Title: Bone Wizardry / OMM Mastery / 3.Thorax and Ribcage
Tags: #BW_OMM::Region::Thorax_Ribs #BW_OMM::Type::Cloze BoneWizardry bonewizardry-free omm omt #ribs #motion #dysfunction #Atypical #RuleOf3 #Thoracic #Typical # #False #Floating #SP #True #diaphragm #exhalation #inhalation TP
On every note of this deck, unless a note says otherwise:
Review Links: - Bone Wizardry rib mechanics
- Practice: Thorax and Ribs QBank
Show outside sources
- Inhaled rib dysfunction
- MET for exhaled ribs
- MET for thoracic restriction
- HVLA thoracic vertebrae

Q: From T1 to T3, the spinous process lines up with its [...] transverse process.
A: corresponding
Q: From T4 to T6, the spinous process drops [...] a segment [...] the matching transverse process.
A: one-half; below
Q: From T7 to T9, the spinous process sits at the transverse process of the vertebra [...]
A: below
Q: The T10 spinous process behaves like the spinous processes of [...].
A: T7-T9
Q: The T11 spinous process behaves like the spinous processes of [...].
A: T4-T6
Q: The T12 spinous process behaves like the spinous processes of [...].
A: T1-T3
Comment: For example, the spinous process of T2 is located at the transverse process of T2.
Comment 2: For example, the spinous process of T5 is located halfway between the transverse processes of T5 and T6.
Comment 3: For example, the spinous process of T8 is at the level of T9's transverse process.
Comment 4: So it is located at the level of the transverse process below (i.e. T11).
Comment 5: So it is located halfway between the transverse process of T11 and T12.
Comment 6: So it is located at the level of the corresponding transverse process.
Topic: Thorax and Ribcage
Bone Wizardry Lock: T1-T3: SP aligns with its own TP. T4-T6: SP drops half a level. T7-T9: SP drops a full level. T10 behaves like T7-T9, T11 like T4-T6, T12 like T1-T3.

Q: The spine of the scapula corresponds with [...].
A: T3
Q: The inferior angle of the scapula corresponds with the spinous process of [...]
A: T7
Q: The sternal notch is level with [...].
A: T2
Q: The sternal angle (angle of Louis) attaches to the 2nd rib and is level with [...].
A: T4
Q: The sternal angle (angle of Louis) attaches to the [...] rib and is level with T4.
A: 2nd
Q: The nipple is at the [...] dermatome
A: T4
Q: The umbilicus is at the [...] dermatome
A: T10
Topic: Thorax and Ribcage
Bone Wizardry Lock: Spine of scapula = T3. Inferior scapular angle = T7. Sternal angle = T4 and marks rib 2. These landmarks let you count thoracic levels without imaging.

Q: The main motion of the thorax is [...].
A: rotation
Topic: Thorax and Ribcage
Bone Wizardry Lock: Thoracic facet orientation makes rotation the dominant motion. Sidebending and flexion-extension are secondary, which is why thoracic dysfunctions are named primarily by their rotation component.

Q: What nerve innervates the diaphragm?
[...]
A: Phrenic nerve (C3-C5)
Q: The diaphragm [...] with inspiration
A: contracts
Q: The diaphragm contracts with [...]
A: inspiration
Topic: Thorax and Ribcage
Bone Wizardry Lock: Phrenic nerve comes from C3, C4, and C5. Diaphragm contraction during inhalation flattens the dome and drops intrathoracic pressure. Exhalation at rest is passive recoil.

Q: A typical rib will have all of the following anatomical landmarks:
1. [...]
2. [...]
3. Tubercle
4. Angle
5. Shaft
A: Head; Neck
Q: A typical rib will have all of the following anatomical landmarks:
1. Head
2. Neck
3. [...]
4. Angle
5. Shaft
A: Tubercle
Q: The [...] of a rib articulates with the corresponding transverse process
A: tubercle
Q: The [...] of a rib articulates with the vertebra above and corresponding vertebra.
A: head
Topic: Thorax and Ribcage
Bone Wizardry Lock: The rib head articulates with two vertebral bodies: the one above and its own level. The tubercle articulates with the transverse process of the same-level vertebra. The angle is where the rib curves sharply and is the landmark for posterior palpation.

Q: Typical ribs: ribs [...]
A: 3-10
Q: [...] ribs: ribs 3-10
A: Typical
Topic: Thorax and Ribcage
Bone Wizardry Lock: Ribs 3-10 are typical because they have all five bony landmarks and full costovertebral plus costotransverse articulations. Knowing what typical looks like makes it easier to identify what each atypical rib lacks.

Atypical ribs: ribs 1, 2, 11, and 12
Q: [...] ribs: ribs 1, 2, 11, and 12
A: Atypical
Comment: Atypical ribs have 1's and 2's
Topic: Thorax and Ribcage
Bone Wizardry Lock: Ribs 1 and 2 are unusually shaped and have unique muscular attachments. Ribs 11 and 12 are floating, without anterior attachment to the sternum. Each atypical rib is missing features that ribs 3-10 share.

Q: Rib 1 is atypical because it articulates only with T1 and has no [...]
A: angle
Q: Rib 2 is atypical because it has a large tuberosity on the shaft for the [...]
A: serratus anterior
Q: Rib 11 and 12 are atypical because they articulate only with the corresponding [...] and lack [...]
A: vertebrae; tubercles
Q: Rib 10 is sometimes considered atypical because it articulates only with [...].
A: T10
Topic: Thorax and Ribcage
Bone Wizardry Lock: Rib diagnosis starts with breath. Inhaled ribs stay up; exhaled ribs stay down. BITE keeps the key rib straight: bottom inhaled, top exhaled.

Q: True ribs: ribs [...]
A: 1-7
Q: [...] ribs: ribs 1-7
A: True
Comment: Their costal cartilages connect directly to the sternum. That uninterrupted cartilage bridge is what earns ribs 1 through 7 the 'true' label.
Topic: Thorax and Ribcage
Bone Wizardry Lock: Rib diagnosis starts with breath. Inhaled ribs stay up; exhaled ribs stay down. BITE keeps the key rib straight: bottom inhaled, top exhaled.

Q: False ribs: ribs [...]
A: 8-12
Q: [...] ribs: ribs 8-12
A: False
Comment: Ribs 8 through 12 have no direct sternal connection. Ribs 8-10 borrow the costal cartilage of rib 7, while 11 and 12 have no anterior anchor at all. That missing sternal link is the 'false' defining feature.
Topic: Thorax and Ribcage
Bone Wizardry Lock: Rib diagnosis starts with breath. Inhaled ribs stay up; exhaled ribs stay down. BITE keeps the key rib straight: bottom inhaled, top exhaled.

Q: Floating ribs: ribs [...]
A: 11 and 12
Q: [...] ribs: ribs 11 and 12
A: Floating
Comment: Ribs 8-10 are also false ribs, but they attach to rib 7's costal cartilage. Ribs 11 and 12 skip that entirely. No anterior attachment at all is what earns them the 'floating' subcategory.
Topic: Thorax and Ribcage
Bone Wizardry Lock: Rib diagnosis starts with breath. Inhaled ribs stay up; exhaled ribs stay down. BITE keeps the key rib straight: bottom inhaled, top exhaled.

Q: The upper ribs (ribs 1-5) move primarily in a [...] motion.
A: pump-handle
Q: The [...] ribs (ribs [...]) move primarily in a pump-handle motion.
A: upper; 1-5
Q: The middle ribs (ribs 6-10) move primarily in a [...] motion.
A: bucket-handle
Q: The [...] ribs (ribs [...]) move primarily in a bucket-handle motion.
A: middle; 6-10
Q: The lower ribs (ribs 11 and 12) move primarily in a [...] motion.
A: caliper
Q: The [...] ribs (ribs [...]) move primarily in a caliper motion.
A: lower; 11 and 12
Topic: Thorax and Ribcage
Bone Wizardry Lock: Rib diagnosis starts with breath. Inhaled ribs stay up; exhaled ribs stay down. BITE keeps the key rib straight: bottom inhaled, top exhaled.

Q: Inhalation dysfunction: the dysfunctional rib will move [...] during inhalation, however the dysfunctional rib will not move [...] during exhalation
A: cephalad; caudad
Q: [...] dysfunction: the dysfunctional rib will move cephalad during inhalation, however the dysfunctional rib will not move caudad during exhalation
A: Inhalation
Q: With pump-handle rib inhalation dysfunction, the elevated rib will be held [...]
A: anteriorly
Q: With bucket-handle rib inhalation dysfunction the rib will be elevated [...]
A: laterally
Comment: The rib will therefore appear to be held up
Topic: Thorax and Ribcage
Bone Wizardry Lock: Rib diagnosis starts with breath. Inhaled ribs stay up; exhaled ribs stay down. BITE keeps the key rib straight: bottom inhaled, top exhaled.

Q: Exhalation dysfunction: The dysfunctional rib will move [...] during exhalation, however the dysfunctional rib
will not move [...] during inhalation.
A: caudad; cephalad
Q: [...] dysfunction: The dysfunctional rib will move caudad during exhalation, however the dysfunctional rib
will not move cephalad during inhalation.
A: Exhalation
Topic: Thorax and Ribcage
Bone Wizardry Lock: Rib diagnosis starts with breath. Inhaled ribs stay up; exhaled ribs stay down. BITE keeps the key rib straight: bottom inhaled, top exhaled.

Q: The "[...]" rib is the rib that is responsible for causing the inhalation/exhalation rib dysfunction
A: key
Q: In inhalation dysfunctions the key rib is the [...] rib of the dysfunction.
A: lowest
Q: In [...] dysfunctions the key rib is the lowest rib of the dysfunction.
A: inhalation
Q: In exhalation dysfunctions the key rib is the [...] rib of the dysfunction.
A: uppermost
Q: In [...] dysfunctions the key rib is the uppermost rib of the dysfunction.
A: exhalation
Comment 2: BITE
Bottom = Inhaled
Top = Exhaled
Topic: Thorax and Ribcage
Bone Wizardry Lock: Rib diagnosis starts with breath. Inhaled ribs stay up; exhaled ribs stay down. BITE keeps the key rib straight: bottom inhaled, top exhaled.

Q: Using the rule of threes:
the TP of T5 is located halfway between the spinous process of [...] and [...]
A: T4; T5
Topic: Thorax and Ribcage
Bone Wizardry Lock: Rib diagnosis starts with breath. Inhaled ribs stay up; exhaled ribs stay down. BITE keeps the key rib straight: bottom inhaled, top exhaled.

Q: What muscle(s) do you use to treat rib 1 dysfunction?
[...]
A: Anterior/middle scalene
Q: What muscle(s) do you use to treat rib 2 dysfunction?
[...]
A: Posterior scalene
Q: What muscle(s) do you use to treat ribs 3-5 dysfunction?
[...]
A: Pec minor
Q: What muscle(s) do you use to treat ribs 9-10 dysfunction?
[...]
A: Latissimus dorsi
Q: What muscle(s) do you use to treat ribs 11 and 12 dysfunction?
[...]
A: Quadratus lumborum
Comment 3: Easy way to remember this is "Pec" has 3 letters, you use it to treat ribs 3-5 and there are 3 ribs that can be treated.
Topic: Thorax and Ribcage
Bone Wizardry Lock: Rib diagnosis starts with breath. Inhaled ribs stay up; exhaled ribs stay down. BITE keeps the key rib straight: bottom inhaled, top exhaled.