Dr.

Vaishali Sanjay Mandhana

Asso.Prof.(Anatomy)
MBBS,DCP,MD.
 Introduction

 Respiration-2 Phases
 Inspiration-Active Process
 1 sec. in quiet breathing
 Expiration-Mostly Passive (In quiet
breathing)
 For 3 sec.
 RR
 16-20 / min.-in adults.
 25-30 / min. – in children.
 30-40/ min.- in infants.
 For Inspiration we want to
increase

 1.AP diameter of the thoracic

cage.
 2.Transverse diameter of
thoracic cage.
 The above 2 are increased by rib
movements.
 3.Vertical diameter of thoracic
cage
 It is increased by contraction of
diaphragm.
Principles of Movements

 The Respiratory movements

occure because of some
peculiarities of ribs.
 Factors increasing AP Dia.
 1.Ribs act as a lever.
 Its fulcrum is just lateral to the
tubercle.
 Hence 2 unequal segments
 Slight movements at posterior
end causes magnified movement
at anterior end.
 2.Anterior end at lower level than
Posterior end.
 Hence during elevation of the rib
anterior end also moves forward.
 Hence AP diameter is increased
due to up and down movement of
Ribs(more due to 2-6th rib)
 This is pump handle movement.
 Factors increasing Transverse
Dia
 3.Shaft lies at lower level than
both the ends.
 So during elevation of the Ribs,
shaft moves outward ,more
prominently in 7-10th ribs (2-
10th ribs)
 This is bucket handle movement.
 4.Thoracic cage as a cone.
 Hence during elevation of
ribs,lower larger rib occupies
the position of upper smaller
rib.
 This increases the transverse
diameter.
 Movements of the Ribs

 Pump handle movement.

 Bucket handle movement.

 Line of the axis of movement

passes through costotransverse
joint, costovertebral joint and
contralateral costochondral
joint.
Movements of the Ribs

 Pump handle movement

 Increases A.P.diameter

 Occurs primarily at 2nd - 6th

rib.

 Movement occurs at
costovertebral joint.
Pump Handle Movement
Movement of the Ribs

 Bucket handle movement

 Increases transverse
diameter.

 Occurs primarily in 7th-10th

rib.

 Movement occurs at
costotransverse joint.
Bucket Handle Movement
WHY STERNAL ANGLE IS
PRODUCED?
 Movement of the sternum
 Direction of 2nd to 6th ribs &
cartilage is downward n medially.
 Their elevation moves the body of
sternum forward.
 7th to 10th ribs directed downward
n forward but their cartilages are
directed upward n medially.
 Their elevation moves the body of
sternum backward
Hence body of sternum shows
Forward movement—with 2nd to
6th ribs and……
Backward movement—with7th to
10th cartilages .

This forward and backward

movement produces sternal
angle.
 Muscles of Inspiration

 Diaphragm
 2/3 in quiet breathing.
 Only Muscle in neonats and infants
 Intercostal Muscles
 1 cm. circumference – 200 ml. air. Sucked
 Lower mus.-in quiet inspiration-EMG.
 Upper mus.-in deep inspiration-EMG.
 Erector spinae
 Straightening the thoracic part of v.column.
 Scalani & Sternocledomastoid Mus.
 Elevates 1st rib (Deep Insp.)
 Pectoral Mus.& Serratus Anterior Mus.
 Act in forced inspiration.
 Quadratus Lumborum.
 Fixes the last rib.
External and Internal Intercostal Muscles
Muscles of Expiration
 Elastic Recoil of the lung.

 Muscles of Anterior Abdominal

Wall.

 Latissmus Dorsi mus.

Role of Diaphragm
 Contraction of Diaphragm –piston
movement.
 Lower Ribs fixed and Vault Desends.
 Ant. Abd. Wall bulges.
 Central Tendon becomes fixed.
 Further contraction elevates lower ribs
 Range of Movement
 1.5 cms. in quiet breathing..
 Surface area of Diaphragm = 270 sq.cm
 1.5 cm descent = increases 400 cc volume
 4th to 5th costal cartilage after forced
expiration.
 6-10cm descend in forceful inspiration
 i.e. Goes upto11th to 12th vertebra.
 Position of Diaphragm
 Highest in supine position.
 Then in erect position.
 Lowest in sitting position.
 Higher on that side on which the body lies.
Summery

 Quiet Inspiration
 AP Diameter-2-6 ribs.(1st rib fixed)
 Transverse Diameter-7-10 ribs.
 Vertical Diameter-Diaphragm
 Deep Inspiration
 Above movements Increased.
 Scalani & Sternocledomastoid(for 1st rib)
 Erector spinae(reduces concavity of spine
 Forced Inspiration
 Above movements exagerated
 Trapezius Levator scapulae Rhomboidus
elevate & fix the scapulae. Seratus ant.&
pectoralis minor act on ribs
 Erector spinae action exagerated.
Summery…

 Quiet Expiration
 Elastic Recoil

 Deep/Forceful Expiration
 Abdominal Muscles
 Latissmus Dorsi
Applied Anatomy
 Dyspnoea-Difficulty in
breathing.
 Respiratory Diseases
 Restrictive-Asthma,Status
Asthmaticus
 Obstructive-COPD.
 Phrenic Nerve injury-
 Paralysis of Hemi diaphragm.
 Plural effusion-
dyspnoea,collapse of lungs.
 Pnumothorax-open/tension
Applied Anatomy
 Pigeon Chest Deformity. (Pectus
Carinatum)

 Funnel chest Deformity. (Pectus

Excavetum)

 Barrel Chest Deformity.

 Flail Chest Deformity-Several

Rib # paradoxical movement of
chest wall.
Pigeon Chest Deformity Funnel chest Deformity
Barrel Chest Deformity
Joints of Thoracic Cage
Joints of Thoracic cage
 Manubrio-sternal Joint.
 Secondary cartilagenous jt.
 Angular and AP movements.
 2nd -6th Ribs moves it forward.
 7th – 10th Ribs move it backward.
 Xiphi-sternal Joint.
 Primary cartilagenous Jt.(no movements.)
 Costovertebral Joint.
 Rib with own vertebra & higher vertebra.
 Plain synovial joint.
 Lig.-Intra articular
 Capsular
 Triradiate(forms hypo chordal bow)

 Movement-Pump handle movement.(2nd-6th Rib).

Joints of Thoracic cage…
 Costotransverse Joint.
 Synovial jt.
 Lig. -Superior costotransverse
 -Inferior costotransverse
 -Lateral costotransverse
 Movement-Bucket handle(7th-10th rib)
 Costochondral Joint.
 Primary cartilagenous-No movement.
 Chondro-sternal Joint.
 1st-Primary cartilagenous
 2nd-7th Synovial jt.
 Inter-Chondral Joint.
 Synovial jt.
Costochondral Joint & Chondro-sternal Joint.
Joints of Thoracic cage…
 Inter-Vertebral Joint.
 2 joints with articular facets-Zygapophysial jt.
 Body of vertebras-Secondary cartilegenous jt.
 Intervertebral Disc
 Annulus fibrosus
 Nucleus Pulposus(Ramnant of notocord)

 Ligaments.
 .-Ant.Longitudinal lig.
 -Post. Longitudinal lig.
 -Intertransverse lig.
 -Interspinous lig.
 -Supraspinous lig.
 -Ligamenta flava
 Movements-Flexion –Cervical and Lumbar V.
 -Extension –Cervical and Lumbar V.
 -Lat.Flexion-
 -Rotation Thoracic V.
Joints of thorax
 Sternoclavicular joint
 Saddle type-
synovial,compound,complex jt.
 Lig.-capsule
 Articular disc.
 Interclavicular lig.
 Costoclavicular lig
Inter-Vertebral Joint.
Inter-Vertebral Joint.