1.

01 THORAX AND CHEST WALL

Ms. Dane || March 2021
KINESIOLOGY
Transcribers: ​Bebelone, Bo, Co, Cobile, Cuadra, Honoridez, Jalang, Pasion, Polvorosa

OUTLINE
I. GENERAL STRUCTURE AND FUNCTION
A. RIB CAGE
II. ARTICULATIONS OF THE RIB CAGE
A. COSTOVERTEBRAL JOINT
B. COSTOTRANSVERSE JOINT
C. COSTOCHONDRAL AND
CHONDROSTERNAL JOINTS
III. MUSCLES ASSOCIATED WITH THE RIB CAGE
A. PRIMARY MUSCLES OF VENTILATION
1. DIAPHRAGM
2. INTERCOSTAL MUSCLES
3. SCALENES
B. MUSCLES OF INSPIRATION
C. MUSCLES OF EXPIRATION
IV. MECHANISMS OF BREATHING
V. ADDITIONAL READING

I. GENERAL STRUCTURE AND FUNCTION

● process of inspiration and expiration is dependent on an

extraordinary and complex set of musculoskeletal and
kinesiology interrelationships involved with the structure
and function of the chest wall
● ventilatory “bellows”​ - a complex involving some 88
joints and more than 46 muscles
● respiratory muscles are the only ​skeletal muscles​ on
which the body depends on to sustain life and
consequently, must function continuously
● respiratory muscles are the only muscles that are high
enduring because they need to function 24/7

A. RIB CAGE
● 12 pairs of ribs
o 1st - 7th ribs​ - ​“true ribs”​ or ​“vertebrosternal ribs”
because it attaches directly to the sternum
o 8th - 10th rib​ - share a single costal cartilage to attach
to the sternum
▪ “vertebrochondral ribs”​ or ​“false ribs”

▪ costocartilage of ribs 8-10 articulates with the

costocartilage of the superior rib, indirectly
articulating with the sternum via rib 7
o 11th - 12th ribs ​- ​“floating ribs”​ or ​“vertebral ribs”
because no anterior attachment to the sternum

● 12 thoracic vertebrae
○ transverse costal facet
○ superior costal facet
○ inferior costal facet

● Sternum - an osseous protective plate for the heart

○ Manubrium
○ Body
○ Xiphoid Process

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B. COSTOTRANSVERSE JOINT
II. ARTICULATIONS OF THE RIB CAGE ● Formed by the articulation of the costal tubercle of the rib
● Manubriosternal - junction between the manubrium and with the costal facet of the transverse processes of the
sternum thoracic vertebrae
● Xiphisternal - junction between xiphoid process and sternum ● Floating ribs have no CT joints
● Costovertebral ● In the costotransverse joints of T7 through T10, both articular
● Costotransverse surfaces are flat and gliding motions predominate
● Costochondral ● T1-T6 vertebra​ = slightly concave
● Chondrosternal ● T1-T6 rib​ = slightly convex, with gliding and slight rotation
movements
A. COSTOVERTEBRAL JOINT ● surrounded by a thin, fibrous capsule
● Formed by ​head of rib​ and​ two demifacets​ in the adjacent ● three major ligaments support the costotransverse joint
thoracic vertebrae capsule
● Also includes articulation with the interposed intervertebral ○ lateral costotransverse ligament
disks ■ short, stout band located between the lateral
● 1st, 11th, and 12th pair of ribs articulate with one vertebra portion of the costal tubercle and the tip of the
only (atypical ribs) corresponding transverse process
● Intra-articular ligament​ ​- attaches to the disk and head of ○ costotransverse ligament
the rib directly and dividing the joint cavity into two ■ composed of short fibers that run within the
● ribs 2-9​ have typical costovertebral joints costotransverse foramen between the neck of
● Each rib’s inferior facet articulates with the superior facet of the rib posteriorly and the transverse process at
its own numbered vertebrae the same level
● What are the costovertebral articulations of rib 5? ○ superior costotransverse ligament
○ rib’s superior facet articulates with the inferior facet of T4 ■ runs from the crest of the neck of the rib to the
and the rib’s inferior facet articulates with the superior inferior border of the cranial transverse process
facet of T5
● What are the costovertebral articulations of rib 4?
○ rib’s superior facet articulates with vertebral body above,
and the rib’s inferior facet articulates with the superior
facet of the vertebral body below
● Radiate/Stellate ligament​ - attaches to the anterolateral part
of the CV joint; has 3 bands
○ superior band​ - attaches to the superior vertebra
○ inferior band​ - attaches to the inferior vertebra
○ intermediate band​ - attaches to the IV disc
● Ligaments role = to prevent excessive motion in the area
● CV joints that articulate with a single vertebra only are more
mobile (ribs 1, 10, 11, 12)
● rotation and gliding only

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C. COSTOCHONDRAL (CC) and CHONDROSTERNAL (CS)
JOINTS
● 1st-7th rib articulate with costal cartilages = ​CC joints
○ no ligamentous support
○ synchondroses
● cartilages mentioned above articulate with the
manubriosternum = ​CS joints
○ has a thin joint capsule reinforced by anterior and
posterior radiate ligaments
○ formed by the articulation of the costal cartilages of ribs
1 through 7 anteriorly with the sternum

III. MUSCLES ASSOCIATED WITH THE RIB CAGE

● (A) if diaphragm is​ relaxed​ = dome shaped
● ventilatory muscles ● (B) if ​contracting​ (inhaling) = flat shape and increase pressure
○ muscles that “power” the ventilatory bellows in abdominal viscera
○ striated skeletal muscles ○ when maximum pressure is reached in abdomen,
○ have increased fatigue resistance and greater pressure is returned back to the diaphragm through
oxidative capacity exhalation
○ contract rhythmically throughout life rather than
episodically
○ work primarily against the elastic properties of
the lungs and airway resistance rather than
against gravitational forces
○ neurological control of these muscles is both
voluntary and involuntary
○ actions of these muscles are life-sustaining
● any muscle that attaches to the chest wall and many that
attach to the shoulder girdle and the thoracic vertebrae
contribute to ventilation
● classified into ​primary or accessory muscles of
ventilation
● ventilation vs. respiration
○ ventilation​ = actual process of inhalation and
exhalation
○ respiration​ = actual exchange of gases in
tissues and alveoli

A. PRIMARY MUSCLES OF VENTILATION

● Diaphragm, intercostal (parasternal) muscles, scalene
muscles
● All act on the rib cage to promote inspiration
● primary​ = normal resting breathing (inspiration)
● No primary muscle for expiration​ during normal resting
breathing because expiration at rest is passive (meaning
no muscle involved) and elastic recoil of lungs
● What is the primary muscle of ventilation? (board exam
question lol)
○ diaphragm because does 70-80% of the work

1. DIAPHRAGM
● anatomically consists of two major components:
○ central tendon ● With inspiration, the thoracoabdominal movement is
■ serves as direct attachment caused by the contraction of diaphragm
■ boomerang shaped ● when diaphragm descends, there is an increase in
■ forms the tip of the dome of relaxed thoracic size and displacement of abdominal viscera
diaphragm anteriorly and laterally
■ has the presence of a foramen for the
vena cava
○ circular margin of radially oriented muscle 2. INTERCOSTAL MUSCLES
fibers ● parasternal muscles​ - portion of the internal
intercostals immediately adjacent to the sternum

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[KINESIOLOGY] 1.01 THORAX AND CHEST WALL – Ms. Dane
● rotation of the costosternal junction resulting to elevation B. MUSCLES OF INSPIRATION
of the ribs and anterior movement of the sternum ● Relaxed Inspiration
● primary function​ = stabilization of the rib cage and ○ Diaphragm
sternum during decreased intrapulmonary pressure ■ accounts for 75% of intrathoracic
during diaphragmatic contraction (inspiration)
volume
■ primary muscle for inspiration
○ Internal intercostals
■ 25% of intrathoracic volume
○ Scalenes
● Forceful Inspiration (accessory muscles act during
forceful ventilation)
○ Sternocleidomastoid
○ Pectoralis minor
○ Serratus anterior (​ only if scapula is fixed)
○ External intercostals

C. MUSCLES OF EXPIRATION
● Relaxed Expiration - passive elastic recoil (no muscles
involved)
● Forced Expiration
○ Abdominals (​ transversus abdominis, internal
and external obliques, rectus abdominis)
○ Internal intercostals

IV. MECHANISMS OF BREATHING

3. SCALENES ● General motions that are happening when we are
● attach to the transverse process of C3 to C7 and breathing
descend to the upper borders of the first rib (scalenus ● Pump-handle motion
anterior and medius) and second rib (scalenus posterior) ○ upper ribs and sternum
● lifts the first two ribs, including the sternum, in the
pump-handle motion of the upper rib cage ○ increased anterior-posterior diameter
● action of scalene muscles begin at onset of inspiration ○ primarily due to scalenes action
and increases as inspiration gets closer to total lung ● Bucket-handle motion
capacity ○ lower ribs
○ increased lateral diameter

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[KINESIOLOGY] 1.01 THORAX AND CHEST WALL – Ms. Dane

● Caliper motion
○ 8th - 10th ribs
○ increased lateral diameter
○ felt with bucket-handle motion
○ when diaphragm contracts, 8th-10th ribs will
push sidewards, causing caliper motion
● Piston action
○ diaphragm
○ increased superior-inferior diameter
○ because of dome-flat motion of diaphragm

V. ADDITIONAL READING
● What are the differences in structure and function of the
rib cage between an infant and an adult?
○ p.208 - Joint Structure and Function
Levangie, Pamela - 5th Edition

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[KINESIOLOGY] 1.01 THORAX AND CHEST WALL – Ms. Dane
● What are the effects of scoliosis to ventilation?

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