Dr.Vaishali Sanjay Mandhana
Asso.Prof.(Anatomy)
MBBS,DCP,MD.
Introduction
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Respiration-2 Phases
Inspiration-Active Process
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Expiration-Mostly Passive (In quiet
breathing)
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1 sec. in quiet breathing
For 3 sec.
RR
16-20 / min.-in adults.
25-30 / min. – in children.
30-40/ min.- in infants.
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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
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The Respiratory movements
occure because of some
peculiarities of ribs.
Factors increasing AP Dia.
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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.
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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.
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Factors increasing Transverse
Dia
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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 (210th ribs)
This is bucket handle movement.
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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.
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Line of the axis of movement
passes through costotransverse
joint, costovertebral joint and
contralateral costochondral
joint.
Movements of the Ribs
 Pump
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handle movement
Increases A.P.diameter
Occurs primarily at 2nd - 6th
rib.
Movement occurs at
Pump Handle Movement
Movement of the Ribs
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Bucket handle movement
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Increases transverse
diameter.
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Occurs primarily in 7th-10th
rib.
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Movement occurs at
costotransverse joint.
Bucket Handle Movement
WHY STERNAL ANGLE IS
PRODUCED?
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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 .
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This forward and backward
movement produces sternal
angle.
Muscles of Inspiration
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Diaphragm
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Intercostal Muscles
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Elevates 1st rib (Deep Insp.)
Pectoral Mus.& Serratus Anterior Mus.
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Straightening the thoracic part of v.column.
Scalani & Sternocledomastoid Mus.
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1 cm. circumference – 200 ml. air. Sucked
Lower mus.-in quiet inspiration-EMG.
Upper mus.-in deep inspiration-EMG.
Erector spinae
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2/3 in quiet breathing.
Only Muscle in neonats and infants
Act in forced inspiration.
Quadratus Lumborum.
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Fixes the last rib.
External and Internal Intercostal Muscles
Muscles of Expiration
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Elastic Recoil of the lung.
Muscles of Anterior Abdominal
Wall.
Latissmus Dorsi mus.
Role of Diaphragm
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Contraction of Diaphragm –piston
movement.
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Range of Movement
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Lower Ribs fixed and Vault Desends.
Ant. Abd. Wall bulges.
Central Tendon becomes fixed.
Further contraction elevates lower ribs
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
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Highest in supine position.
Then in erect position.
Lowest in sitting position.
Higher on that side on which the body lies.
Summery
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Quiet Inspiration
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Deep Inspiration
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AP Diameter-2-6 ribs.(1st rib fixed)
Transverse Diameter-7-10 ribs.
Vertical Diameter-Diaphragm
Above movements Increased.
Scalani & Sternocledomastoid(for 1st rib)
Erector spinae(reduces concavity of spine
Forced Inspiration
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Above movements exagerated
Trapezius Levator scapulae Rhomboidus
elevate & fix the scapulae. Seratus ant.&
pectoralis minor act on ribs
Erector spinae action exagerated.
Summery…
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Quiet Expiration
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Elastic Recoil
Deep/Forceful Expiration
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Abdominal Muscles
Latissmus Dorsi
Applied Anatomy
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Dyspnoea-Difficulty in
breathing.
Respiratory Diseases
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Restrictive-Asthma,Status
Asthmaticus
Obstructive-COPD.
Phrenic Nerve injuryParalysis of Hemi diaphragm.
Plural effusiondyspnoea,collapse of lungs.
Pnumothorax-open/tension
Applied Anatomy
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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
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Manubrio-sternal Joint.
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Xiphi-sternal Joint.
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Secondary cartilagenous jt.
Angular and AP movements.
2nd -6th Ribs moves it forward.
7th – 10th Ribs move it backward.
Primary cartilagenous Jt.(no movements.)
Costovertebral Joint.
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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…
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Costotransverse Joint.
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Costochondral Joint.
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Primary cartilagenous-No movement.
Chondro-sternal Joint.
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Synovial jt.
Lig. -Superior costotransverse
-Inferior costotransverse
-Lateral costotransverse
Movement-Bucket handle(7th-10th rib)
1st-Primary cartilagenous
2nd-7th Synovial jt.
Inter-Chondral Joint.
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Synovial jt.
Costochondral Joint & Chondro-sternal Joint.
Joints of Thoracic cage…
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Inter-Vertebral Joint.
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Intervertebral Disc
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2 joints with articular facets-Zygapophysial jt.
Body of vertebras-Secondary cartilegenous jt.
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
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Sternoclavicular joint
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Saddle typesynovial,compound,complex jt.
Lig.-capsule
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Articular disc.
Interclavicular lig.
Costoclavicular lig
Inter-Vertebral Joint.
Inter-Vertebral Joint.