FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 314:740-744 March 20, 1986 Number 12 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

Traumatic tetraplegia produces paralysis of all the well-recognized muscles of expiration. Yet, tetraplegic subjects usually have a small expiratory reserve volume on spirographic examination. To understand the mechanism that enables these patients to empty their lungs actively, we studied the pattern of chest-wall motion during voluntary expiration. We found negligible changes in abdominal dimension, but all subjects had a marked and reproducible decrease in the dimension of the upper rib cage. Electrical measurements established that the subjects had active use of the clavicular portion of the pectoralis major, and changing the orientation of these muscle fibers by maintaining the shoulders in abduction reduced their expiratory reserve volume by about 60 percent (P less than 0.001). We therefore conclude that the clavicular portion of the pectoralis major plays a crucial part in the mechanism of active expiration in tetraplegic subjects. Training of this muscle bundle could, by increasing its strength and endurance, improve the effectiveness of coughing in such subjects and perhaps diminish the prevalence of bronchopulmonary infections.

This article has been cited by other articles:

• Aboussouan, L. (2009). Mechanisms of exercise limitation and pulmonary rehabilitation for patients with neuromuscular disease. Chronic Respiratory Disease 6: 231-249 [Abstract]  
• DiMarco, A. F., Kowalski, K. E., Geertman, R. T., Hromyak, D. R. (2006). Spinal Cord Stimulation: A New Method to Produce an Effective Cough in Patients with Spinal Cord Injury. Am. J. Respir. Crit. Care Med. 173: 1386-1389 [Abstract] [Full Text]  
• Laghi, F., Tobin, M. J. (2003). Disorders of the Respiratory Muscles. Am. J. Respir. Crit. Care Med. 168: 10-48 [Abstract] [Full Text]  
• Lougheed, M. D., Flannery, J., Webb, K. A., O'Donnell, D. E. (2002). Respiratory Sensation and Ventilatory Mechanics during Induced Bronchoconstriction in Spontaneously Breathing Low Cervical Quadriplegia. Am. J. Respir. Crit. Care Med. 166: 370-376 [Abstract] [Full Text]  
• Baydur, A., Adkins, R. H., Milic-Emili, J. (2001). Lung mechanics in individuals with spinal cord injury: effects of injury level and posture. J. Appl. Physiol. 90: 405-411 [Abstract] [Full Text]  
• Rocco, G., Della Pona, C., Massera, F., Robustellini, M., Rossi, G., Rizzi, A. (2000). Lobectomy for destroyed lung in quadriplegic patients. Ann. Thorac. Surg. 69: 1002-1005 [Abstract] [Full Text]  
• ESTENNE, M., PINET, C., DE TROYER, A. (2000). Abdominal Muscle Strength in Patients with Tetraplegia. Am. J. Respir. Crit. Care Med. 161: 707-712 [Abstract] [Full Text]  
• Bolser, D. C., Reier, P. J. (1998). Inspiratory and expiratory patterns of the pectoralis major muscle during pulmonary defensive reflexes. J. Appl. Physiol. 85: 1786-1792 [Abstract] [Full Text]  
• ESTENNE, M., VAN MUYLEM, A., GORINI, M., KINNEAR, W., HEILPORN, A., DE TROYER, A. (1997). Effects of Abdominal Strapping on Forced Expiration in Tetraplegic Patients. Am. J. Respir. Crit. Care Med. 157: 95-98 [Abstract] [Full Text]  
• Estenne, M., De Troyer, A. (1990). Cough in Tetraplegic Subjects: An Active Process. ANN INTERN MED 112: 22-28 [Abstract]