not flat; rather, it “balloons” [superiorly/inferiorly], on both the right and left sides, to form domes. The right dome is higher than the left, reaching as far as rib V

T8

The inferior vena cava passes through the central tendon at approximately vertebral level…..

T10

The esophagus passes through the muscular part of the diaphragm, just to the left of midline, approximately at vertebral level…..

T12

The aorta passes behind the posterior attachment of the diaphragm at vertebral level…..

esophagus

The vagus nerves pass through the diaphragm with the…

aorta

The thoracic duct passes behind the diaphragm with the…..

crura

The azygos and hemiazygos veins may also pass through the aortic hiatus or through the ______ of the diaphragm.

anteroposterior and lateral

Elevation and depression of the ribs cause changes in the _______ dimensions

inhalation

During ______, the ribs move anteriorly, superiorly and laterally.  The more superior the ribs 1-5, (6) move more anterior and superiorly; thus, increasing the anterior-posterior dimension of the the thorax.  The lower ribs (6) 7-10 move more laterally; therefore, increase the transverse dimension of the thorax. 

exhalation

During _______, the ribs move posteriorly, inferiorly, and medially. 

transverse

The anterior and superior rib movement is primarily around the _______ rib axis.  This axis travels through the costotransverse   and costovertebral joints.  The motion occurs in a sagittal plane. 

anterior-posterior

The lateral rib movement is primarily around an ______ rib axis.  This axis travels through the costotransverse and sternocostal joints.  The motion occurs in a frontal/coronal plane. 

Pump handle ribs

______ (ribs 1-5) move more anteriorly and superiorly than laterally during inhalation. They move more around the transverse rib axis in a sagittal plane. They increase the anterior posterior dimension of the thorax during inhalation and decrease it during exhalation.  

Bucket handle ribs

______ (ribs (6)7-10) move more laterally then anteriorly and superiorly in inhalation. Increase the transverse dimension of the thorax

midaxillary line

Bucket handle ribs are best assessed at the…..

frontal coronal plane

Bucket handle ribs primarily move around an anterior posterior axis and move in a……

caliper

Ribs 11-12 move in a _____ motion. The 11th and 12th ribs have only costovertebral articulations. Because there are no transverse process limitations, the motion of these ribs is ______ like along a horizontal plane. This motion produces slight changes in both the anteroposterior and the transverse dimensions.

inhalation

Contraction of the external intercostal muscles will cause…..

sternum

Contraction of the sternocleidomastoid muscle raises the _____ and thereby the raises the ribs in a pump handle motion

first rib

The anterior and middle scalene muscles attach to the the _____ and bring it into inhalation in a pump handle motion.  

second rib

The posterior scalene muscle attaches to the the _____ and brings it into inhalation in a pump handle motion.  

Pectoralis minor

_______ will cause inhalation of ribs 3-5.

Serratus anterior

_______ will cause inhalation of ribs 1-8 or 9.

quadratus lumborum

A hypertonic or tight _______ can cause the 12^th rib to be to move in inhalation

Latissimus dorsi

causes the 10^th, 11^th and 12^th ribs to move into inspiration during forceful breathing. This includes coughing and sneezing.

Exhalation

mostly achieved by the relaxation of the diaphragm and natural recoil of the lungs.  Contraction of the abdominal muscles (rectus abdominis, internal and external oblique, and transverse abdominis) will augment this

internal intercostal

Contraction of the ______ muscles will cause exhalation. 

Hypertonic

_______ pectoralis minor tone can cause an inhalation dysfunction of ribs 3-5.

Hypotonic

_______ pectoralis minor tone can lead to exhalation dysfunction of ribs 3-5.

Lymphatic system functions

Purification/cleansing of tissues, Maintaining fluid balance, Defense/Immunology, Nutrition

Organized Lymph Tissue

Spleen, liver, thymus, tonsils, appendix, lymphoid tissues in GI and pulmonary tracts, lymph nodes

Lymph Channels/Lymphatic Vessels

Disseminated throughout the entire body.  They are NOT found in the brain, spinal cord, epidermis, endomysium of muscle, cartilage, bone marrow and selected portions of peripheral nerves.

lymphatic duct

Lymph Eventually drains into either the thoracic duct or right ______

skeletal muscles

The movement of lymph through the lymphatic vessels is achieved mainly by the action of _____ and pulses in the arteries. 

0.1- 2.5 cm

Lymph nodes are _______ long

Valves

_____ in the vessels maintains the one- way flow. 

brachiocephalic veins

Lymph vessels coalesce to form larger trunks or ducts.  These ducts or trunks drain into venous system in the neck where the internal jugular and subclavian form the…… 

Superficial system

Drains the musculoskeletal system and skin.  They drain symmetrically towards cervical, axillary and inguinal lymph nodes. Once through the cervical, axillary and inguinal lymph nodes, this lymph is then circulated through the deep system.

Deep system

Drains the thorax,  abdomen, pelvis, and perineum.  Then drains into the right lymphatic duct or thoracic duct. 

Thoracic duct

the principle channel through which most of the lymph from the body is returned to the venous system.  It starts from L 2 and cisterna chyli and travels superiorly to the root of the neck. 

Cisterna chyli

a confluence of lymph trunks that can form saccular dilations.  It receives lymph from abdomen, pelvis, perineum and lower extremities.  Starting point of the thoracic duct.