Ribs/Sternum Exam

How many pairs of ribs are there?

12

Purpose of ribs

Support walls of pleural cavity and diaphragm; protects heart and lungs

Ribs shape

Conical

Rib bone classification

Flat bone

Costal cartilage

Head of rib

Articulates with body of vertebra

Neck of rib

Flattended area between the neck and tubercle

Tubercle of rib

Has a facet that articulates with transverse process of vertebra

Which ribs connected to the sternum?

1-7

Which ribs have costal cartilage?

1-10

Which ribs are “floating” ribs?

11-12

1?

Tubercle

2?

Neck

3?

Head

Vertebral end

End of rib which attaches to the thoracic vertebra

Angle of rib

Posteriorly, before connection to vertebra

Body/shaft

Main part of rib

Sternal end

End of rib which attaches anteriorly

Costal groove

Located on the inferior/ internal border containing costal arteries, veins, and nerves; trauma to the ribs can damage this area and cause pain and hemorrhaging

Costovertebral Joint

The head connects to vertebral body; synovial gliding joints

Costotransverse Joint

The tubercle connects to transverse process; synovial gliding joint

1?

Costovertebral joint

2?

Costotransverse joint

True ribs

1-7

False ribs

8-12

Costochondral Joint

Anterior connection of sternal end of rib with the costal cartilage; cartilaginous synchondroses joints and allow no movement

Costcochondral joint

Interchondral Joints

Between costal cartilages of 6-7, 7-8, 8-9 and 9-10; synoival gliding joint

Intercostal Space

Space between each rib

How much does the diaphragm move between deep inspiration and deep expiration?

1 ½ inches

Ribs located aboce the diaphragm (1-9) are best examined on ______________

Inspiration

Ribs below the diaphragm (8-12) are best examined on ________________

Expiration

Where is the rib cage the widest?

8-9

Sternum bone classification

Flat bone

Cervical rib

Extra rib attached to C7

What are the 3 parts of the sternum?

Manubrium, body and xiphoid process

1?

Manubrium

2?

Body

3?

Xiphoid process

Clavicular notches

On the superior lateral sides where the sternal ends of the clavicle articulate

Costal Notch

For the cartilage of the first rib attachment

What vertebra level does the jugular notch correspond with?

T2/T3

Manubriosternal Joint

Joint space between the manubrium and sternal body; cartilaginous symphysis joint with little to no movement

Sternal Angle

At the manubriosternal joint - this area forms a slight angle; makes a palpable transverse ridge

What vertebra does the sternal angle correspond to?

T4/T5

Costal Notches

Attachments of ribs 2-7, sternocostal joints; synovial gliding joints

Xiphoid Process

Cartilaginous early in life then partially or completely ossifies later in life; palpable and corresponds to the superior portion of the liver aspect of the heart

Xiphisternal Joint

Joint space between the sternal body and xiphoid process; cartilaginous synchondrosis joint which allow little or no movement

Sternum routine

RAO and lateral

What vertebra does the xiphoid process correspond to?

T10

What is the sternum RAO obliquity for a large barrel chest patient?

15 degrees

What is the sternum RAO obliquity for a thin chested patient?

20 degrees

Subcutaneous Emphysema

Presence of air in subcutaneous tissue

Subcutaneous emphysema

Flail Chest

Two or more contiguous rib fractures with two or more breaks per rib 

Flail chest

Pectus Carinatum – Pigeon Chest

Uncommon birth defect in which a child's breastbone protrudes outward abnormally

Pectus carinatum pigeon chest

Pectus Excavatum – Funnel Chest 

Condition in which the person's breastbone is sunken into the chest

Pectus Excavatum – Funnel Chest 

Rib SID

72

What side of ribs goes against the IR

Affected side

What must you annotate on rib images?

Erect

Anterior rib pain position

PA

Posterior rib pain position

AP

What do you do if a patient pin points an area of pain on a rib?

BB

Bilateral rib collimation

17×14

Unilateral rib collimation

14×17

PA rib lower image tube angle

10-15 caudad

If inital rib image is PA, what do you do for oblique?

RAO/LAO

If inital rib image is AP, what do you do for oblique?

RPO/LAO