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CAM201 Anatomy > Anatomy of the Thoracic Wall > Flashcards

Anatomy of the Thoracic Wall Flashcards

1
Q

The endothoracic fascia creates a natural cleavage plain between which two layers of the thoracic wall?

A

It separates the parietal pleura from its costal attachments.

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2
Q

Thoracic cage

A

Consists of 12 pairs of ribs and costal cartilages, sternum, 12 thoracic vertebrae and associated intervertebral discs.

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3
Q

Rib classification

A

_True ribs _(1-7) - articulate with sternum

False ribs (8-10) - articulate with the rib above

_Floating ribs _(11-12)

Also may be classified as:

Typical* *(3-9)

Atypical (1,2, 10-12)

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4
Q

Tubercle of typical rib

A

Facet for articulation with transverse process.

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5
Q

Abnormalities of ribs

A

Abnormalities of ribs are fiarly common:

  • Extra ribs (cervical or lumbar: cervical rib relatively common (0.5-2%) and may affect the brachial plexus and/or subclavian vessels.
  • Rudimentary 12th rib
  • Congenitally fused ribs
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6
Q

Jugular notch

A

Level of vertebra T2

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7
Q

Sternal angle of Louis

A

Manubriosternal joint.

  • Site of articulation of second costal cartilage.
    • Level of T4/T5.
      *
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8
Q

Kyphosis

A

Anatomically used to describe the natural anteiror concavity of the thoracic spine.

Clinically is used to describe an excessive anterior concavity which may result from compression fractures of vertebral bodies.

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9
Q

Costovertebral joints

A
  • Head of rib ‘x’ and thoracic vertebral bodies ‘x’ and ‘x-1’.
  • Synovial plane joint.
  • Ligament: mainly radiate ligament.
  • Exceptions are irbs 1,11,12 (T1, T11, T12).
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10
Q

Costotransverse joint

A
  • Tubercle of rib ‘x’ and transverse process of thoracic vertebra ‘x’.
  • Synovial plane.
  • Liagment: costotransverse ligament
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11
Q

Intervertebral T1-T12

A
  • Symphysis (secondary cartilaginous) - vertebral bodies covered by hyaline cartilage united by fibrocartilage.
  • Ligaments - anterior and posterior longitudinal.
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12
Q

Joints of the thoracic cage

A
  • Costovertebral joint
  • Costotransverse joint
  • Intervertebral joints
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13
Q

Sternal joints

A
  • Sternal angle of Louis/manubriosternal joint
  • Sternoclavicular joint
  • Sternocostal joints
  • Costochondral junction
  • Interchondral joint
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14
Q

Sternal angle of Louis

A

Manubriosternal joint.

  • Symphysis - fibrocaritlage, often ossifies later in life.
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15
Q

Sternoclavicular joint

A

Synovial saddle

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16
Q

Sternocostal joints

A

Cartilages of ribs 1-7.

  • First is primary cartilaginous (synchondrosis) usually ossifies in later life.
  • Ribs 2-7 synovial plane.
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17
Q

Costochondral junction

A

Not really a joint. Degenerates with age so useful forensically.

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18
Q

Interchondral joint

A
  • Between cartilages 6-7, 7-8, 8-9.
  • Synovial plane.
  • Ribs 9-10 fibrous.
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19
Q

Boundaries of thorax

A
  • Superior thoracic aperture: rib 1, manubrium and T1.
  • Inferiorly enclosed by diaphragm
20
Q

Diaphragm

A

Most important muscle of respiration. It is a musculotendinous sheet which separates thoracic and abdominal cavities.

Central portion is tendinous (central tendon - dense fibrous CT), outer portions are muscular.

21
Q

Diaphragm innervation

A

Phrenic nerve (C3-C5)

22
Q

Diaphragm attachments

A
  • Ribs 7-12
  • Lumbar vertebrae
  • Xiphoid process
  • Crura (right and left crus)
  • Arcuate ligaments
    • Median
    • Medial
    • Lateral
23
Q

Diaphragm openings

A
  • IVC at T8
  • Oesophagus and vagal trunks at T10
  • Aorta and thoracic duct as T12
24
Q

External intercostal membranes

A

External intercostal muscles do not continue all the way to the sternum.

25
Q

Internal intercostal membrane

A

Internal intercostal muscles do not continue all the way to the thoracic spine

26
Q

Subcostals

A

Similar to innermost intercostals except transverse more than one rib

27
Q

Changes upon inspiration

A

During inspiration:

  • The vertical, lateral and anteroposterior diameters of the thoracic cavity increase.
  • The upper ribs have a ‘pump handle’ action which increases A-P diameter.
  • The lower ribs have a ‘bucket handle’ action which increases the transverse diameter.
28
Q

The external intercostals

A

Mainly inspiration

29
Q

The internal intercostals

A

Mainly expiration - during normal respiration they mainly increase in tone and only during forced respiration do they create movement.

30
Q

Innermost intercostals and subcostals actions

A

The innermost intercostals and subcostals probably act similar to internal intercostal muscles and transversus thoracis is probably active in forced expiration and is also involved in proprioception.

31
Q

Levator costarum

A

Probably elevate the ribs in forced inspiration

32
Q

Serratus posterior superior and inferior

A

Most likely only proprioceptive.

33
Q

Accessory muscles of respiration

A
  • Pectoralis minor and major
  • Serratus anterior
  • Scalene muscles
34
Q

Forced expiration

A

During forced expiration the abdominals contract - increasing intra-abdominal pressure, forcing diaphragm superiorly.

35
Q

Location of intercostal VAN

A

Located between internal and innermost intercostals, deep to the costal groove.

Smaller collateral branches are located above the rib below.

36
Q

Posterior intercostal arteries

A

Arise from the superior intercostal a (rib 1,2) and from the thoracic aorta (rib 3-11).

37
Q

Anterior intercostal arteries

A

Arise from the internal thoracic a (ribs 1-6) and musculophrenic artery (ribs 7-9).

Anastamoses exist between anterior and posterior intercostal aa.

38
Q

Anterior intercostal veins

A

Drain to the musculophrenic and internal thoracic vein.

39
Q

Posterior intercostal veins

A
  • Right: 4-11 drain to the azygos v then to the SVC.
  • Left: 4-11 drain to the hemiazygos vein and accessory hemiazygos vv then to the azygos vein.
  • Superiorly the first intercostal vv drain into the right or left brachioephalic vv.
  • The second and third (fourth) drain into the superior intercostal vv and then into the azygos v on the right or the brachiocephalic v on the left.
40
Q

Intercostal nn

A

Arise form the ventral rami of spinal nerve T1-T12 (T12 = subcostal n), remember most of T1 goes to the brachial plexus.

T1-11 supply intercostal and abdominal mm and give off lateral and anterior cutaneous braches to skin of the trunk.

41
Q

Base of breast surface anatomy

A

Overlies ribs 2-6, most of pectoralis major, part of serratus anterior.

42
Q

Lateral mammary branches

A

From the lateral thoracic a, thoracoacromial a and posterior intercostal aa.

43
Q

Medial mammary branches

A

Arise from the internal thoracic a.

44
Q

Veins of the breast region

A

Veins drain mainly to the axillary v with some drainage to the internal thoracic v

45
Q

Breast innervation

A

Intercostal nerves 2-6 (anteiror and lateral cutaneous branches).

Niiple and areola - T4 dermatome.

46
Q

Breast lymphatic drainage

A

Breast cancer commonly spreads via lymphatics.

  • Approximately 75% lymph drains to pectoral (anterior axillary) nodes, then to central axillary nodes and to apical axillary nodes.
  • Approximately 20% of lymph to parasternal (internal thoracic) nodes
  • 5% of lymph to interpectoral nodes, intercostal (posterior parietal) nodes, opposite breast and subdiaphragmatic nodes.

CAM201 Anatomy (8 decks)

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