Procedures: chapter 10

which one is A

Costochondral junction

what is it pointing to?

sternocostal joint

what is it pointing to?

interchondral joints

what is it pointing to? diarthrodial, and plane (gliding)

sternoclavicular joint (SC joint)

what is it pointing to? synarthrodial

first sternocostal joint

what is it pointing to? diarthrodial, plane (gliding)

2nd-7th sternocostal joint

what is E pointing to? diarthrodial, plane (gliding)

6th-9th interchondral joints

what are the 3 parts of the bony thorax?

1. sternum

2. 12 thoracic vertebrae

3. 12 pairs of ribs that connect them

1. expand/contract during respiration

2. protect organs of respiratory system, heart, great vessels

what are these 2 functions of?

bony thorax

what are the 3 parts of the sternum?

1. manubrium

2. body (corpus/gladiolus)

3. xiphoid process/tip

made of cartilage till age 40, then turns to bone (endochondral), level of T9-T10

xiphoid process

cartilage to bone

endochondral

what is the level of the jugular notch?

T2-T3

what is the level of the sternal angle?

T4-T5

what is the level of the lower lateral rib margin?

L2-L3

which ribs are true ribs (ribs _ - _)

ribs 1-7

ribs go from high to low moving from ___ to ___

posterior to anterior

• plane (gliding) motion

• diarthrodial (freely moveable)

• tubercle of rib connects to transverse process of vertebrae

  • found on all ribs EXCEPT ribs 11-12

costotransverse joint

• plane (gliding) motion

• diarthrodial (freely moveable)

• head of rib connects to body of thoracic vertebrae

  • found on ALL ribs

costovertebral joint

for a RAO you would angle someone with a large chest ___º

15º

for a RAO you would angle someone with a small chest ___º

20º

why do we do an oblique when doing a sternum exam?

this puts sternum in the heart’s shadow

where the pain is determines what 3 things?

1. routine

2. breathing

3. technical factors

why do we do an oblique of the ribs?

demonstrates the axillary portion of ribs

CR (PA) will be at ___

T7

CR (AP) will be ___” below jugular notch

3-4”

breathing instructions for above the diaphragm?

inspiration

breathing instructions for below the diaphragm?

expiration

where the jugular notch and body of sternum come together 

sternal angle

what is the only bony connection between the shoulder girdle and bony thorax?

SC joint

what is does the SC joint consist of? (2 things)

1. sternum

2. clavicle

ribs that connect directly to sternum

true ribs

which ribs are the true ribs?

ribs 1-7

don't connect directly to sternum, joins onto rib 7

false ribs

which ribs are the false ribs?

ribs 8-12

ribs that don't connect to sternum at all

floating ribs

which ribs are the floating ribs?

ribs 11-12

posterior end of ribs is ___ inches higher than the anterior end

3-5”

part of ribs that connects with thoracic vertebrae

Vertebral end (posterior)

articulates with thoracic vertebrae (posterior)

head

ligament attaches, articulates with the transverse process of the thoracic vertebrae

tubercle

actual piece of anatomy that articulates with vertebrae

facet

inside margin of a rib that includes an artery, vein, and a nerve

coastal groove

why do we ask are you coughing up any blood?

because there are blood vessels in ribs

which end of rib connects with sternum

sternal end (anterior)

Widest diameter of ribs/bony thorax is at rib ___ or ___

8 or 9

Ribs get longer and longer till about the ___ rib, then they get smaller and smaller

7th

named for what is connecting what

joints

what 2 ways can joints be classified?

structure and function

are these diarthrodial (movable) or synarthrodial (doesn’t move)

• costochondral junction

• 1st sternocostal joint

synarthrodial

are these diarthrodial (movable) or synarthrodial (doesn’t move)

• sternoclavicular joint

• sternocostal joint of ribs 2-7

• interchondral joints of ribs 6-9

diarthrodial

what is this the routine for?

• PA CXR (72”)

• AP or PA unilateral (40”)

  • side of injury closest to IR

• Axillary/Oblique (40”)

  • 45º oblique

rib routine

for a AP/PA ribs above the diaphragm, which ribs should be visualized?

ribs 1-9

Is this for ribs above or below diaphragm?

• (PA) CR: T7

• (AP) CR: 3-4” below jugular notch and centered to affected side

above the diaphragm

what is the degree of oblique for ribs above and below the diaphragm?

45º

Is this for ribs above or below diaphragm?

• AP/PA: CR midway between xiphoid process and lower ribs margin

below the diaphragm

for a ribs below the diaphragm, which ribs should be visualized?

ribs 8-12

Is this for ribs above or below diaphragm?

• CR midway between lateral rib margin and xiphoid tip or MSP (bottom of IR at top of crest)

below the diaphragm

axillary ribs best demonstrated in obliques = rotate spine ___ from the area of interest to elongate

away

for recumbent exam is the CR the same as erect or not?

CR is the same

what are the 2 projections for a sternum exam?

1. RAO

2. lateral

which exam is this for?

• CR is 1” left of midline and midway between jugular notch and xiphoid process

sternum exam

what breathing technique is used for sternum?

orthostatic breathing technique (panting) 2-3 sec

for RAO projection for sternum, what is the degree of obliquity?

15-20º

what is the SID for RAO of sternum?

40”

what is the SID range for lateral sternum exam?

60-72”

what projection do we do sternoclavicular joints exams in?

PA

what exam is this for?

• CR at T2-T3 (3” distal to vertebra prominens)

sternoclavicular joints exams (PA and oblique)

why do we perform sternoclavicular joints exams PA?

they are on front side of body, so closest to IR

what degree of obliquity do we use for anterior obliques of SC joints?

10-15º

evaluation criteria for RAO SC joint exam:

• SC joint ___ and shifted away from spine

open

during SC joint exams, what exam would you do for right side pain?

RAO

anterior obliques for SC joints best visualize when pain is ___

down

for SC joint exam, anterior = ___

same (pain side down) - DIFFERENT FROM WHAT I KNOW!!!