Head Neck Trunk slides 120 to 233 Flashcards
Structure of Individual Vertebrae
Parts of a typical vertebra include…
Parts of a typical vertebra include….
a body, a vertebral arch, and several processes
Look at slide 121 / 122 / 123 images to differentiate between the following:
Parts of a typical vertebra include a body, a vertebral arch, and several processes
Four types of vetebral processes shown
You’re doing swell
What are the four types of vetebral processes shown (seven total processes per vertebrae with four types)… (answer is on slide 122)
All four TYPES of these processes (seven total processes per vertebrae with four types) connect to the….
Transverse Process (2/ vertebrae)
Superior Articular Process (2 /vertebrae)
Inferior Articular Process (2 /vertebrae)
Spinous Process (1 / vertebrae)
These processes above connect to the pedicle
Imagine how the superior articular process and inferior articular process come together. What do we see in between these two processes and the vetebral body?
The intervetrebral foramen (slide 123)
A typical vertebrae has the following parts?
Body
Vetebral Arch
Vetebral foramen
Seven processes
Vetebral notches
The body of a typical vetebrae is used for:
weight bearing
The vetebral arch is made up of the:
pedicles and laminae
The vertebral foramen is where?
A large hole in superior view and look at image on slide 124
How many processes are in a typical vertebrae and of which type?
Seven processes
- 2 transverse
- 1 spinous
- 4 articular
is all vertebral foramina together
Spinal canal
slide 125 image
are 2 vertebral notches together
Intervertebral foramina
slide 125 image
There are _ cervical vertebrae
7
There are 7 cervical vertebrae:
The first cervical vertebra is the ___. It supports the skull
The second cervical vertebra is the ___, which permits side-to-side rotation of the head
The third to sixth correspond to the ___ ____ of the typical cervical vertebrae
The seventh called the ___ ___ is somewhat different from vertebrae 3 through 6
There are 7 cervical vertebrae:
The first cervical vertebra is the atlas. It supports the skull
The second cervical vertebra is the axis, which permits side-to-side rotation of the head
The third to sixth correspond to the structural patterns of the typical cervical vertebrae
The seventh called the vertebra prominens is somewhat different from vertebrae 3 through 6
There are 7 cervical vertebrae:
The first cervical vertebra is the atlas. It…
The second cervical vertebra is the axis, which….
The third to sixth correspond to….
The seventh called the vertebra prominens is somewhat different from vertebrae 3 through 6
There are 7 cervical vertebrae:
The first cervical vertebra is the atlas. It supports the skull
The second cervical vertebra is the axis, which permits side-to-side rotation of the head
The third to sixth correspond to the structural patterns of the typical cervical vertebrae
The seventh called the vertebra prominens is somewhat different from vertebrae 3 through 6
Smaller bodies but larger spinal canal
Transverse processes: shorter, with transverse foramen for vertebral artery
Spinous processes of C2 to C6 often bifid (divided by a deep cleft or notch into two parts.)
1st and 2nd cervical vertebrae are unique - atlas & axis
Typical Cervical Vertebrae (C3-C6)
What is different about Typical Cervical Vertebrae (C3-C6) in relation to the vetebral bodies and spinal canal?
In regard
Smaller bodies but larger spinal canal
What is different about Typical Cervical Vertebrae (C3-C6) in regards to the transverse processes?
Transverse processes: shorter, with transverse foramen for vertebral artery
What is different about Cervical Vertebrae (C2-C6) in regards to the spinous processes?
Spinous processes of C2 to C6 often bifid (divided by a deep cleft or notch into two parts.)
The _____ transmit the vertebral arteries
transverse foramina
There are two craniovertebral joints:
Atlanto-occipital joint: between the atlas and occipital bone of the skull
Atlantoaxial joint: between the atlas and axis
Atlanto-occipital joint
Atlantoaxial joint
are the two what?
are they synovial?
What about their range of movement?
Articulations involve?
These are the two craniovertebral joints
Craniovertebral joints are synovial joints
They have a wider range of movement than the rest of the vertebral column
The articulations involve the occipital condyles, atlas, and axis
between the atlas and occipital bone of the skull
Atlanto-occipital joint:
between the atlas and axis
Atlantoaxial joint:
Craniovertebral joints are ____ joints
They have a _________than the rest of the vertebral column
The articulations involve the ______, _____, and ____
synovial
They have a wider range of movement than the rest of the vertebral column
The articulations involve the occipital condyles, atlas, and axis
ring of bone, has superior facets for occipital condyles
nodding movement at atlanto-occipital joint signifies “yes”
Atlas C1
Axis C2
__ or ___ process is body of atlas
pivotal movement at atlanto-axial joint signifies ____
dens or odontoid process is body of atlas
pivotal movement at atlanto-axial joint signifies “no”
Atlas C1
ring of bone, has superior facets for occipital condyles
nodding movement at atlanto-occipital joint signifies “yes”
dens or odontoid process is body of atlas
pivotal movement at atlanto-axial joint signifies “no”
Axis C2
Atlas C1
ring of bone, has superior facets for …
nodding movement at atlanto-occipital joint signifies ___
…occipital condyles
“yes”
The ________ is a strong band extending between right and left tubercles of C1 which holds the dens of C2 against the anterior arch of C1, forming the posterior wall of a socket for the dens
transverse ligament
slide 132 image
The transverse ligament is a strong band extending between right and left tubercles of ___ which holds the ____ of C2 against the anterior arch of ____, forming the posterior wall of a socket for the ____
(slide 132 image)
The transverse ligament is a strong band extending between right and left tubercles of C1 which holds the dens of C2 against the anterior arch of C1, forming the posterior wall of a socket for the dens
(slide 132 image)
The _____ is the strong superior continuation of the posterior longitudinal ligament across the central atlantoaxial joint through the foramen magnum to the central floor of the cranial cavity
(slide 133 image)
The tectorial membrane is the strong superior continuation of the posterior longitudinal ligament across the central atlantoaxial joint through the foramen magnum to the central floor of the cranial cavity
(slide 133 image)
The tectorial membrane is the strong superior continuation of the ____ _____ ligament across the ____ atlantoaxial joint through the foramen magnum to the ___ ____of the cranial cavity
(slide 133 image)
The tectorial membrane is the strong superior continuation of the posterior longitudinal ligament across the central atlantoaxial joint through the foramen magnum to the central floor of the cranial cavity
(slide 133 image)
is the colloquial name given to a fracture of both pedicles of vertebra C2 (axis)
Hangman’s fracture
Cause is forcible hyperextension of the head, commonly in falls, motor accidents, and sports activities in which the victim’s face or chin strike an unyielding object with the neck in extension, placing a large axial load onto the C2 vertebra
Hangman’s fracture
Cause of Hangman’s fracture
forcible hyperextension
Survival is relatively common since the fracture tends to expand the spinal canal at the C2 level, and it is not unusual for patients to walk in for treatment only to have the fracture discovered on X-rays
Hangman’s fracture
Hangman’s fracture on slide 135 for image of common MOA which is….
auto accident
Thoracic Vertebrae (T1-T12)
Articulate with the ____
Larger and stronger ____
Longer ___ and ___
Facets or demifacets on body for ___ __ ___
Facets on transverse processes (T1-T10) for ___ __ ___
Thoracic Vertebrae (T1-T12)
Articulate with the ribs
Larger and stronger bodies
Longer transverse and spinous processes
Facets or demifacets on body for head of rib
Facets on transverse processes (T1-T10) for tubercle of rib
Look at Facets and Demifacets on slide 137
YOU DID IT!
or you’re a turd
Rib Articulation:
Tubercle articulates with….
Head articulates with ___
….transverse process
vertebral bodies
Strongest and largest
Short thick spinous and transverse processes
Lumbar Vertebrae
Lumbar Vertebrae:
Strongest and largest
Short thick ___ and ____
Lumbar Vertebrae:
Strongest and largest
Short thick spinous and transverse processes
The sacrum is formed by the union of 5 sacral vertebrae, S1 – S5 (usually by age 30 years), and serves as a strong foundation for the….
pelvic girdle
Sacrum:
The auricular surface is the site of the synovial part of the…
sacroiliac joint.
The _____ is the continuation of the vertebral canal in the sacrum
sacral canal
It contains the nerve roots of the cauda equina
Sacrum
Sacrum:
Median sacral crest represents fused…
rudimentary spinous processes
Sacrum:
Medial (intermediate) crests represent fused…
articular processes (medial crests illustrated above, but not labeled)
Sacrum:
Lateral sacral crests are tips of transverse processes of…
fused sacral vertebrae
Spinous processes are not present on S_ and sometimes S_, resulting in formation of a _____ due to the absence of the spinous processes and associated laminae
Spinous processes are not present on S5 and sometimes S4, resulting in formation of a LARGE SACRAL HIATUS due to the absence of the spinous processes and associated laminae
The _____ represents the inferior articular process of S5 vertebra, and is a helpful guide to the location of the sacral hiatus
sacral cornu
The coccyx is formed by the fusion of….
The _____ are rudimentary articular processes
…4 coccygeal vertebrae, generally by age 30
coccygeal cornua
frequently used during labor
146
Caudal anesthesia (epidural block),
Caudal anesthesia (epidural block)
numbness in which nerves?
important landmarks
A local anesthetic agent injected into the sacral canal at the sacral hiatus, which
causes numbness in the regions innervated by the sacral and coccygeal nerves (approximately from the waist to the knees)
sacral and coccygeal cornu are important landmarks
Joints between vertebrae
We will distinguish two types of joints:
joints of the vertebral bodies (joints between vertebrae)
joints of the vertebral arches (joints between vertebral arches).
Intervertebral Discs
Between adjacent vertebrae absorbs vertical shock
Permit various movements of the vertebral column
Fibrocartilagenous ring with a pulpy center
Between adjacent vertebrae absorbs vertical shock
Permit various movements of the vertebral column
Fibrocartilagenous ring with a pulpy center
Intervertebral Discs
HNP - herniation of nucleus pulposus
_____ of the vertebral column pushes the nucleus pulposus ______ toward the thinnest part of the anulus fibrosus
Flexion
posteriorly
If degeneration of the HNP - herniation of nucleus pulposus
_______ ______ligament and wearing of the anulus have occurred, the nucleus pulposus may herniate into the vertebral canal and compress the spinal cord or the nerve roots of the cauda equina
posterior longitudinal
Compression by protruding disc
When an intervertebral disc protrudes, it may compress the nerve roots numbered one _____to the disc
but the IV disc forms the inferior part of the foramen and bulges out….
inferior
… below the exit of the nerve
Hyperflexion of the neck
A forcible hyperflexion of the cervical region may rupture the intervertebral disc….
The most commonly ruptured IV discs are those between _____ thereby compressing spinal nerve roots ____
IV disc protrusions result in pain in the….
….posteriorly without fracturing the vertebral body
C5 / C6 and C6 / C7,
C6 and C7, respectively
….neck, shoulder, arm, and hand
Severe hyperextension of the neck may stretch or tear the ___________
anterior longitudinal ligament
Rear-end automobile collision commonly results in such
hyperextension (whiplash) injury
Joints between vertebral arches
Zygapophyseal joints:
The joints of the _____ ____ are the zygapophysial joints (facet joints)
vertebral arches
Joints between vertebral arches
Zygapophyseal joints:
They are plane synovial joints (permit gliding) between the….
….superior and inferior articular processes of adjacent vertebrae
Accessory ligaments unite the laminae, transverse processes, and spinous processes, and help stabilize the joints
Zygapophysial joint
Injury and disease of zygapophysial joints:
Zygapophysial joints are close to the ______ through which the spinal nerves emerge from the vertebral canal
intervertebral foramina
Injury and disease of zygapophysial joints:
When the joints are injured or diseased from osteoarthritis, the ______ are often affected
This causes pain along the distribution patterns of the dermatomes and spasm in the muscles derived from the associated _____
spinal nerves
myotomes
means narrowing of one or more spinal foramina, commonly at C5/6 and C6/7 in the neck, and at L3/4, L4/5, and L5/S1 in the low back
Foraminal Stenosis
Foraminal Stenosis
Symptoms: associated with back or neck pain with ___ or _____.
In the lumbar region it may be associated with sciatic pain particularly after standing or walking for prolonged periods, due to….
sciatica or brachialgia
…..settlement in the spine decreasing the diameter of the foramen
Ligaments of the vertebral column
The _____ ligament is a strong, broad fibrous band that covers and connects anterior aspects of vertebral bodies and intervertebral discs
anterior longitudinal ligament
It extends from the atlas to the sacrum
The ligament maintains stability of the joints between vertebral bodies, and helps prevent hyperextension of the vertebral column
anterior longitudinal ligament
anterior longitudinal ligament extends from?
anterior longitudinal ligament extends from the atlas to the sacrum
The _____ ligament runs within the vertebral canal along the posterior aspect of the vertebral bodies
Posterior longitudinal ligament
It is narrower and weaker than the anterior longitudinal ligament
It helps prevent hyperflexion of the vertebral column and herniation or posterior protrusion of the discs
Posterior longitudinal ligament
helps prevent hyperflexion of the verebral column?
Posterior longitudinal ligament
The _____ are broad, yellow elastic fibrous tissue that join laminae of adjacent vertebral arches
Ligamenta flava (flavum)
They prevent separation of the vertebral lamina, arrest abrupt flexion of the vertebral column, and help prevent injury to the intervertebral discs
Ligamenta flava (flavum)
The ______ ligament joins tips of spinous processes from C7 to the sacrum
supraspinous
The _____ _____ is a thickening of the supraspinous ligament in the neck, extending from C7 to the occipital protuberance
ligamentum nuchae
Vasculature of the vertebral column
In general, a ______ is related around each vertebra, and supplies it
segmental artery
Spinal arteries enter the IV foramina and divide, then are distributed to….
…. dorsal and ventral roots of spinal nerves and their coverings
Venous drainage of the vertebral column
Spinal veins form _____ along the vertebral column both inside and outside the vertebral canal:
which two?
venous plexuses
Anterior vertebral venous plexus, both internal and external
Posterior vertebral venous plexus, both internal and external
Venous drainage of the vertebral column:
Anterior vertebral venous plexus, both ___ and ____
Posterior vertebral venous plexus, both ___ and ____
internal and external
internal and external
Venous drainage of the vertebral column
_____ veins are large and tortuous, and are in the substance of the vertebral bodies
Basivertebral
Venous drainage of the vertebral column
_____ veins accompany the spinal nerves through the IV foramina and receive blood from the spinal cord and vertebral plexuses
Intervertebral
The vertebral venous plexus is a _____ system.
As such, it is clinically significant because it can…
For example?
valveless
….transmit cancer metastases to distant locations that do not lie in the normal venous pathway.
For example: to the brain, but not to the lungs.
Skeleton of the Rib Cage and Pectoral Girdle
Rib cage:
Externally visible features of the thoracic wall?
The serratus anterior, costal margin, and pectoralis major are easily distinguished
Bony thorax
Formed by ?
Thoracic portion of the vertebral column
12 pairs of ribs with their costal cartilages
Sternum
Bony thorax
Openings:
____, which is bounded by the first pair of ribs and the sternum
_____, which is larger, and closed by the diaphragm
Superior thoracic aperture
Inferior thoracic aperture
Attributes of selected ribs:
Ribs 1 – 7
Have costal cartilage, and attach directly to the sternum
Vertebrosternal ribs
Attributes of selected ribs:
Has the sharpest curvature of all the ribs
Articulates with the manubrium at a point below the clavicle
First rib
Attributes of selected ribs:
Sternal costal articulations are direct to the body of the sternum
Referred to as “true ribs” (as are ribs 1 and 2)
Ribs 3 – 7
Attributes of selected ribs
Ribs 8 – 10
Do not have a direct articulation with the sternum
Indirectly articulate with the sternum by joining the costal cartilage of rib 7
Costal arch is the arrangement of costal cartilages that provide for the indirect articulation of ribs 8, 9, and 10
Are termed “false ribs”
Vertebrochondral ribs
Vertebrochondral ribs are termed what?
false ribs
Do not have a direct articulation with the sternum
Vertebrochondral ribs
Indirectly articulate with the sternum by joining the costal cartilage of rib 7
Vertebrochondral ribs
Costal arch is the arrangement of costal cartilages that provide for the indirect articulation of ribs 8, 9, and 10
Are termed “false ribs”
Vertebrochondral ribs
Have no anterior articulation with the sternum
Are called floating ribs (due to the lack of anterior articulation with the sternum)
Are also false ribs
Ribs 11 and 12
floating ribs
Ribs 11 and 12
The head has either one articulating facet which articulates with the ________________, or two articulating facets which articulate with ___________________
facet of the body of the corresponding vertebra
the demifacets of the bodies of adjacent vertebrae, as well as the intervertebral disc
The ______ has a site of articulation of the rib with the transverse process of posterior vertebrae of the same number
tubercle
The ____ attaches the head of the rib to the body (shaft) of the rib
neck
The _______ is the site of costochondral articulation of the rib to its cartilage
sternal extremity
The ______ begins near the tubercle on the body of the rib and provides some protection for the intercostal nerve and vessels
costal groove
The ______ is an abrupt change in the curvature of the shaft of the rib
costal angle
The sternum is a flat, elongated bone in the middle of the anterior portion of the thoracic cage
Average length is _____ in adults
Composed of 3 parts?
5 to 6 inches
Manubrium
Body
Xiphoid process
lies between the clavicles, and is the most superior landmark on the sternum
Jugular notch (suprasternal notch)
is the point of articulation of the sternal extremity of the clavicle with the manubrium
Sternoclavicular notch
- At the junction of the manubrium and body of the sternum
- Is the location of the cartilaginous articulation of the second pair of ribs
Sternal angle
Articulations
Costovertebral, Sternocostal images on slide 188 and 189
slide 188 and 189… do it!
Each rib articulates posteriorly with the body and ________- of a thoracic vertebra
transverse process
The posterior articulation of each rib is _____ in position to the anterior articulation
superior
The head of a typical rib (2-8) articulates with the ___ ___ ___ of the thoracic vertebra of the same number, and the costal tubercle articulates with the…..
superior costal facet
….transverse process of the vertebra of the same number
Articulations
Xiphisternal, Interchondral, Costochondral
Look at slide 191
slide 191… Your country needs you!!!
Articulation between xiphoid process and the body of the sternum
Xiphisternal joint
Synchondrosis
Xiphisternal joint
Progressively fuses as one ages, becoming a synostosis in older persons
Xiphisternal joint
Articulation between costal cartilages of . . .
6th – 7th ribs
7th – 8th ribs
8th – 9th ribs
Synovial joints (they are synovial plane joints)
Interchondral joint
Articulation of lateral end of costal cartilage with sternal end of rib
Cartilaginous joint
Costochondral joint
is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the sternum
Costochondritis
The condition causes localized chest pain that can be reproduced by pushing on the cartilage in the front of the ribcage
Costochondritis
Costochondritis is a relatively harmless condition and usually goes away without treatment. The cause is usually unknown… T or F?
True my good Watson
Superficial group of muscles that produce and control limb movements
Intermediate group of muscles that are involved in respiration
Extrinsic back muscles
True back muscles (i.e. intrinsic back muscles)
Specifically act on the vertebral column, producing its movements and maintaining posture
Intrinsic back muscles
Superficial back muscles
The group comprises?
Trapezius Levator scapulae Rhomboideus ----Minor -----Major Latissimus dorsi
These muscles are discussed as part of upper limb coverage
These muscles are discussed as part of upper limb coverage
Superficial back muscles
The serratus posterior group comprises superficial respiratory muscles
Intermediate back muscles
The serratus posterior superior lies….
deep to the rhomboids, running underneath the shoulder blades
Intermediate back muscles
Serratus posterior inferior is deep to the
latissimus dorsi
Intermediate back muscles
Both serratus muscles are innervated by
intercostal nerves
Respiratory muscle
Deep to rhomboideus muscles
Elevates rib cage – important in inspiration
Innervated by spinal intercostal nerves
Serratus posterior superior (posterior superior serratus)
Serratus posterior superior AKA
(posterior superior serratus)
Respiratory muscle
Deep to latissimus dorsi
Depresses lower four ribs – important in forceful expiration
Innervated by spinal intercostal nerves
Serratus posterior inferior (posterior inferior serratus)
Serratus posterior inferior AKA
(posterior inferior serratus)
Intrinsic muscle groups
Erector spinae
Transversospinal (transversospinalis group of muscles)
Muscles that Move the Vertebrae
Quite complex due to overlap
Erector spinae fibers run longitudinally
Smaller, deeper muscles
Muscles that Move the Vertebrae:
run longitudinally
3 groupings
Spinalis (medial)
Longissimus (intermediate)
Iliocostalis (lateral)
Erector spinae fibers
Muscles that Move the Vertebrae:
Smaller, deeper muscles
transversospinalis group: semispinalis, multifidis and rotatores
run from transverse process to dorsal spine of vertebrae above and help rotate vertebrae
Erector spinae group of muscles
LOOK AT SLIDE 202
LOOK AT SLIDE 202… GREAT VISUAL OF THE AFOREMENTIONED FLASH CARDS
Names of the transversospinalis group of muscles from deepest to most superficial:
Mnemonic:
Rotate
My
Spine
rotatores muscles
multifidus muscles
semispinalis muscles
Transversospinalis group of muscles is deep to erector spinae. They are innervated by
IMAGE ON SLIDE 203
dorsal rami of spinal nerves.
Transversospinal actions
Stabilization of individual vertebrae
Rotation
Extension
Lateral bending
Innervation of intrinsic back muscles by….
…posterior (dorsal) primary rami
These imaginary lines facilitate anatomical descriptions, identification of thoracic areas, and the location of lesions
LOOK AT SLIDE 206 for these lines
LOOK AT SLIDE 206 for these lines
Description to follow
line runs vertically along the anterior axillary fold, which is formed by the border of the pectoralis major as it spans from the thorax to the humerus
Anterior axillary
line runs from the apex (deepest part) of the axilla, parallel to the anterior axillary line
Midaxillary
line is parallel to the anterior axillary line, vertically along the posterior axillary fold formed by the latissimus dorsi and teres major muscles as they span from the back to the humerus
Posterior axillary
(midvertebral, midspinal) line is a vertical line described by the tips of the spinous processes of the vertebrae
Posterior median
are parallel to the posterior median line and cross the inferior angles of the scapulae
Scapular lines
Groups of muscles in the thoracic wall:
Thoracoappendicular muscles
Muscles of the thorax that assist in breathing
Anterior thoracic muscles or axial muscles that produce and control limb movements
Generally considered to be upper limb muscles
Thoracoappendicular muscles
Groups of muscles in the thoracic wall:
Muscles of the thorax that assist in breathing
Alter the size of the thoracic cavity so breathing can occur
Comprise????
Diaphragm*
Scalenes*
Some thoracoappendicular muscles*
Intercostal muscles
Thoracoappendicular
muscles
These are upper limb muscles that attach to the thoracic cage
Comprise ????
Anteriorly…
- —Pectoralis major
- —Pectoralis minor
- —Subclavius
- —Serratus anterior
Posteriorly: latissimus dorsi
These muscles are discussed as part of upper limb coverage
These muscles are discussed as part of upper limb coverage
Thoracoappendicular muscles
Groups of muscles in the thoracic wall:
These are upper limb muscles that attach to the thoracic cage
Comprise
Anteriorly…
- —Pectoralis major
- —Pectoralis minor
- —Subclavius
- —Serratus anterior
Posteriorly: latissimus dorsi
Intercostal muscles
Occupy the intercostal spaces
Comprise three layers…. which three layers?
Outermost layer – external intercostal
Middle layer – internal intercostal
Innermost layer - comprised of the following:
Transversus thoracis (anteriorly)
Subcostal muscles
Innermost intercostal muscles (posteriolaterally)
Intercostal muscles are ALL innervated by
segmental intercostal nerves
Outermost layer (once pectoralis has been reflected)
External intercostal muscles
External intercostal muscles
Travels obliquely (from lateral to medial) downward from the ____ border of one rib to the _____ border of the rib below
inferior
superior
Elevates the rib cage (muscle of inspiration)
External intercostal muscles
Originate from the superior border of a rib
Insert on the inferior border of the rib above
Internal intercostal muscles
Internal intercostal muscles
Origination?
Insertion?
Originate from the superior border of a rib
Insert on the inferior border of the rib above
Fibers are oriented at right angles to the external intercostal muscle (angle up and in)
Depress the rib cage, which is important in forced expiration
Internal intercostal muscles
Internal intercostal muscles
Fibers are oriented at…
….right angles to the external intercostal muscle (angle up and in)
Originate from the sternum
Insert on cartilages of ribs 2 - 6
Depress the ribs
Transverse thoracic muscles
Transverse thoracic muscles
Origination?
Insertion?
Action?
Originate from the sternum
Insert on cartilages of ribs 2 - 6
Depress the ribs
Innermost layer of ribs have two types of muscles
Subcostal muscles
Innermost intercostal muscles
Subcostal muscles bridge two intercostal spaces, and probably elevate the ribs, making them muscles of inspiration
Innermost intercostal muscles bridge an intercostal space, and are probably muscles of expiration
Innermost layer
Nerves of the thoracic wall
The 12 pairs of thoracic spinal nerves supply the thoracic wall.
The general distribution in the thoracic wall reflects the structure of the thoracic cage in that the nerves—intercostal nerves—run in the…
intercostal spaces parallel to the ribs
Upon leaving the intervertebral foramina the spinal nerves divide into….
anterior and posterior primary rami.
of nerves T1 –T11 form the intercostal nerves.
The anterior rami
pass posteriorly to supply the joints, muscles, and skin of the back in the thoracic region
The posterior rami
Cutaneous innervation to the thoracic wall:
Are generally supplied by dorsal roots of spinal nerves C5 and T1 – T6
C5 and T1 also supply the upper limb
Which part of thorax?
Dermatomes of the anterior thorax
Dermatomes of the anterior thorax
Are generally supplied by dorsal roots of spinal nerves…
__ and ___ also supply the upper limb
….C5 and T1 – T6
C5 and T1
Dermatome landmarks for the thorax and abdomen
jugular (suprasternal) notch and clavicles (actually, the clavicles generally coincide with the boundary between C4 and C5)
Which dermatome?
C5
Dermatome landmarks for the thorax and abdomen
just inferior to jugular notch, and down anterior portion of arm
Which dermatome?
T1
Dermatome landmarks for the thorax and abdomen
nipples
Which dermatome?
T4
Dermatome landmarks for the thorax and abdomen
xiphoid process
Which dermatome?
T7
Dermatome landmarks for the thorax and abdomen
umbilicus
Which dermatome?
T10
Dermatome landmarks for the thorax and abdomen
umbilicus
Which dermatome?
T10
is the most superior dermatome of the back that does not supply the upper limb.
T1
Just count sequentially up or down from there.
The general pattern of vascular distribution in the thoracic wall reflects the structure of the thoracic cage in that the arteries—intercostal arteries—run in the intercostal spaces parallel to the ribs
Arteries of the thoracic wall
Intercostal arteries:
Arise from the aorta
Travel toward the anterior thorax, giving off a lateral cutaneous branch
Posterior intercostal arteries
Intercostal arteries:
Is a branch of the subclavian artery
Gives rise to the anterior intercostal artery, which anastamoses with the posterior intercostal arteries from the aorta (just discussed)
Gives rise to perforating cutaneous branches that supply the skin in that area
Internal thoracic artery
Internal thoracic artery
Gives rise to the ?
Which anastamoses with?
Also gives rise to this which supply the skin?
Gives rise to the anterior intercostal artery, which anastamoses with the posterior intercostal arteries from the aorta (just discussed)
Gives rise to perforating cutaneous branches that supply the skin in that area
Veins of the thoracic wall
Intercostal veins accompany the intercostal arteries (and nerves)
They lie ____ in the costal grooves
Each side has . .
which two veins anastamose?
most superior
….Eleven posterior intercostal veins
Eleven anterior intercostal veins
Anterior and posterior intercostal veins anastamose
Veins of the thoracic wall:
The _______ are tributaries of the internal thoracic veins (the internal thoracic veins accompany the internal thoracic arteries)
anterior intercostal veins
Veins of the thoracic wall:
Most posterior intercostal veins end in the…
azygos / hemiazygos venous system
images on slide 229 and 230
azygos / hemiazygos venous system
Where MOST posterior intercostal veins end
images on slide 229 and 230
Most superficial lymphatic vessels superior to the umbilicus drain to the
axillary lymph nodes
slide 231
Some lymphatic vessels drain medially and deeply to the
parasternal and anterior diaphragmatic lymph nodes
slide 231
Superficial lymph nodes inferior to the umbilicus drain to the
superficial inguinal lymph nodes
slide 231
space between adjacent ribs
intercostal space
the location of muscles, nerves, and vessels of the thoracic wall
intercostal space
The word VAN describes the sequence of…
vein, artery, nerve for structures in the intercostal space (dissected, above showing posterior part of intercostal space)
slide 232
Intercostal nerve block:
Local anesthesia of an intercostal space is produced by injecting a local anesthetic agent around the intercostal nerves, infiltrating the anesthetic around the…
…intercostal nerve trunk and its collateral branches
Intercostal nerve block:
Considerable overlap occurs because any particular area of skin usually receives innervation from two adjacent dermatomes, therefore…
complete loss of sensation usually does not occur unless two or more intercostal nerves are anesthetized
