VENTILATION: KINEMATICS
AND KINETICS.
Thorax Structure and Function.
Provides a base for the attachment of
muscles of the upper extremities, the head
and neck, the vertebral column, and the
pelvis.
Forms protection for the heart, lungs, and
viscera.
Probably the most important function of
the chest wall is its role in ventilation.
THE THORAX.
RIB CAGE: OSTEOLOGY.
RIB CAGE: OSTEOLOGY.
RIB CAGE: OSTEOLOGY.
RIB CAGE: OSTEOLOGY.
RIB CAGE: OSTEOLOGY.
RIB CAGE: OSTEOLOGY.
The articulations that join the bones of the rib cage include
the manubriosternal (MS), xiphisternal (XS), costovertebral
(CV), costotransverse (CT), costochondral (CC),
chondrosternal (CS), and the interchondral joints.
ATROLOGY: ARTICULAR SURFACES AND
JOINT CLASSIFICATION.
MANUBRIOSTERNAL
(MSJ) AND
XIPHISTERNAL JOINT
(XSJ)
Articular surfaces of
distal end of the
manubrium and Synchondrosis Synarthrosis
proximal end of the
sternum.
Hyaline cartilage–
Very little or no
Disposition: Horizontal covered articulating Fibrocartilaginous disk
movement
ends
ATROLOGY: ARTICULAR SURFACES AND
JOINT CLASSIFICATION.
COSTOVERTEBRAL JOINT
(CVJ)
Articular facets (or so-
called demifacets) of the
head of the ribs and
Synovial Diarthrosis (Plane)
inferior and superior costal
facets of the thoracic
vertebrae.
Disposition: Vertical (on
Simple “Very mobile”
sagital plane).
ATROLOGY: ARTICULAR SURFACES AND
JOINT CLASSIFICATION.
COSTOTRANSVERSE JOINT
(CTJ)
Articular facets of the
costal tubercle of the rib
with a costal facet on the Synovial Diarthrosis (Plane)
transverse process of the
corresponding vertebra.
Disposition: Vertical (on
frontal plane, 50°-35° Simple “Very mobile”
toward sagital plane).
ATROLOGY: ARTICULAR SURFACES AND
JOINT CLASSIFICATION.
COSTOCHONDRAL (CCJ) AND
CHONDROSTERNAL JOINT (CSJ)
Articular facets of the of the 1st
through 10th ribs anterolaterally
with the costal cartilages and Synchondrosis
Synarthrosis
costal cartilages of ribs 1 to 7
anteriorly with the lateral facet of
the manubrium.
Disposition: Vertical (sagital Periosteum and the
Very little or no movement.
plane). perichondrium are continuous.
ATROLOGY: ARTICULAR SURFACES AND JOINT CLASSIFICATION.
INTERCHONDRAL JOINT
(ICJ)
The 7th through the
10th costal cartilages Synovial
each articulate with the Diarthrosis (Plane)
cartilage immediately
above them.
Disposition: Vertical Ribs 1-2: Composed.
“Very mobile”
(sagital plane). Ribs 3-7: Simple.
ATROLOGY: ARTICULAR SURFACES AND
JOINT CLASSIFICATION.
The movement of the rib cage is an amazing
combination of complex geometrics governed
by the types and angles of the articulations,
the movement of the manubriosternum, and
the contribution of the elasticity of the costal
cartilages.
OSTEOKINEMATICS: PLANES OF
MOTION AND AXIS OF ROTATION.
35°-45°
25°-35°
OSTEOKINEMATICS: PLANES OF MOTION AND
AXIS OF ROTATION.
OSTEOKINEMATICS: PLANES OF MOTION AND
AXIS OF ROTATION.
This axis for the upper ribs lies close to the frontal plane,
allowing thoracic motion predominantly in the sagittal
plane.
The axis of motion for the lower ribs is nearly in the
sagittal plane, allowing for thoracic motion
predominantly in the frontal plane.
OSTEOKINEMATICS: PLANES OF MOTION AND
AXIS OF ROTATION.
OSTEOKINEMATICS: PLANES OF MOTION AND
AXIS OF ROTATION.
VERTICAL CHANGES
ANTERIOR-
POSTERIOR
CHANGES
MEDIAL-LATERAL
CHANGES
OSTEOKINEMATICS: Changes in Intrathoracic
Volume during Ventilation.
OSTEOKINEMATICS:
OSTEOKINEMATICS:
OSTEOKINEMATICS:
Interosseous or intra-articular ligament: This ligament
extends from the crest of the head of the rib to attach to
the anulus fibrosus of the intervertebral disk.
The radiate ligament: (has three bands)
1. The superior band, which attaches to the superior
vertebra;
2. The intermediate band, which attaches to the
intervertebral disk;
3. The inferior band, which attaches to the inferior
vertebra.
ATROLOGY: CV JOINT LIGAMENTS.
1. The lateral costotransverse ligament (21)-+: is a short, stout
band located between the lateral portion of the costal tubercle
and the tip of the corresponding transverse process.
2. The posterior costotransverse ligament (23): is composed of
short fibers that run within the costotransverse foramen
between the neck of the rib posteriorly and the transverse
process at the same level.
3. The superior costotransverse ligament (24): runs from the
crest of the neck of the rib to the inferior border of the cranial
transverse process.
ATROLOGY: CT JOINT LIGAMENTS.
The sternocostal ligament:
Anterior and posterior
radiate costosternal
ligaments.
Manubriosternal ligament.
The costoxiphoid ligament:
connects the anterior and
posterior surfaces of the seventh
costal cartilage.
ATROLOGY: SC JOINT LIGAMENTS.
The ventilatory muscles are striated skeletal muscles that differ from
other skeletal muscles in a number of ways:
1. The muscles of ventilation have increased fatigue resistance and
greater oxidative capacity;
2. These muscles contract rhythmically throughout life rather than
episodically;
3. The ventilatory muscles work primarily against the elastic properties
of the lungs and airway resistance rather than against gravitational
forces;
4. Neurologic control of these muscles is both voluntary and
involuntary; and (5) the actions of these muscles are life sustaining.
KINETICS: BIOMECHANICS OF THE RESPIRATORY MUSCLES.
KINETICS: PRIMARY MUSCLES
OF VENTILATION.
KINETICS: PRIMARY MUSCLES
OF INSPIRATION.
KINETICS: MUSCLES OF
FORCED INSPIRATION.
Diaphragm
Anatomically, the diaphragm muscle may be
divided into sternal, costal, and lumbar parts:
The sternal fibers originate from two slips
at the back of the xiphoid process.
The costal fibers originate from the lower
six ribs and their costal cartilages.
The lumbar fibers originate from the crura
of the lumbar vertebra, and the medial and
lateral arcuate ligaments.
The diaphragm has a phrenic C3–4 motor
innervation and sensory supply by the lower
six intercostal nerves.
70% to 80% of inspiration force during quiet
breathing.
KINETICS: PRIMARY MUSCLES
OF VENTILATION.
Biomechanics of respiration.
(Reproduced with permission from
Morton DA, Foreman KB, Albertine
KH. The Big Picture: Gross Anatomy.
2nd ed. New York, NY: McGraw-Hill
Education; 2019.)
KINETICS: PRIMARY MUSCLES
OF VENTILATION.
KINETICS: PRIMARY MUSCLES
OF VENTILATION.
KINETICS: PRIMARY MUSCLES
OF VENTILATION.
KINETICS: ACCESSORY MUSCLES
OF VENTILATION.
KINETICS: ACCESSORY MUSCLES
OF VENTILATION.
KINETICS: FORCED
EXPIRATION.
KINETICS: FORCED
EXPIRATION.
The process of ventilation depends on the mobility of the bony rib
thorax and the ability of the muscles of ventilation to move it.
Ventilation allows for the exchange of oxygen
and carbon dioxide between the alveoli of the
lungs and the blood. This exchange is essential to oxidative
metabolism within muscle fibers. The process
converts chemical energy stored in ATP into
the mechanical energy needed to move and
stabilize the joints of the body.
The change in intrathoracic volume causes a
change in air pressure as described by Boyle’s
law.
Because air flows spontaneously from high to
low pressure
VENTILATION: OVERVIEW.
Total lung capacity is about 5.5 to 6
L of air.
Vital capacity, normally about 4500
mL, is the maximum volume of air
that can be exhaled after a maximal
inhalation.
Tidal volume is the volume of air
moved in and out of the lungs
during each ventilation cycle. At
rest, tidal volume is about 0.5 L,
approximately 10% of vital capacity.
The lung volumes and capacities in the normal adult. Lung capacity is the
sum of two or more volumes. (From Guyton AC, Hall JE: Textbook of
medical physiology, ed 10, Philadelphia, 2000, Saunders.)
VENTILATION: THE LUNG VOLUMES AND CAPACITIES IN THE
NORMAL ADULT.
VENTILATION: THE MUSCULAR MECHANICS OF INSPIRATION AND
ANALOGY USING BOYLE’S LAW.
VENTILATION: STRUCTURES, CAVITIES AND PRESSURES.
VENTILATION: MECHANICS OF THE INSPIRATION.
VENTILATION: MECHANICS OF THE EXPIRATION.
Function, especially ventilatory function, can be affected when
pathology interferes with the structure of the bony thorax.
Advanced age
Increased stiffness
Reduced compliance
Elastic recoil loss.
Diseases or abnormal postures.
Muscular dystrophy
Inflammation of the muscles
A complete spinal cord lesion at
the T4 level.
Peripheral nerve damage
Myasthenia gravis
Rheumatoid arthritis
Scoliosis or kyphosis
Factors That Can Oppose
Expansion of the Thorax
SHAPHE OF THE CHEST: RIB
CAGE DISFUNCTIONS.
SHAPHE OF THE CHEST: RIB
CAGE DISFUNCTIONS.
SHAPHE OF THE SPINE: RIB CAGE
DISFUNCTIONS.
SHAPHE OF THE SPINE: RIB CAGE
DISFUNCTIONS.
Function, especially ventilatory function, can be affected when
pathology interferes with the structure of the bony thorax.
RIB CAGE DYSFUNCTIONS
Heimlich’s maneuver.
THE COUGH: PHYSIOLOGY, MECHANISM AND
HEIMLICH’S MANEUVER.
Mary Nasser is a 12-year-old who is trying out for her town’s tennis team. This
is the first time she has ever really played tennis beyond lessons in childhood.
She began to have complaints of shortness of breath with portions of practice
that involved a high level of exertion. She saw her primary care physician, who
picked up evidence of a scoliosis (curvature of the spine) in her initial
screening. Spine radiographs were done, and Mary was diagnosed with an
idiopathic right thoracic scoliosis, with a 40° angle. A medical workup was
negative for an acute pulmonary process. Mary was referred to an orthopedic
surgeon and to physical therapy for management of the scoliosis and shortness
of breath.
PATIENT CASE
