Sternalis
Origin: manubrium of sternum/clavicle
Insertion: Xiphoid process, pectoral fascia, lower ribs, costal cartilages or rectus sheath
Nerve: Medial and Lateral Pectoral Nerves C6-T1
Action: Unknown
TrPs
- Satellite Trps can develop from SCM
- Can mimic Chostochondritis/Tietzes
- Lower SCM + Pec major needs to be treated with Sternalis
External Intercostals
Origin: Tubercles of the ribs, posterior fibres of superior costotransverse ligaments, external intercostal membrane, lower border of one rib
Insertion: Upper border of the rib below, free ends of the costal carilages
Nerve: Adjacent Intercostal nerves
Action: Stiffens chest wall - prevents paradoxical motion during descent of the diaphragm in inspiration
External Intercostals - Palpation
- Just inferior to pec major on rib cage
- Roll finger across rib space
- Pt takes several slow deep breaths
Internal Intercostals
Origin: Rib - Superior Border |
Insertion: Rib - Inferior border |
Nerve: Adjacent intercostal nerves |
Action: Holds ribs steady during expiration |
- Antagonist - External intercostal
Myofascial
- Intercostals have a postural role |
- Tx rotation can be limited by TrPs in intercostals |
- Raising arm above the head will be difficult in patients with intercostal TrPs due to pain |
- Intercostal TrPs may narrow the intercostal space enough for this to be palpated |
Diaphragm
Origin: Sternal: Back of the xiphoid process Costal: Internal surfaces of the lower 6 costal cartillages, interdigitations with Trasnverse Abdominis Lumbar: Medial and lateral arcuate ligaments
Nerve: Phrenic Nerve C3-5
Action: Respiration
Diaphragm palpation
Side lying/supine with knees bent and bolstered
Curl fingers on underside of ribs as patient exhales
External Obliques
Origin: Ribs 5-12
Insertion: Xiphoid Process, outer lip iliac crest, pubic crest, pubic tubercle, linea alba, inguinal ligament , ASIS
Nerve: Terminal Branches of lower five intercostal nerves + subcostal nerve from ventral rami of lower 6 tx spinal nerves
Action: Maintenance of abdominal tone, increasing intra-abdominal pressure and lateral flexion of the trunk against resistance
External Obliques - Palpation
Internal Obliques
Origin: Inguinal Ligament, iliac crest and lumbodorsal fascia
Insertion: Linea alba, Pectinal line of pubis, Ribs 10-12
Nerve: Thoracoabdominal (T7-T11), Subcostal (T12), Iliohypogastric (L1), Ilioinguninal (L1)
Action: Bilateral: Compresses abdomen (expiration) Unilateral: Ipsilateral Trunk Rotation
Pyramidalis
Origin: Pubic Symphysis and Pubic Crest
Insertion: Linea Alba
Nerve: Subcostal Nerve (T12)
Actions: Tenses the Linea Alba
Rectus Abdominis
Origin: Crest of Pubis
Insertion: Costal Cartilages of ribs 5-7 , Xiphoid process of sternum
Nerve: Thoracoabdominal nerves (T7-T11), Subcostal (T12)
Action: Flexion of Lumbar spine
Rectus Abdominis - Palpation
TrPs
- Lower Rectus and upper rectus can overlap
- Lower Rectus TrPs can increase pain in menstration
Transverse abdominis
Origin: Iliac Crest, Inguinal ligament, thoracolumbar fascia and costal cartilages 7-12
Insertion: Xiphoid Process, linea alba, pubic crest, pecten pubis
Nerve: Thoracoabdominal nerve (T6-T11), Subcostal (T12), iliohypogastric nerve (L1), Ilioinguinal nerve (L1)
Action: Compresses abdominal contents
Abdominal Pain of Myofascial Origin (APoMO)
Causes: Visceral Disease Acute Direct Trauma to Abdomen Chronic Trauma from Occupational or Postural Stresses Paradoxical Breathing Trauma/scarring from injury Structural Problems (LL inequality, scoliosis) Overuse of abdominals |
TrPs: Abdominal musculature, QL, Iliocostalis Thoracis, Multifidus, Iliospsoas, Adductors of the thigh |
- Can refer pain to the genitals/groin/back (entrapment of the anterior branch of the spinal nerve) |
Management: Rule out visceral causes, fascial release of scars, Home stretch (1-2 reps for 10 seconds), allow stomach to sag and take a deep breath, moist heat, self massage, diaphragmatic breathing |
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