Osteopathic Diagnosis of the Ribs

The chest wall consists of skin, fat, muscles, bones, and cartilage. The bony structure of the chest wall is composed of the ribs, sternum, and thoracic vertebrae. The chest wall serves as armor for the vital intrathoracic organs and provides the stability necessary for the movement of the shoulders and arms. The interconnections between the bones, cartilage, and muscles allow for the rhythmic expansion and reduction of the chest wall during breathing, which facilitates changes in intrathoracic pressure to allow expansion of the lungs during inspiration. The extrinsic muscles have 2 bony attachments; the intrinsic muscles only attach to the thoracic skeleton.

The shoulder complex comprises the glenohumeral joint, sternoclavicular joint, acromioclavicular joint, and the scapulothoracic articulation, and connects the upper limb to the trunk. This group of joints consists of the clavicle, scapula, and humerus bones, multiple muscles and supporting ligaments, cartilage, and bursae. The muscles ensure the mobility and stability of the shoulder and upper limb and are divided into 3 groups: anterior axioappendicular, posterior axioappendicular, and scapulohumeral muscles.