External Thorax Flashcards
-Describe the borders of the thoracic wall.
-List the joints of the ribs (sternocostal and vertebrocostal joints) and the joints of the vertebral column (ligaments, intervertebral disk, intervertebral joints).
-List the muscles of the deep layer of the thoracic wall.
-Describe the location, order, and clinical significance of the neurovascular bundle of the intercostal space.
-List the muscles of the middle layer of the thoracic wall.
-Describe the clavipectoral fascia and the blood vessels and nerves that penetrate this fascia.
-Describe the blood supply and nerve innervation of the thoracic wall.
-Describe the blood supply and nerve innervation of the mammary gland.
How many thoracic borders are there?
Upper and lower border
Upper Border:
_______ thoracic aperture: ______ notch, ___st ribs, T__
Superior thoracic aperture, jugular notch, first rib, T1
Lower Border
_____ thoracic aperture: ______ process, _____ arches (Right and left), T____
Inferior thoracic aperture: Xiphoid process, Costal Arches (right and left), and T12
What are the layers of the thoracic wall?
Deep layer:
Middle layer (muscular layer):
Superficial layer:
Deep layer
- osteothorax, intercostal internsic back muscles
Middle layer (muscular layer)
- Thoracohumeral
- Back muscle
- Fasciae, blood vessels
- Nerves
Superficial layer
- Skin
- Superficial Fascia
- Mammary glands
What is the deep layer osteothorax
- Ribs
- Sternum
- Thoracic Vertebrae
______ - flat bone form, and interior midline of thoracic wall
Sternum
______ - two clavicular notches that articulate with left and right clavicles
Manubrium
______ notch/________ notch - shallow superior depression, between the clavicular notches
Jugular notch/ suprasternal notch
_______ notches - articulation for ribs first costal cartilages
Costal notches
Sternum ______ - Costa cartilages from ribs 2-7 attached here
body
Where does rib to attach in the sternum?
Sternal angle
What is the cartilaginous projection at tip of sternum?
The xiphoid process
Deep layer, muscles include:
External intercostal
Internal intercostal
Innermost intercostal (intercostale intimi)
-________ intercostal - run obliquely downward and forward
- Inhalation
External intercostal
________ intercostal - beneath external intercostal, run a bleakly downward, and backward exclamation
Internal intercostal
______ intercostal (______ intimi)
- beneath internal intercostal
- run oblique downward, and a backward
- exhalation
Innermost intercostal (intercostal intimi)
What does van stand for?
Posterior intercostal vein, artery, and intercostal nerve
Where is van located?
Located near the Costal groove
Between internal and innermost intercostal
How do you perform a intercostal injection
Performed with oblique entry of needle (upward and inward) and above the upper edge of the relevant rib this
Where are subcostal located and how do they run and do they help with inhalation or exhalation?
- They are located on the inner surface of the poster thoracic wall
- they run obliquely upward and backward
- helpful for exhalation
Where is the transverses thoracis? Which way does it run and what is its purpose?
It is located on the surface of the anterior thoracic wall
- runs horizontally
- exhalation
Erector Spinae have three columns. What are they?
- Iliocostalis
- Longissimus
- Spinalis
- They are covered by Thoracolumbar fascia
List from most laterally, intermediate, to medially
Laterally -
erector spinal: iliocostalis lumborum
intermediate:
longissimus Thoracis
medially
Spinalis Thoracis
answer E
Answer: B
(top) Vein-artery-nerve (bottom)
Answer: Just above the upper edge of rib five
Answer: External intercostal
which deep layer muscle is located on the inner surface of the posterior thoracic wall?
It runs up weekly upward and backward
- it’s useful for exhalation
Subcostals
_______ thoracic
- located on the inner surface of the interior thoracic wall
- run horizontally
- exhalation
Transversus Thoracis
The middle layer is known as the _________
Thoracohumeral muscles
middle layer:
What is the first layer?
Pectoral’s major
middle layer
What is part of the second layer?:
The subclavian/pectoralis minor/ serratus anterior
Subclavius
origin:
insertion:
Function:
origin: costal cartilage of rib 1
insertion: Anteroinferior surface of middle third of clavicle
Function: Stabilizing the clavicle at the sternoclavicular joint and depressing clavicle
2nd layer: Pectoralis minor
origin 3rd-5th ribs
insertion: Medial border and coracoid process of the scapula
Function: Stabilization, protraction, depression and downward rotation of the scapula
2nd layer: serrates anterior
Origin: The super-lateral surfaces of 1st to the 8th or 9th ribs
Insertion: The superior, medial and inferior angle of the scapula
Function: Protraction and upward rotation of scapula
What Fascia attaches to the clavicle and sternum? It covers the pectorals major.
Pectoral Fascia
What Fascia is deep to the pectoral fascia and it encloses 2 muscles Subclavius and pectorals minor.
Clavipectoral Fascia
What structures pierce the clavipectoral Fascia?
C)cephalic vein
L)ymphatics
A)cromiothoracic/thoracoacromial artery
P)ectoral nerve (lateral)
Middle layer - back muscles
Trapezius, levator scapulae,
Latissimus dorsi, Rhomboid minor/major
1st layer muscles in the back
Trapezius and Latissimus dorsi
1st layer trapezius
origin:
Insertion:
Function:
Origin: external occipital protuberance nuchal ligment and the spinous processes of C7-T21
Insertion: Acromion and spine of scapula, clavicle
Function:
Upper fibers: elevate the scapula
middle fibers: retract the scapula
Lower fibers: depress the scapula
1st layer: Latissimus dorsis
origin
Spinous processes of T6-T12, Thoracolumbar fascia, iliac crest, and the inferior three ribs
Insertion: Intertubercular groove of the humerus
Function: Extends, adducts and medially rotates the arm
How many muscles insert into the inter tubercular groove?
Biceps, pectorals major and latissimus dorsi
What is the third layer of the back muscle? _______ muscle
There are two muscles two know and they are?
1) Serratus Posterior superior
2) Serratus Posterior Inferior
Serratus posterior superior
origin:
insertion : \
function:
Origin: The lower part of nuchal ligament and the cervical and thoracic vertebrae (C7-T3)
Insertion: ribs 2-5
Function: Elevates the ribs and inhalation
Serratus posterior inferior
Origin:
Insertion:
Function:
Origin: The thoracic and lumbar vertebrae (T11-L3)
Insertion: ribs 9-12
Function: Depresses ribs 9-12 and exhalation
What are the layers of thoracic wall?
- Superficial layer
- Skin
- Superficial Fascia (Adipose tissue, Cutaneous nerves and superficial vessels)
- Mammary gland
Superficial layer - mammary gland
__________: Glandular tissue
- lobes produce _______
- Lactiferous duct transport ______
- Latiferous duct enlarges to form sinus before they open into the nipple: Temporary storage area for milk
Parenchyma/milk/milk
Superficial layer - mammary gland
________ stroma: suspensory ligaments of Cooper
- septa between lobes
- Suspends the mammary gland from pectoral fascia
Fibrous stroma
Superficial layer - mammary gland
________: the supporting framework
Stroma
________ stroma: adipose tissue
- supports the parenchyma
- Gives the breast its shape and size
Fatty Stroma
Blood supply and nerve innervation of external thorax
______ artery: anterior aspect of the thoracic wall
Subclavian artery
________ artery: Upper part of the anterior thoracic wall, lateral thoracic wall and part of posterior thoracic wall
Axillary artery
__________ aorta: Posterior thoracic wall
Thoracic aorta
The internal thoracic artery come from which artery?
The subclavian artery
Branches off of the Subclavian artery -
the _____________ artery:
descends along the internal surface of the thoracic wall, running parallel to the sternum
- give rise to 9 pairs of anterior intercostal arteries at each intercostal space
- Supply anterior intercostal spaces
Internal thoracic artery
Branches off of the Subclavian artery -
___________ Trunk
- supreme intercostal artery
- Gives rise to 1st and 2nd posterior intercostal artery to supply the 1st and 2nd intercostal space
Costocervical trunk
Thoracic _______ : Supply the posterior thoracic wall
Thoracic Aorta
_________ intercostal artery
POSTERIOR INTERCOSTAL ARTERY
- Run with 3rd to 12th Castle groove
- anastomosis with the anterior intercostal arteries, allowing for collateral circulation between anterior and posterior parts of the thoracic wall
What are the 4 arteries that branch off of the axillary artery?
- Superior Thoracic artery
- Thoracoacromial artery
- Lateral Thoracic Artery
- Subscapular artery
What is the name of the first artery that branches off of the axillary artery? Where is it located?
- Superior thoracic Artery
- located upper part of the anterior thoracic wall
What is the second branch that comes off of the thoracoacromial artery? What muscles does it innervate?
Pectoral’s major,
Clavicular and acromial region
What is the third artery that braches off of the axillary artery
Lateral Thoracic artery
What are the veins of the external thorax?
- Azygos Vein
- Hemiazygos vein
- Accessory Hemiazygos vein
Anterior or posterior wall? posterior intercostal veins drain into 3 azygos veins
Posterior wall
________ vein:
Right side of the posterior thoracic wall
Drain into the sup. vena cava
Azygos vein
__________ vein
Hemiazygos vein
- lower left side of the posterior thoracic wall
- joins the Azygos vein
the _______ thoracic vein
- runs alongside the artery of the same of the same name
- drains into the auxiliary vein
lateral thoracic vein
_________ hemiazygos vein: Upper left side of the thoracic wall; join the azygos vein
Accessory Hemiazygos vein
Nemonic
A..
Hemi…
Accessory…
azygos vein
hemiazygos vein
Accessory hemiazygos vein
The vein that is located in the anterior thoracic wall?
- it runs alongside the artery of the same name
- receives blood from the anterior intercostal veins
- drains into the brachiocephalic vein
The internal thoracic vein
Blood supply of mammary gland
- artery
- artery
- vein
- vein
Internal and lateral thoracic artery
Internal thoracic vein and auxiliary vein
Motor innervation (middle layer): Brachial plexus
What are the nerves?
Long Thoracic nerve
Subclavian nerve
2 pectoral nerves
Thoracodorsal nerve
The long thoracic nerve innervates
Serratus anterior muscle
Subclavian nerve innervates
Subclavius
2 pectoral nerves innervate:
- Pectoral’s major (lateral)
- Pectoralis minor (medial)
Thoracodorsal nerve innervates
- latissimus dorsi
- Run alongside the blood vessels of the same name
Nerve innovation of memory gland -
Sensory innovation of the _________ nerve 3rd to 6th
Intercostal nerve 3rd to 6th
________ cutaneous branch: is the medial portion of the mammary gland
Anterior
________ cutaneous branch: lateral portion of the mammary gland
Lateral cutaneous branch
pectorals major is supplied by
a. Superior thoracic artery
b. thoracodorsal artery
c. Lateral thoracic artery
d. thoracoacromial artery
e. thoracic aorta
Thoracoacromial artery
The mammary gland is innervated by:
a. 1st-3rd intercostal nerve
b. 3rd-6th intercostal nerve
c. 6st-9th intercostal nerve
d. 9st-12th intercostal nerve
e. 4th-8th intercostal nerve
3rd-6th intercostal nerve
