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Images of Anatomy > Anatomy of the Thorax 1 New > Flashcards

Anatomy of the Thorax 1 New Flashcards

1
Q

What does the clavicle articulate with?

A

Clavicle – bone articulates medially with the sternum and laterally with the scapula

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2
Q

What is the function of the clavicle?

A

It holds the upper limb away from the trunk to allow it to function

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3
Q

What does the scapula articulate with and where is it found?

A

found on the posterior thoracic wall. It articulates with the head of the humorous

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4
Q

What bones form the pectoral girdle?

A

Scapula, Humorous and clavicle

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5
Q

What does the anterior and posterior thoracic cage consist of?

A

The thoracic cage consists of the anterior sternum, ribs and costal cartilages (12 pairs), 12 posterior thoracic vertebrae found posteriorly

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6
Q

What is the function of the thoracic cage?

A

These structures help to support the thorax, protects the organs (and viscera) within the thoracic cavity, protects the abdominal organs (such as the liver and stomach), functions to resist pressures generated by recoil of the lungs during respiration, provides attachment for supporting the upper limb

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7
Q

What is inferior to the thoracic cavity?

A

The inferior boundary of the thoracic cavity is the diaphragm (which support the abdominal viscera)

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8
Q

What are the 3 regions of the sternum?

A

Manubrium

Body

Xiphoid process

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9
Q

Label the anterior sternum

A

Page 1

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10
Q

How does the sternum change as we become adults?

A

In children, these elements are joined by cartilage. The cartilage ossifies to bone during adulthood.

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11
Q

What shape is the manubrium?

Is the superior aspect concave and what does it form?

What lines the lateral edges of the manubrium?

What does the manubrium articulate with inferiorly?

A
  • The manubrium is the most superior portion of the sternum. It is trapezoid in shape.
  • The superior aspect of the manubrium is concave, producing a depression known as the jugular notch – this is visible underneath the skin. Either side of the jugular notch, there is a large fossa lined with cartilage. These fossae articulate with the medial ends of the clavicles, forming the sternoclavicular joints.
  • On the lateral edges of the manubrium, there is a facet (cartilage lined depression in the bone), for articulation with the costal cartilage of the 1st rib, and a demifacet (half-facet) for articulation with part of the costal cartilage of the 2nd rib.
  • Inferiorly, the manubrium articulates with the body of the sternum, forming the sternal angle. This can be felt as a transverse ridge of bone on the anterior aspect of the sternum. The sternal angle is commonly used as an aid to count ribs, as it marks the level of the 2nd costal cartilage.
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12
Q

What shape is the body of the sternum and what does it articulate with?

What forms the lateral edges of the body?

A
  • The body is flat and elongated – the largest part of the sternum. It articulates with the manubrium superiorly (manubriosternal joint) and the xiphoid process inferiorly (xiphisternal joint).
  • The lateral edges of the body are marked by numerous articular facets (cartilage lined depressions in the bone). These articular facets articulate with the costal cartilages of ribs 3-6. There are smaller facets for articulation with parts of the second and seventh ribs – known as demifacets.
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13
Q

What level is the xiphoid process at?

A

T10 vertebrae

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14
Q

What are the two thoracic apertures?

Label these on diagram

A

So superiorly we have the superior thoracic aperture (thoracic outlet – linked to thoracic outlet syndrome, compression of nerves and vessels which come out of the thoracic cavity into the head and neck). And inferiorly we have the inferior thoracic aperture.

On image

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15
Q

What does the superior thoracic aperture connect and what plane does it lie?

A

• The superior thoracic aperture connects the root of the neck with the thoracic cavity, it lies in an oblique transverse plane, so it is tilted (tilted anteroinferiorly)

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16
Q

What structures pass through the superior thoracic aperture?

A
  • A number of important structures pass through the superior thoracic aperture such as the brachiocephalic trunk which divides into the subclavian and common carotid artery.
  • The brachiocephalic vein on each side will form the subclavian and internal jugular vein which all come from the superior vena cava
  • Nerves such as the brachial plexus pass out of the superior thoracic aperture, to innervate the upper limb. They curve over the 1st rib
  • The structures pass over to the upper limb are most vulnerable to being compressed between the clavicle and the 1st rib.
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17
Q

What is found postolaterally and anteriolaterally to the inferior thoracic aperture?

A
  • Postolaterally we have the lower ribs (12 and 11)

* Anterolaterally we have the costal margin formed from the costal cartilage from ribs 7-10

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18
Q

What is the xiphisterna joint?

Is the xiphoid process part of the abdominal cavity?

A

• Following these ribs anteriorly is the xiphisterna joint, the joint between the body of the sternum and xiphoid process. This means the xiphoid process lies within the abdominal region because it lies below the level of the inferior thoracic aperture. It is an attachment of all the muscles from the anterior abdominal wall.

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19
Q

What is the thoracic lumbar separated by?

What does the thoracic lumbar protect?

A
  • The thoracic spine is the second segment of the vertebral column, located between the cervical and lumbar vertebral segments. It consists of twelve vertebrae, which are separated by intervertebral discs.
  • Along with the sternum and ribs, the thoracic spine forms part of the thoracic cage. This bony structure helps protect the internal viscera – such as the heart, lungs and oesophagus.
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20
Q

What are the 4 features of the thoracic vertebrae and label them

A
  • Vertebral body is heart shaped.
  • Presence of demi-facets on the sides of each vertebral body – these articulate with the heads of the ribs.
  • Presence of costal facets on the transverse processes – these articulate with the tubercles of the ribs. They are present on T1-T10 only.
  • The spinous processes are long and slant inferiorly. This offers increased protection to the spinal cord, preventing an object such as a knife entering the spinal canal.
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21
Q

What do the demi-facets and transverse process articulate with?

A
  • The demi-facets is where the head of the ribs articulate

* We have transverse processes – articulate with the tubercles of the ribs

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22
Q

What does the spinous process do?

A

spinus process protects the spinal cord, prevents objects entering the spinal canal

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23
Q

What do the superior and inferior articular demi-facets articulate with?

A

• We have the superior and inferior articular demi-facets which article of the head of the adjacent rib for superior and the head of the rib below for the inferior demi-facet

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24
Q

Which vertebral bodies have typical facets?

A

In the majority of the vertebrae (T2-T9) these facets are demi-facets. There are some atypical vertebrae that possess whole facets.

25
Q

What forms the atypical vertebrae?

A
  • The atypical thoracic vertebrae display variation in the size, location and number of their superior and inferior costal facets.
  • T1 – Superior facet is not a demifacet, as this is the only vertebrae to articulate with the 1st rib.
  • T10 – A single pair of whole facets is present which articulate with the 10th rib. These facets are located across both the vertebral body and the pedicle.
  • T11 and T12 – Each have a single pair of entire costal facets, which are located on the pedicles.
26
Q

How are ribs classified?

A

• Ribs can be classified as atypical or typical based on the structure and articulation anteriorly with the sternum, so you have true ribs, false ribs and floating ribs.

27
Q

What are the 3 regions of a typical rib?

A

The head is wedge shaped, and has two articular facets separated by a wedge of bone. One facet articulates with the numerically corresponding vertebra, and the other articulates with the vertebra above.

The neck contains no bony prominences, but simply connects the head with the body. Where the neck meets the body there is a roughed tubercle, with a facet for articulation with the transverse process of the corresponding vertebra.

The body, or shaft of the rib is flat and curved. The internal surface of the shaft has a groove for the neurovascular supply of the thorax, protecting the vessels and nerves from damage

28
Q

Label the typical rib

A

On image

29
Q

What are the atypical ribs and describe why they are atypical

A

Rib 1 is shorter and wider than the other ribs. It only has one facet on its head for articulation with its corresponding vertebra (there isn’t a thoracic vertebra above it). The superior surface is marked by two grooves, which make way for the subclavian vessels.

Rib 2 is thinner and longer than rib 1, and has two articular facets on the head as normal. It has a roughened area on its upper surface, from which the serratus anterior muscle originates.

Rib 10 only has one facet – for articulation with its numerically corresponding vertebra.

Ribs 11 and 12 have no neck, and only contain one facet, which is for articulation with their corresponding vertebra.

30
Q

What are the true, false and floating ribs?

A

Ribs 1-7 attach independently to the sternum.

Ribs 8 – 10 attach to the costal cartilages superior to them.

Ribs 11 and 12 do not have an anterior attachment and end in the abdominal musculature. Because of this, they are sometimes called ‘floating ribs’.

31
Q

Have a look at the structures that become compressed between the clavicle and first rib

A

On image

32
Q

What is the most superficial muscle of the thorax?

What is the shape?

Where does it originate and insert into?

What is its function?

A

Pectoralis major is one of the most superficial muscles within the thorax

It is a fan shaped muscle that has a clavicular head and a sternal head which will insert into the humorous. It has a broad origin

On image

33
Q

Label the diagram of the pectoralis major and deltoid muscle

A

On image

34
Q

What muscle lies deep to pectoralis major?

What is its function and where does it insert?

Label the diagram

A

On image

35
Q

What does border does Serratus anterior form?

What is its origin?

Where does it insert?

What does it do?

A

This forms the medial border of the axillary region

originates from digitated strips that attach to the lateral edges of the ribs from ribs 1-8

the muscle inserts to the medial border of the scapula

Raises arm over 90 degrees, protraction and rotation of scapula

36
Q

What are the 5 muscles that make up the thoracic cage?

What is there function?

A

There are five muscles that make up the thoracic cage; the intercostals (external, internal and innermost), subcostals, and transversus thoracis

There are some other muscles that do not comprise the thoracic wall, but do attach to it. These include the pectoralis major, minor, serratus anterior and the scalene muscles.

37
Q

Describe the origin and insertion of the external, internal and innermost intercostal muscles

A

On image

38
Q

What are the intercostal membranes of the 3 intercostal muscles?

A

On image

39
Q

Describe the direction of the external intercostal muscle, internal and innermost intercostal muscle

A

External Intercostal (A)

  • Downwards and forwards
  • ‘Hands in pockets’
  • Runs inferoanteriolly from the rib above to below

Internal and innermost Intercostal (B)

  • Upwards and forwards
  • ‘Hands on shoulders’
  • Run inferoposterioally

Internal Intercostal (interchondral portion) (C)

  • Upwards and forwards
  • ‘Hands on shoulders’
  • Runs inferoposteriorlly
40
Q

What are interosious muscle fibres and interchondral fibres?

A

Muscles fibres that run between the bony parts of the rib are called interosious muscle fibres and fibre that run between the costal cartilage are called interchondral fibres

41
Q

What are the two types of innermost intercostal muscle?

A

Subcostalis and Trasverse thoracic

42
Q

What is the function of the 3 intercostal muscles?

A

On image

43
Q

What is the diaphragm, where is it located and what are its 2 functions?

A

The diaphragm is a double-domed musculotendinous sheet, located at the inferior-most aspect of the rib cage. It serves two main functions:

Separates the thoracic cavity from the abdominal cavity

Undergoes contraction and relaxation, altering the volume of the thoracic cavity and the lungs, producing inspiration and expiration.

44
Q

Describe the anatomical position and attachments (peripheral) of the diaphragm

A

The diaphragm is located at the inferior-most aspect of the ribcage, filling the inferior thoracic aperture. It acts as the floor of the thoracic cavity and the roof of the abdominal cavity. The attachments of diaphragm can be divided into peripheral and central attachments. It has three peripheral attachments:

  • Lumbar vertebrae and arcuate ligaments.
  • Costal cartilages of ribs 7-10 (attach directly to ribs 11-12).
  • Xiphoid process of the sternum.
45
Q

What are the left and right crura?

Where does the right crus arise from?

Where does the left crus arise from?

A

The parts of the diaphragm that arise from the vertebrae are tendinous in structure, and are known as the right and left crura:

  • Right crus – Arises from L1-L3 and their intervertebral discs. Some fibres from the right crus surround the oesophageal opening, acting as a physiological sphincter to prevent reflux of gastric contents into the oesophagus.
  • Left crus – Arises from L1-L2 and their intervertebral discs.
46
Q

What do the muscle fibres of the diaphragm form?

What does this ascend as and attach to?

A

The muscle fibres of the diaphragm combine to form a central tendon. This tendon ascends to fuse with the inferior surface of the fibrous pericardium. Either side of the pericardium, the diaphragm ascends to form left and right domes. At rest, the right dome lies slightly higher than the left – this is thought to be due to the presence of the liver.

47
Q

What is the primary action of the diaphragm?

A

The diaphragm is the primary muscle of respiration. During inspiration, it contracts and flattens, increasing the vertical diameter of the thoracic cavity. This produces lung expansion, and air is drawn in. During expiration, the diaphragm passively relaxes and returns to its original dome shape. This reduces the volume of the thoracic cavity.

48
Q

What are the pathways of the diaphragm?

A

Caval Hiatus (T8) - inferior vena cava, terminal branches of right phrenic nerve

Oesophageal Hiatus (T10) - oesophagus

Aortic Hiatus (T12) - Aorta, thoracic duct and azygous vein

49
Q

What are the two phases of respiration?

What does this result in?

A

• Consists of two phases;
o Inspiration

o Expiration

  • Alternate increase and decrease of capacity of the thoracic cavity
  • As there is only a single entrance (trachea) an increase in capacity of the thoracic cavity results in air moving into the lungs under atmospheric pressure
50
Q

What causes changes in the diameter of the thoracic cage?

A

• Vertical diameter
o Through contraction of Diaphragm

• Anteroposterior diameter
o Downward sloping ribs raised at sternal end
 First rib is fixed, intercostals contract bringing ribs closer together
• External intercostals and interchondral part of internal intercostals and innermost intercostals
• Transverse diameter
• Ribs articulate in front with the sternum and behind with vertebral column
• Curve downward and resemble bucket handles

51
Q

Where does the intercostal neurovascular bundle lie?

Label them on diagram

A

• Lies between the internal intercostal muscle and the innermost intercostal muscle

52
Q

How many intercostal spaces are there?

A

11 intercostal spaces: name according to the rib superior

53
Q

What makes up the intercostal neurovascular bundle?

A

On Image

54
Q

Where do the intercostal nerves originate and what do they innervate?

A

• They originate from the anterior rami of spinal nerves T1-T11, they have both motor and sensory fibres (sensory fibres deliver sensory information to the skin from the intercostal muscle, also from the ribs and pleura)

55
Q

Where does the anterior rami of:

  1. T1-T6 pass?
  2. T7-T9 pass?
  3. T10-T11 pass?

What is unique about T1?

What does the lateral cutaneous branch divide into?

A

Anterior Rami T1-T11

1-6 intercostal spaces
7-9 pass deep to CCs to enter anterior abdominal wall
10-11 pass directly to anterior abdominal wall

T1: Joined to brachial plexus
No lateral cutaneous branch
Also no anterior cutaneous branch

Anterior and posterior branch

56
Q

What is the blood supply to the intercostal arteries?

Where do they originate from?

What do the branches supply?

A
  • Blood supply via the anterior and posterior intercostal arteries
  • Anterior originate from the internal thoracic artery (branch of the subclavian) and posterior come from the descending thoracic aorta respectively
  • Each intercostal artery gives off branches to the muscles, skin and parietal pleura and in the region of the breast in the female the branches to the superficial structures are particularly large
57
Q

What arteries supplies the posterior intercostal muscles of spaces 1-2 and 3-12?

Why is the right posterior intercostal muscle longer?

What arteries supply the anterior intercostal muscles of spaces 1-6 and 7-9?

A

Posterior intercostal arteries:
Spaces 1-2 from the superior intercostal artery; a branch of the subclavian
Spaces 3-12 from the aorta
Right: longer

Anterior intercostal arteries:
Spaces 1-6 from the internal thoracic artery
Spaces 7-9 from the musculophrenic artery (terminal branch of internal thoracic)

58
Q

Describe the intercostal veins

A

• Veins correspond the branches of the intercostal arteries :
o Anterior intercostal veins drain into the internal thoracic and musculophrenic veins

o Eventually into the subclavian and then the SVC
• The posterior veins will drain via the azygous and hemi-azygous system of veins drains the intercostal spaces, as well as the pericardium and parts of the posterior abdominal region
o Posterior intercostal veins drain into the azygous and hemi-azygous systems
o Main azygous vein on right, and superior (accessory) and inferior hemiazygous (proper)on left
• Important as it drains the posterior thoracic wall and posterior abdominal wall. Anastomotic pathway for venous return if IVC becomes blocked
• Azygous formed by union of right ascending lumbar and right subcostal veins
• Inferior hemiazygous formed by union of left ascending lumbar and left subcostal veins

59
Q

Label the the intercostal veins

A

On image

Images of Anatomy (21 decks)

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