GA: Thoracic Wall

Question 1

At what vertebral level are the following located?

1. Suprasternal notch
2. Sternal Angle
3. Xiphisternal Junction

Answer 1

1. Suprasternal (juglular) notch- T2
2. Sternal angle- T4-T5
3. Xiphisternal Junction- T9

Question 2

The sternal angle is at what vertebral level?
It is a landmark for the location of what?
It is at the junction between which two bones?

Answer 2

Located at T4-5
Landmark for location of costal cartilage of second rib

It is a ridge at the junction of the manubrium and body of sternum

Question 3

What vascular structure and which respiratory structure are deep to the sternal angle?

Answer 3

The beginning of the arch of the aorta and the bifurcation of the trachea are deep to the sternal angle

Question 4

What are the boundaries of the superior thoracic aperture?

What structures are within it?

Answer 4

Boundaries: T1, 1st ribs and costal cartilage, superior border of manubrium

Contains the esophagus, trachea, major vessels and nerves

Question 5

What is thoracic outlet syndrome? What symptoms does it have?

Answer 5

Damage to structures within the superior thoracic aperture (thoracic outlet)…the brachial plexus and subclavian artery and vein are closely related to the upper surface of the first rib and clavicle in this area…compression of these can cause diminished blood flow (pulse) and usually lower root nerve symptoms (C8-T1)

Question 6

What are the three categories of ribs and how many ribs belong to each?

Answer 6

True ribs: upper 7 pairs have costal cartilage attaches directly to sternum
False ribs: pairs 8-10 attach indirectly to upper costal cartilages
Floating/free ribs: ribs 11 and 12

Question 7

What is the motor and sensory innervation of the diaphragm?

Answer 7

Motor: Phrenic nerve, C3,4,5 (C3,4,5 keep diaphragm alive)
Sensory (central): phrenic nerve
Sensory (peripheral): intercostal nerves

Question 8

Which intercostal muscle fibers run like “hands in your pocket”?

Answer 8

External intercostals

Question 9

Which structures protect the thoracic organs?

Answer 9

Anterior: Ribs and sternum
Posterior: thoracic vertebrae (posterior)
Additional: skin, three layers of muscle

Question 10

What is the clinical term for the loss of the stability of the thoracic wall with the inward movement of part of the wall on inspiration and then on expiration outward movement?

Answer 10

Flail chest: 3 or more ribs with two or more breaks…the broken segments acts in an opposite direction to the rest of the thoracic wall

Question 11

Broken ribs can cause a variety of complications, which types of complications can result from broken 1st rib, middle ribs, and lower ribs?

Answer 11

Fracture of the first rib may damage the brachial plexus or the subclavian artery.
Broken ends of the middle rib fractures may damage the lungs or the spleen. Puncture of the pleura may occur with air introduced into the pleural cavity leading to a pneumothorax.
Lower rib fracture may also tear the diaphragm.

Question 12

Which structure within the superior thoracic aperture when compressed might result in a diminished radial pulse and cold and pallor of the upper limb?

Answer 12

Subclavian artery

Question 13

What major structure is located in the superior thoracic aperture could result in tingling and numbness on medial side of hand (C8) and medial side of arm (T1)?

Answer 13

The brachial plexus is located in the superior thoracic aperture. Compression of C8 or T1 would provide the symptoms related to pain, numbness, and tingling at the medial side of the hand and the medial forearm.

Question 14

Which anatomical structure can be palpated to locate the costal cartilage of the second rib and which bones attach to form this structure?

Answer 14

Sternal angle- a palpable ridge formed at the junction of the manubrium and body of the sternum

Located T4-T5