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Assessment – Nutrition-Focused Physical Exam to Detect Macronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Similarly, the external intercostal muscles can be inspected with the patient in the sitting position. Intercostal muscles lie in the intercostal spaces between the ribs. Inspect the thoracic region for protruding ribs and depressions between the ribs. A severe depression between the ribs may indicate muscle loss. Palpate the muscles between the ribs with the index finger to identify whether loss of chest wall muscle mass is apparent. In well-nourished patients, the chest muscles will be well-defined with no apparent depressions. In severely malnourished patients, the apparent depression between ribs will be visible and can be felt on palpation.
Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
MND commonly starts with progressive weakness, wasting and fasciculation of initially one but later all four limbs. Reflexes are brisk, with increased tone, clonus and extensor plantars. This combination of upper and lower motor neurone features in the absence of sensory changes is strongly suggestive of MND. There may be slurred speech, difficulty swallowing, choking, and nasal regurgitation of food and fluid due to bulbar involvement, with increased jaw jerk, and a slow, stiff, waster fasciculating tongue. Involvement of the intercostal muscles and the diaphragm may lead to type II respiratory failure. There may be wasting and fasciculation of the intercostal muscles.
Basic medicine: physiology
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
The main muscle of respiration is the diaphragm which forms a continuous sheet separating the chest and abdominal cavities* Most quiet breathing is effected by the diaphragm, but during exercise or chest disease, when increased inspiratory effort is required, extra muscles can be recruited. Chief among these are the intercostal muscles which run between the ribs. Respiratory capacity is measured by a process termed spirometry; the subject breathes in and out through a tube connected to a gas chamber, with a floating drum in the chamber to record the volume of air moved. The vital capacity or maximum volume expelled after a deep inspiration is about 4.5 litres in healthy individuals.
“Undercutting of the corresponding rib”: a novel technique of increasing the length of donor in intercostal to musculocutaneous nerve transfer in brachial plexus injury
Published in British Journal of Neurosurgery, 2023
Kuntal Kanti Das, Jeena Joseph, Jaskaran Singh Gosal, Deepak Khatri, Pawan Verma, Awadhesh K Jaiswal, Arun K Srivastava, Sanjay Behari
Intercoastal nerves are frequently used for neurotization procedures in brachial plexus injuries. Due to a number of concerns, the upper intercostal nerves T3-T5 are favored as donors. The upper intercostal nerves (T3-T6) run parallel to the corresponding ribs in between the middle and the innermost intercostal muscles. For musculocutaneous nerve neurotization, ICNS 3rd to 5th are used as these 3 nerves combined not only provide a perfect size match but also the requisite number of motor axon available in these otherwise mixed nerves.6,7 The intercostal nerves are harvested starting proximally from the anterior axillary line, from the point of origin of serratus anterior muscle digitations to the costochondral junction distally. The general recommendation is to dissect as distally as possible to have a long donor nerve. However, the ICN becomes thinner as it moves towards the midline, with most of the motor branches leaving the nerve to supply the muscles. More proximally, the ICN remains hidden beneath the rib in the costal groove, which is itself covered by serratus anterior digitations. This anatomical fact was utilized by us and undercutting of the rib provided us with a few extra centimeters of ICN to obtain a tensionless co-aptation of ICN-MCN (Figure 3(B)).
The rationale of applying inspiratory/expiratory muscle training within the same respiratory cycle in children with bronchial asthma: a placebo-controlled randomized clinical investigation
Published in Journal of Asthma, 2023
Ragab K. Elnaggar, Ahmad M. Osailan, Mohammed F. Elbanna
The mechanism whereby the In/Ex-SC training improved the measured outcomes remains unclear. However, several hypotheses may explain the advantageous effects associated with the combined respiratory training. First, learned response – a reaction that occurred as a consequence of the inspiratory/expiratory stimuli, could have resulted in an improved neuromuscular recruitment pattern [33], which may explain the large improvement in respiratory muscle strength over the 12-week training. Second, perceptual adaptation to additional inspiratory and expiratory loading may have also contributed to the enhanced respiratory muscle strength [34]. Third, the adaptive changes in the structure of the diaphragm (i.e. increased cross-sectional area) and intercostal muscles (increased fiber size and proportion of Type II fibers) may have enabled these muscles to create greater forces responding to certain levels of respiratory muscle drive [34–36]. Fourth, the recruitment of abdominal muscles during the expiratory phase may have helped to preserve the diaphragm’s length and force-generating capacity for the onset of inspiration [15], and directly increased the efficiency of expiratory muscles. Eventually, improved pulmonary functions (FEV1, FVC, and FEV1/FVC) and asthma symptoms may have resulted from a greater contribution of the enhanced respiratory muscle strength, which probably led to increased thoracic excursion and reduced energy cost of breathing [36,37], thereby increased lung volumes and mitigated asthma symptoms.
A randomized placebo-controlled study investigating the efficacy of inspiratory muscle training in the treatment of children with bronchial asthma
Published in Journal of Asthma, 2021
The IMT group exhibited greater increases in the IPmax and EPmax, denoting a higher acquisition of respiratory muscle strength. These results were consistent with those of previous studies including pediatric patients (20) and adult patients (7,14,16,17,29,33–35) suffering from bronchial asthma, where uniform improvements of respiratory muscles strength have been demonstrated. On the contrary, we found only one randomized clinical trial including 18 subjects with stable mild/moderate asthma pointed out there was no difference between the IMT group and the age- and gender-matched control group for the EPmax and asthma symptoms (37). The improvement in respiratory muscle strength herein might be attributed to an improved neuromuscular recruitment pattern of respiratory musculature, and increased diaphragm cross-sectional area, and increased type II muscle fibers in the external intercostal muscles, permitting them to generate higher forces in response to a given level of respiratory muscle drive (38,39). Also, reduced energy costs of respiratory muscles may represent another plausible explanation for improvements in respiratory muscle strength and endurance (40).