SternalisOrigin: 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 IntercostalsOrigin: 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 IntercostalsOrigin: 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 |
DiaphragmOrigin: 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 palpationSide lying/supine with knees bent and bolstered
Curl fingers on underside of ribs as patient exhales
External ObliquesOrigin: 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 ObliquesOrigin: 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
PyramidalisOrigin: Pubic Symphysis and Pubic Crest
Insertion: Linea Alba
Nerve: Subcostal Nerve (T12)
Actions: Tenses the Linea Alba
Rectus AbdominisOrigin: 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 abdominisOrigin: 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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