CVR session 2A- the pectoral region and the bones of the thoracic cage

Question 1

Manubrium- what articulates with what? and inferiorly with what?

Answer 1

manubrium is superior part and contains a notch known as suprasternal (jugular) notch and laterally articulates with the clavicle and the sternoclavicular joint and the first rib. Inferiorly it articulates with the body of the sternum at the sternal angle (manubriosternal joint)

Question 2

body of the sternum- what does it articulate with?

Answer 2

ribs 2-7 (rib 2 at the sternal angle/manubriosternal angle)

Question 3

xiphoid process or xiphisternum

Answer 3

articulates with sternum, small and varibale in shape (sword like)

Question 4

Ribs- name of where costal cartilage and rib meet called? what number ribs are ‘true’ ribs? what number are ‘false’? what number are floating? what is point costal cartilage and sternum articulate called? what number ribs form costal margin?

Answer 4

anterior parts of rib are costal cartilage, the point they articulate is called costochondral joints

ribs 1-7: costal cartilage articulates directly with sternum at sternocostal joints (true)
ribs 8-10: costal cartilage unite and join 7th rib (false)
ribs 11,12: do not articulate with sternum and are floating

ribs 7-10 form costal margin whoch is lowst part of ribs anteriorly

Question 5

ribs articulate posteriorly at what joint?

Answer 5

ribs articulate with thoracic vertebrae (at costovertebral joints)

tubercle articulates with transverse process

Question 6

the vertebrae joint to rib bone and 2 points? what makes up the superior thoracic apetures?

Answer 6

T1-T12, spinous process that are palable along midline of back, the head of ribs articulates with vertebral body and the tebercle of the rib articulates with the transverse process

the manubrium, first rib and clavicle make up - superior thoracic aperture (passage for structures between neck and the thorax).

Question 7

vertical lines- name both?

Answer 7

midclavicular line- at nipple
axillary line- just below armpit

Question 8

dermatomes of the thoracic wall- somatic fibres controll? sympatehtic fibres controll? what spinal nerve innervates nipple? what spinal nerve innervates umbilicus?

Answer 8

somatic fibres innervate the skeletal muscle
sympathatic fibres innervate sweat glands, smooth muscleof blood vessels and hair follicles
T1- inner forarm
nipple- T4, umbilicus- T10

Question 9

the breast- differnet tissues present? arrangement?

Answer 9

part of breast tissue extends towards under armpit- called axillary tail,
contains fat (amount dependant on different people), glandular or secretory tissue arranged in lobules which open up into ducts which converge into a nipple. Also contains ligaments, blood vessels and lymphatics.

Question 10

vascular supply of breast and intercostal space- what arteries supply breast and intercostal space? what veins drain the breast and intercostal space?

Answer 10

supplied by arterial blood by branches of internal thoracic artery and axillary artery

branch of subclavian artery which runs deeps to lateral of sternum and gives rise to anterior intercostal arteries- supply breast and intercostal space

venous blood then returns to axillary and internal thoracic veins

Question 11

neuro supply of breast? what nerves and fibres supply breast? what nerves and fibres supply skin?

Answer 11

somatic nerves and sympathetic fibres supply breast via intercostal nerves, sensory somatic fibres innervate the skin, sympathic fibres innervate smooth muscle on blood vessel walls and nipple

Question 12

lymphatic drainage of the breast- where lymph drainage from breast goes? where else drains into here?

Answer 12

5 groups of lymph nodes in axilla: breast, upper limb, chest wall, scapula region and abdominal wall. Apical nodes receive lymph from all other lymph nodes in axilla.

Question 13

intercostal muscle- 3 layers?

Answer 13

external
internal
innermost

Question 14

pectoralis major, pectoralis minor, serratus anterior- role in body? position?

Answer 14

pectoralis major- superficial anterior muscle, connects proximal humerus, sternum, clavicle and upper 6 ribs, abducts humerus
pectoralis minor- deep to pectoralis major, attached to scapula and rib 3-5, protracts scapula
serratus anterior- superfical muscle, around lateral aspect of thoracic cage, attaches to scapula and upper eight ribs, protracts scapula

also have roles as accesory muscles of breathing as attached to lungs, use of these muscles with inspiration can show signsof respiratory disease

Question 15

clinical relevance- rib fracture

Answer 15

typically symptoms worse on inspiration, if concerns of multiple fracture or pneumothorax then chest X- ray or CT scan

Question 16

clinical relevance- shingles

Answer 16

presents as red, painful and itchy rash over chest or abdomen in a strip like distribution (across one dermatome). Caused by chicken pox virus laying dormant in dorsal root ganglion until reactivated.

Question 17

clinical relevance- breast cancer

Answer 17

breast malignacy can metastasise (spread) to axillary lymph node, lump in axillary node may be palpable before breast, biopsie taken of this, removal of this node can cause accumilation and swelling in upper limb as this limb also drains lymph into the node (lympheodema)