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Anatomy of the Thorax > 2. The Thoracic Wall > Flashcards

2. The Thoracic Wall Flashcards

1
Q

Anterior (ventral)

A

Towards FRONT of body

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2
Q

Posterior (dorsal)

A

Towards BACK of body

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3
Q

Superior (cranial)

A

Towards HEAD

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4
Q

Inferior (caudal)

A

Towards FEET

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5
Q

Midline (median), mid-sagittal

A

Straight down middle, divides body into 2 equal sides

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6
Q

Medial

A

Towards the midline

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7
Q

Lateral

A

Away from the midline

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8
Q

Proximal

A

Towards body (when referring to a limb)

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9
Q

Distal

A

Away from body (when referring to a limb)

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10
Q

Superficial

A

Close to surface

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11
Q

Deep

A

Far from surface

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12
Q

Sagittal

A

Cuts through from front to back (vertical)

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13
Q

Frontal (coronal)

A

Cuts through from side to side

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14
Q

Horizontal (transverse or axial)

A

Cuts through horizontally to body

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15
Q

Number of thoracic vertebrae

A

12

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16
Q

Number of pairs of ribs

A

12

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17
Q

Describe the arrangement of the ribs.

A

Ribs 1-7 are true ribs: their costal cartilages articulate directly with the sternum
Ribs 8-10 are false ribs: their costal cartilages join onto the costal cartilages of the ribs above them before joining the sternum
Ribs 11 + 12 are floating ribs: Lack anterior attachment (not connected to sternum)

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18
Q

What are articulations? Describe the articulations of the ribs

A

Joinings
All ribs articulate with vertebral column via head and tubercle
Most of the ribs articulate with costal cartilages

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19
Q

Tubercle

A

Sticks out of a bony structure, provides site of attachment for ligaments/ muscles

20
Q

Facet

A

Place where bones join to other bones

21
Q

Where is the ribcage wider?

A

Bottom

22
Q

How do the ribs slope as they come to the anterior?

A

Ribs slope downwards as they come to the anterior

23
Q

What are the 3 divisions of the sternum?

A

Manubrium
Body
Xiphoid

24
Q

Where does the 1st rib attach medially?

A

Manubrium

just inferior to the sternoclavicular joint

25
Q

Where does the 2nd rib attach medially?

A

Manubriosternal joint (STERNAL ANGLE)

26
Q

Where do ribs 3 to 7 attach medially?

A

Sternum

27
Q

Where do ribs 8 to 10 attach medially?

A

Costal cartilage above

28
Q

What defines the thoracic inlet (superior thoracic aperture)?

A

1st pair of ribs
1st thoracic vertebra (T1)
Manubrium

29
Q

Contents of thoracic inlet

A

Great vessels from heart emerging to supply head, neck and upper limb
Oesophagus, trachea, nerves and lymphatics descending
= Vulnerable area as not protected by a ‘bony cage’

30
Q

Describe the structure of the diaphragm.

A

Has a flat central tendon with muscle radiating to costal margin and vertebrae.

31
Q

What is the role of the intercostal muscles?

A

Stiffen the chest wall to improve the efficiency of breathing movements.

32
Q

How does the diaphragm move in inspiration?

A

Dome flattens to increase vertical diameter of chest

Pulls costal margin up to increase transverse and antero-posterior diameters

33
Q

How do the ribs move in inhalation?

A

Sternum moves out and up
Ribs swing out and up, “become more horizontal”
Dimensions of thoracic cavity increase antero-posteriorly and medio-laterally

34
Q

How are the intercostal muscles arranged? State the directions of the muscle fibres.

A

External intercostal:
Inferomedially (like hands in pockets) from lower border of rib above to rib below
At the costo-chondrial junction it is replaced by an anterior intercostal membrane
Internal Intercostal:
Supromedially
Attachments begin anteriorly at the sternum
Perpendicular to external intercostals Replaced by a membrane posteriorly
Innermost intercostal:
Same orientation as internal

35
Q

Where is the neuromuscular bundle? Describe the structure

A 
Just below rib
Between internal and innermost intercostals
Vein most superior
Artery in middle
Nerve below
36
Q

How many intercostal nerves are there?

A

11 pairs (T1 - T11)
and a subcostal nerve (T12)
A mix of motor and sensory nerves
Supply the intercostal spaces

37
Q

Describe the branching of intercostal nerves.

A

Lateral cutaneous branch (which splits into an anterior and a posterior branch)
Anterior cutaneous branch (which splits into a medial and a lateral branch)

38
Q

Is the neuromuscular bundle protected?

A

Bottom of rib is like a collar, protects blood vessels but nerve hangs just below

39
Q

What implications does the location of the neuromuscular bundle have for putting a needle or chest drain through the thoracic wall?

A

As the neurovascular bundle is just below the bottom edge of a rib, you would want to insert the needle just above the superior edge of a rib to avoid piercing the neurovascular bundle

40
Q

What are the borders for the safe area for inserting a chest drain?

A

Anterior border of the latissimus dorsi
Lateral border of pectoralis major
A line superior to the horizontal level of the nipple
Apex below the axilla
In general: 5th intercostal space, anterior to the mid-axillary line

41
Q

What is the difference in anastomoses between the nerves and blood vessels in the neuromuscular bundle?

A

Nerves only emerge from spinal cord and have to make way to anterior
Blood vessels come from tributaries of major vessels anterior and posterior

42
Q

Anastomosis

A

Region where arteries/ veins from different directions (front and back) are in close proximity supply same area of tissue

43
Q

What do the internal thoracic arteries branch from?

A

Right and left subclavian arteries

44
Q

What major artery do the intercostal arteries anastomose with?

A

Internal thoracic

45
Q

What is the space between the pleural cavities of each lung called?

A

Mediastinum

46
Q

To what height do the lungs extend to?

A

2-3cm above the clavicle

Anatomy of the Thorax (8 decks)

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