The rib cage in normal and emphysematous subjects: a roentgenographic approach

The configuration and motion of the bony rib cage were studied from lateral chest roentgenograms in 10 young normal subjects (YN), 12 elderly normal subjects, and 12 hyperinflated emphysematous patients [chronic obstructive pulmonary disease subjects (COPD), mean total lung capacity (TLC) 133% of predicted]. The acute angles formed by the fourth through seventh ribs with an axial reference plane were measured at residual volume, functional residual capacity, and TLC in both supine and standing positions and correlated with corresponding lung volumes. both rib angles (RA) and changes in RA with lung volume were greatest with the fourth rib and decreased progressively going down (caudad) the chest. At TLC the RA of upper ribs was significantly less in EN and significantly greater in COPD than in YN. RA's were greater supine than standing. When RA information was used together with autopsy data on the angles formed by intercostal muscles with adjacent ribs, intercostal muscle lengths in hyperinflation could be calculated. Computed intercostal muscle length data suggested that hyperinflation should not be associated with degrees of intercostal muscle shortening or overstretching, that would interfere seriously with tension generation.     

Action of neck accessory muscles on rib cage in dogs

To investigate the action of the neck accessory muscles on the rib cage, we stimulated the sternocleidomastoid and the scalenus muscles separately in supine anesthetized dogs. Hooks screwed into the sternum and ribs were used to measure their axial displacements and the changes in anteroposterior (AP) and transverse (T) diameters of the rib cage. We found that the sternocleidomastoid and scalenus muscles, when they contract alone, cause a large axial displacement of the sternum and the ribs in a cephalad direction and expand the rib cage along both its AP and T diameters. Opening the abdomen increased the cephalad displacement of the ribs and the expansion of the lower rib cage, particularly along its T diameter, but reduced the increase in lung volume. These experiments indicate 1) that the action of the sternocleidomastoid and scalenus muscles on the rib cage is essentially the consequence of a rotation of the ribs' neck axes, resulting from the cephalad displacement of the ribs, and 2) that the fall in abdominal pressure, almost certainly by acting through the zone of apposition of the diaphragm to the rib cage, has a deflationary action on the lower rib cage, more markedly so on its lateral than its anterior wall. The experiments also suggest that the fall in abdominal pressure prevents the diaphragm from moving cephalad and aids the neck accessory muscles in inflating the lungs.     

Role of rib cage elastance in the coupling between the abdominal muscles and the lung.

The abdominal muscles expand the rib cage when they contract alone. This expansion opposes the deflation of the lung and may be viewed as pressure dissipation. The hypothesis was raised, therefore, that alterations in rib cage elastance should affect the lung deflating action of these muscles. To test this hypothesis and evaluate the quantitative importance of this effect, we measured the changes in airway opening pressure (Pao), abdominal pressure (Pab), and rib cage transverse diameter during isolated stimulation of the transversus abdominis muscle in anesthetized dogs, first with the rib cage intact and then after rib cage elastance was increased by clamping the ribs and the sternum. Stimulation produced increases in Pao, Pab, and rib cage diameter in both conditions. With the ribs and sternum clamped, however, the change in Pab was unchanged but the change in Pao was increased by 77% (P < 0.001). In a second experiment, the transversus abdominis was stimulated before and after rib cage elastance was reduced by removing the bony ribs 3-8. Although the change in Pab after removal of the the ribs was still unchanged, the change in Pao was reduced by 62% (P < 0.001). These observations, supported by a model analysis, indicate that rib cage elastance is a major determinant of the mechanical coupling between the abdominal muscles and the lung. In fact, in the dog, the effects of rib cage elastance and Pab on the lung-deflating action of the abdominal muscles are of the same order of magnitude.     

Elastostatic analysis of the human thoracic skeleton

An elastostatic, finite element model (designated THORAX I) of the human thoracic skeleton has been developed. The model includes the primary load-carrying members of the thorax; namely, the sternum, costal cartilage, ribs, and vertebral column. The soft tissue has been neglected.

Using gross geometric data measured from a skeleton with an apparent ‘small’ frame and approximate cross-sectional properties, the THORAX I model has been subjected to three loading distribution applied to the anterior chest wall in the anterior-posterior direction. Calculations were carried out on the IBM 7094 computer, and primary attention was focused upon the displacement fields of the sternum, costal cartilage and ribs and stresses in costal cartilage and ribs. The sternum and rib nodal point displacement fields are reported in detail, and a simple 2-degree-of-freedom model for the sternum, which correlates well with the analytic results, is also presented. Maximum normal stresses in the cartilage and bony regions of the individual ribs for one loading condition are also given.     

Adaptive modeling of the human rib cage in median sternotomy

This paper describes a limited computer-analyzed kinematic model of the rib cage that can be adapted to individual subjects. Also described is its validation and use in assessing the changes in chest wall shape after coronary artery bypass graft (CABG) surgery in 12 patients. The positions of a small number of anatomic locations on the thoracic spine, ribs, manubrium, and sternum are measured from lateral and posterior-anterior chest radiographs. The computer program puts these two views together removing the magnification and reconstructs any missing points to give a three-dimensional picture of the rib cage to which mathematical models of the bones are scaled. The patients had chest radiographs taken at total lung capacity (TLC) and residual volume (RV) to investigate the source of the restrictive ventilatory defect that follows CABG. The predictions from the model were tested by comparing full-sized computer plots with the actual chest radiographs. The estimates of the bony structures were accurate to +/- 3 degrees for orientations and +/- 6 mm for positions. We found reduced rib motion both "pump-handle" (theta) and "bucket handle" (psi) going from theta, psi left, psi right = 9 degrees, 10 degrees, 14 degrees to 4 degrees, 10 degrees, 9 degrees, respectively, after surgery with P less than 0.025, 0.42, 0.07. The angles were measured from the horizontal and increased caudally. There was also reduction in the range of angles subtended by the arc of the thoracic vertebrae between TLC and RV, which went from 12 degrees to -1 degrees (P less than 0.015). These data explain the fall in lung volumes that follow CABG and provide insight into the contribution made by the ribs and spine in full inspiration and full expiration.     

An analysis of possible movements of human upper rib cage

A geometrically realistic mathematical model of the first six ribs and vertebrae of the human rib cage is described. Under the assumption that the individual elements of the rib cage do not deform significantly, the possible range of movements of the model are determined subject to the constraint that the joint surfaces remain in contact. It is shown that normal movements of the ribs cannot be described as a rotation about a single fixed axis. The possible movements of the ribs are analyzed in terms of the misfit incurred at the costovertebral joint surfaces. This analysis shows that there is a movement, corresponding to lateral expansion of the rib for an increase in anteroposterior diameter, in which the misfit at the joint is minimized and also that small deviations from this movement involve only very small degrees of misfit at the joint surfaces. It is concluded that many observed "deformations" of the chest wall can be explained by rigid ribs and normal movements at the costovertebral joints. The interaction between the ribs and the spine is analyzed. It is shown that there can be considerable independent movement of the sternum and the spine, thus allowing mobility of the spine without forcing concomitant movements of rib cage.     

Rib cage distortion during voluntary and involuntary breathing acts

We examined chest wall and rib cage configuration in seven normal subjects during a variety of breathing maneuvers. Magnetometers were used to measure lower rib cage anteroposterior, lower rib cage transverse, upper rib cage anteroposterior, and abdomen anteroposterior diameters. Changes of these diameters were recorded during voluntary maneuvers, rebreathing, reading, and "natural" breathing. Relative motion of the rib cage and abdomen was displayed with the rib cage represented by the product of its lower anteroposterior and transverse diameters. During spontaneous breathing the rib cage and chest wall are near their relaxation configuration. During chemically driven ventilation the chest wall and rib cage progressively depart from this configuration. Much greater distortions of the chest wall and rib cage occurred during some voluntary maneuvers. Additionally, esophageal pressure and gastric pressure were measured during voluntary distortion of the rib cage. Substantial changes in lower rib cage shape occurred during voluntary maneuvers when compared with spontaneous breaths at the same transmural pressure. We conclude that the unitary behavior of the rib cage in normal subjects requires muscle coordination.     

A model for studies of mechanical interactions between the human spine and rib cage

A three-dimensional mathematical model useful for studies of the mechanics of the human skeletal thorax is described. To construct this model, rib cage elements are incorporated into a previously reported model of the thoracolumbar spine. The vertebrae and bony portions of the ribs and sternum are idealized as rigid bodies. The behavior of the discs, ligaments and costal cartilages are modelled by deformable elements. Appropriate geometric and stiffness property data are assigned to the elements of the model. In constructing the model, it was found that the mechanical response of the costo-vertebral joint is strongly influenced by articulation geometry. Although rigid bodies were used to model calcified portions of the ribs, the model predicted rib cage deformations in close agreement with those measured experimentally. These studies indicate that the rigid body motion of calcified portions of the rib makes a major contribution to the deformation of the rib cage in response to certain types of loadings. Quantitative results are also reported on the roles the rib cage plays in bending responses of the spine, the lateral stability of the spine, and the production and correction of several scoliotic deformities.     

Effect of thoracoabdominal breathing patterns on inspiratory effort sensation

The present study examined the effects of elastase-induced emphysema on the structure of the external oblique and transverse abdominis muscles and a non-respiratory muscle, the extensor digitorum longus. Muscle structure was assessed from the cross-sectional area (CSA) and percent of individual fiber types in histochemically stained sections and from the number of sarcomeres arranged in series along the length of individual fibers. Data were obtained in eight hamsters with emphysema and nine saline-injected controls. In the normal (control) animals the external oblique was thicker but contained fewer sarcomeres than the transverse abdominis. Fiber size was similar in the two muscles. In the transverse abdominis the percents of fast-glycolytic and fast-oxidative fibers were greater and smaller, respectively, than in the external oblique. Lung volume of emphysematous hamsters was 168% of control values (P less than 0.001). In emphysematous compared with control animals, the CSA of fast-twitch fibers in the external oblique and transverse abdominis was significantly reduced. Fiber length and sarcomere number were significantly decreased in the transverse abdominis but not in the external oblique in emphysematous hamsters. In contrast, fiber size and composition of the extensor digitorum longus was similar in emphysematous and control animals. These data indicate that cellular responses of the ventilatory muscles to chronic hyperinflation and altered thoracic geometry induced by emphysema are not present in limb skeletal muscle. We speculate that changes in fiber length and CSA of fast fibers in the abdominal expiratory muscles reflect responses to chronic alterations in the mechanics of breathing that may affect muscle load, length, or the pattern of activity.     

Passive mechanics of upright human chest wall during immersion from hips to neck

We have determined the mechanical effects of immersion to the neck on the passive chest wall of seated upright humans. Repeated measurements were made at relaxed end expiration on four subjects. Changes in relaxed chest wall configuration were measured using magnetometers. Gastric and esophageal pressures were measured with balloon-tipped catheters in three subjects; from these, transdiaphragmatic pressure was calculated. Transabdominal pressure was estimated using a fluid-filled, open-tipped catheter referenced to the abdomen's exterior vertical surface. We found that immersion progressively reduced mean transabdominal pressure to near zero and that the relaxed abdominal wall was moved inward 3-4 cm. The viscera were displaced upward into the thorax, gastric pressure increased by 20 cmH2O, and transdiaphragmatic pressure decreased by 10-15 cmH2O. This lengthened the diaphragm, elevating the diaphragmatic dome 3-4 cm. Esophageal pressure became progressively more positive throughout immersion, increasing by 8 cmH2O. The relaxed rib cage was elevated and expanded by raising water from hips to lower sternum; this passively shortened the inspiratory intercostals and the accessory muscles of inspiration. Deeper immersion distorted the thorax markedly: the upper rib cage was forced inward while lower rib cage shape was not systematically altered and the rib cage remained elevated. Such distortion may have passively lengthened or shortened the inspiratory muscles of the rib cage, depending on their location. We conclude that the nonuniform forcing produced by immersion provides unique insights into the mechanical characteristics of the abdomen and rib cage, that immersion-induced length changes differ among the inspiratory muscles according to their locations and the depth of immersion, and that such length changes may have implications for patients with inspiratory muscle deficits.     

On the respiratory function of the ribs.

To assess the respiratory function of the ribs, we measured the changes in airway opening pressure (Pao) induced by stimulation of the parasternal and external intercostal muscles in anesthetized dogs, first before and then after the bony ribs were removed from both sides of the chest. Stimulating either set of muscles with the rib cage intact elicited a fall in Pao in all animals. After removal of the ribs, however, the fall in Pao produced by the parasternal intercostals was reduced by 60% and the fall produced by the external intercostals was eliminated. The normal outward curvature of the rib cage was also abolished in this condition, and when the curvature was restored by a small inflation, external intercostal stimulation consistently elicited a rise rather than a fall in Pao. These findings thus confirm that the ribs play a critical role in the act of breathing by converting intercostal muscle shortening into lung volume expansion. In addition, they carry the compression that is required to balance the pressure difference across the chest wall.     

Length-tension relationship of abdominal expiratory muscles: effect of emphysema

The present study examined the active and passive length-tension relationship of the abdominal expiratory muscles in vitro during electrically stimulated contractions. Studies were performed on isolated strips of transverse abdominis and external oblique muscle from nine adult hamsters with normal lung function. The effect of chronic hyperinflation on the two muscles was assessed in eight hamsters with elastase-induced emphysema. In normal animals the maximal active tension per cross-sectional area (Po) was equal in the two muscles. The absolute muscle fiber length at which Po occurred (Lo) was less for the external oblique than the transverse abdominis and the length-tension curve operated at shorter fiber lengths. However, the change in tension produced by an increase or decrease in muscle length expressed in relative terms (i.e., as %Lo) was greater for the transverse abdominis than the external oblique. Mean total lung capacity of emphysematous animals was 198% of control. Po of the transverse abdominis and external oblique were the same in emphysematous and control animals. However, Lo and the length-tension curve of the transverse abdominis occurred at shorter fiber lengths in emphysematous animals because of a reduction in the number of sarcomeres in series along the fiber. The length-tension curve and the number of sarcomeres in the external oblique was the same in emphysematous and control animals. These results in normal animals indicate that the magnitude of the change in active and passive tension produced by a change in muscle length differs in the transverse abdominis and external oblique. Moreover, chronic hyperinflation of the thorax produced by elastase injection alters the length-tension relationships of some but not all the expiratory muscles.     

Dynamic behavior of excised dog rib cage: dependence on muscle

To assess the contribution of the rib cage to chest wall elastance and hysteresis, we measured force-displacement behavior of the isolated canine rib cage during sinusoidal forcing of the sternum in the midsagittal plane at low frequencies (0.02-2.0 Hz). Elastance of the rib cage was nearly invariant with frequency of forcing from 0.02 to 1.0 Hz and decreased with increasing amplitude. Hysteresis, the width of the force-displacement loop at middisplacement (zero displacement), was nearly constant with frequency below 1.0 Hz and increased with increasing amplitude of forcing. Removal of muscle reduced elastance and hysteresis of the rib cage substantially. The data suggest that the excised dog rib cage shows dynamic behavior similar to that of the intact human rib cage and chest wall and that respiratory muscle is responsible for a major part of the behavior of the passive chest wall. We also calculated the major and minor stiffnesses in the sagittal plane, which differed by a factor of 3-11, and their directions lay close to the dorsoventral and cephalocaudal axes, respectively. Removal of muscle reduced the stiffnesses but did not change their directions. Thus, although respiratory muscles impede motion in the sagittal plane, they do not alter its pattern.     

Effect of respiratory muscle tension on lung volume.

The chest wall is modeled as a linear system for which the displacements of points on the chest wall are proportional to the forces that act on the chest wall, namely, airway opening pressure and active tension in the respiratory muscles. A standard theorem of mechanics, the Maxwell reciprocity theorem, is invoked to show that the effect of active muscle tension on lung volume, or airway pressure if the airway is closed, is proportional to the change of muscle length in the relaxation maneuver. This relation was tested experimentally. The shortening of the cranial-caudal distance between a rib pair and the sternum was measured during a relaxation maneuver. These data were used to predict the respiratory effect of forces applied to the ribs and sternum. To test this prediction, a cranial force was applied to the rib pair and a caudal force was applied to the sternum, simulating the forces applied by active tension in the parasternal intercostal muscles. The change in airway pressure, with lung volume held constant, was measured. The measured change in airway pressure agreed well with the prediction. In some dogs, nonlinear deviations from the linear prediction occurred at higher loads. The model and the theorem offer the promise that existing data on the configuration of the chest wall during the relaxation maneuver can be used to compute the mechanical advantage of the respiratory muscles.     

Chest wall mechanics during artificial ventilation.

Chest wall mechanics were studied in six healthy volunteers before and during anesthesia prior to surgery. The intratracheal, esophageal, and intragastric pressures were measured concurrently. Gas flow was measured by pneumotachography and gas volume was obtained from it by electrical integration. Rib cage and abdomen movements were registered with magnetometers, these being calibrated by "isovolume" maneuvers. During spontaneous breathing in the conscious state, rib cage volume displacement corresponded to 40% of the tidal volume. During anesthesia and artificial ventilation, this rose to 72% of the tidal volume. The relative contributions of rib cage and abdomen displacements were not influenced by a change in tidal volume. Compliance was higher with a larger tidal volume, a finding which could be due to a curved pressure-volume relationship of the overall chest wall.     

Shape of the chest wall in the prone and supine anesthetized dog

The shape of the passive chest wall of six anesthetized dogs was determined at total lung capacity (TLC) and functional residual capacity (FRC) in the prone and supine body positions by use of volumetric-computed tomographic images. The transverse cross-sectional areas of the rib cage, mediastinum, and diaphragm were calculated every 1.6 mm along the length of the thorax. The changes in the volume and the axial distribution of transverse area of the three chest wall components with lung volume and body position were evaluated. The decrease of the transverse area within the rib cage between TLC and FRC, as a fraction of the area at TLC, was uniform from the apex of the thorax to the base. The volume of the mediastinum increased slightly between TLC and FRC (14% of its TLC volume supine and 20% prone), squeezing the lung between it and the rib cage. In the transverse plane, the heart was positioned in the midthorax and moved little between TLC and FRC. The shape, position, and displacement of the diaphragm were described by contour plots. In both postures, the diaphragm was flatter at FRC than at TLC, because of larger displacements in the dorsal than in the ventral region of the diaphragm. Rotation from the prone to supine body position produced a lever motion of the diaphragm, displacing the dorsal portion of the diaphragm cephalad and the ventral portion caudad. In five of the six dogs, bilateral isovolume pneumothorax was induced in the supine body position while intrathoracic gas volume was held constant.(ABSTRACT TRUNCATED AT 250 WORDS)     

Triangularis sterni: a primary muscle of breathing in the dog

The isolated action, pattern of neural activation, and mechanical contribution to eupnea of the triangularis sterni (transversus thoracis) muscle were studied in supine anesthetized dogs. Linear displacement transducers were used to measure the axial displacements of the ribs and sternum. Tetanic stimulation of the triangularis sterni in the apneic animal caused a marked caudal displacement of the ribs, a moderate cranial displacement of the sternum, and a decrease in lung volume. During quiet breathing, there was invariably a rhythmic activation of the muscle in phase with expiration that was independent of the presence or absence of activity in the abdominal and internal interosseous intercostal muscles. This phasic expiratory activity in the triangularis sterni was of large amplitude and caused the ribs to be more caudal and the sternum to be more cranial during the spontaneous expiratory pause than during relaxation. Additional studies on awake animals showed that rhythmic activation of the triangularis sterni occurs in all body positions and is not caused by anesthesia. These findings indicate that expiration in the dog is not a passive process and that the end-expiratory volume of the rib cage is not determined by an equilibrium of static forces alone. Rather, it is actively determined and maintained below its relaxation volume by contraction of the triangularis sterni throughout expiration. The use of this muscle is likely to facilitate inspiration by increasing the length of the parasternal intercostals and taking on a portion of their work.     

Relationship between parasternal intercostal length and rib cage displacement in dogs

The relationship between parasternal intercostal length and rib cage cross-sectional area was examined in nine supine dogs during passive inflation and during quiet breathing before and after phrenicotomy. Parasternal intercostal length (PSL) was measured with a sonomicrometry technique, and rib cage cross-sectional area (Arc) was measured with a Respitrace coil placed around the middle rib cage. During active inspiration as well as during passive inflation, PSL decreased as Arc increased. However, the relationship between PSL and Arc during active inspiration, whether in the intact or phrenicotomized animal, was almost invariably different from that during passive inflation, so that the same increase in Arc was associated with a greater decrease in PSL in the former than in the latter instance. This difference between passive inflation and active inspiration is probably due to the active contraction of the parasternals during inspiration and the consequent caudal displacement of the sternum. In upright humans, the sternum moves cephalad and not caudad during inspiration, so the relationship between PSL and Arc during active breathing might be similar to that during passive inflation.     

Shape and size of the human diaphragm in vivo

Serial computerized tomograph (CT) sections at 5-mm intervals of a human diaphragm in relaxed and contracted states were obtained in one subject while he held his breath and lay supine in a CT scanner. All sections for one state were scanned at the same chest wall configuration as monitored by rib cage and abdominal dimensions, using magnetometers. Sections were scanned at relaxed functional residual capacity and after inspiring approximately 1 liter in such a way that rib cage dimensions increased only slightly. Models of the diaphragm dome in the two states were constructed from the sets of serial sections. Diaphragm length and volume displaced were measured, the zone of apposition of diaphragm to rib cage was mapped, and the line of the diaphragm silhouette in anteroposterior and lateral X-rays identified. Coronal and sagittal sections were constructed. In the inspiration studied, the diaphragm movement displaced 680 ml. Meridian lines in sagittal, coronal, and transverse directions over the right hemidiaphragm dome shortened by 6.7-7.2 cm, but over the left dome by only 4.0-4.3 cm. Lines of X-ray silhouettes were close to meridian lines, and estimates of shortening were similar to those made previously from X-rays. The peculiar saddle shape of the muscle may help the hemidiaphragms to operate independently, the fibers of the saddle acting as an anchor for midline directed fibers of the hemidiaphragm domes. The shape of the diaphragm also has implications for the distribution of transdiaphragmatic pressure and for the kind of distortion of the lower rib cage margin that is seen during inspirations at high lung volume.     

Oxygen cost of resistive-loaded breathing in quadriplegia.

We hypothesized that, in quadriplegia, chest wall distortion would increase the energy cost of ventilation. To assess this, we measured the oxygen cost of breathing (VO2 resp) and changes in chest wall configuration during inspiratory resistive-loaded breathing tasks in five quadriplegic and five normal subjects. Each subject performed three breathing tasks that spanned a range of work rates (Wtot). Configurational changes of the abdomen and upper, lower, and transverse rib cage were assessed with magnetometers. We found that 1) in both groups, VO2resp increased linearly with Wtot over the range of tasks performed, 2) the mean slope of the regression line of VO2resp vs. Wtot was greater for quadriplegic than for normal subjects (3.7 +/- 0.8 vs. 2.0 +/- 0.7 ml O2/J, P less than 0.01), 3) efficiency of breathing (Wtot/VO2resp) was less for quadriplegic than for normal subjects (1.9 +/- 0.6 vs. 3.5 +/- 1.4%, P less than 0.001), 4) during inhalation, upper and lower rib cages behaved similarly in the two groups, but the quadriplegic subjects had a decrease in transverse rib cage and a much greater increase in abdomen than normal subjects, and 5) functional residual capacity decreased in normal but not in quadriplegic subjects during the breathing tasks. We conclude that the lesser efficiency of breathing in quadriplegia may be related to the elastic work of chest wall distortion, shorter mean operational diaphragm length, and possibly differences between normal and quadriplegic subjects in mechanical advantage of available inspiratory muscles.