L4 The Thoracic Wall Flashcards
Name the structures
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- Functions
- Protection (Lungs, heart, …)
- Support and structure
- Borders
- Sternum (anterior)
- Thoracic spine (T1-T12)
- Ribs (I-XII)
- Superior thoracic aperture (Thoracic inlet)
- Top of sternum, T1 and Rib I
- Inferior thoracic aperture (Thoracic outlet)
- Infrasternal angle (Inferior – sternum)
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What are the three types of ribs?
- True ribs (I-VII)
- Direct insertion onto sternum via costal cartilage
- False ribs (VIII-X)
- Indirect insertion onto sternum via costal margin
- Costal margin merges with costal cartilage of Rib VII
- Infrasternal angle
- Floating ribs (XI-XII)
- No anterior attachment (only posterior onto thoracic vertebrae)
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What are the typical features on the rib?
- Head of the rib (posterior)
- Crest
- Neck
- Tubercle (most posterior)
- Articulates with vertebral column
- Costal angle and body
- Costal groove (neurovascular supply)
- Costal cartilage (anterior)
- 3 articular surfaces
- Costal cartilage (ant.)
- Head (post.)
- Tubercle (post.)
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What are the facets of the vertebra that articulates with the rib?
- Demi facets (superior, inferior)
- On the body
- Costal facets
- On the transverse processes
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What are the joints connecting the rib and the vertebra?
- Costovertebral joint
- Two separate synovial joints (movement during respiration)
- Plane/Gliding
- Head of the rib (costo-) – Body of the vertebral bone – Own level AND vertebra above
- Two demi facets – Two vertebral bone
- Ie. Rib IV – T4 and T3
- Two separate synovial joints (movement during respiration)
- Costotransverse joint
- Tubercle of the rib (costo-) – Costal facet on transverse process of thoracic vertebra at own level
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What are the different types of ribs?
- True ribs (I-VII)
- Direct insertion onto sternum via costal cartilage
- False ribs (VIII-X)
- Indirect insertion onto sternum via costal margin
- Costal margin merges with costal cartilage of Rib VII
- Infrasternal angle
- Floating ribs (XI-XII)
- No anterior attachment (only posterior onto thoracic vertebrae)
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What are the anterior joints of the thoracic cage?
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- Costochondral (rib-cartilage) – Solid synchondrosis joint (cartilage)
- Sternocostal (sternum-rib) – Synovial, plane/gliding
Exception: 1st rib – Synchondrosis
Should be called sterno-chondral
- Interchondral (between-cartilage) – Between costal cartilages of false ribs
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Name the different parts of the sternum. Which vertebrae level correspond to the jugular notch and the xiphoid process?
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Identify the two superficial muscles of the thoracic wall
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1st layer
- External intercostal muscles ( \ )
- Anterior, inferior (hands in pockets)
2nd layer
- Internal intercostal membrane
- Internal intercostal muscles ( / )
- Anterior, superior (thumb in armpit palm interior)
1.
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What are the muscles composing the third layer of anterior thoracic wall muscles?
3rd layer
- Innermost intercostal muscles ( \ )
- Transversus Thoracis
- “Christmas tree”
- Body of sternum / Xiphoid process – Ribs 2-6
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The top of the diaphragm corresponds with which rib? Which side is higher? Why?
- Right and left dome
- Central tendon
- Right side higher than left
- Liver under right dome
- Rib 5
Which spinal nerves innervate the diaphragm? Where do the neruovascular structures travel in regards to their corresponding rib?
“C3, C4, C5 – Keeps the diaphragm alive!”
- Right and left Phrenic nerve
- Innervated by two nerves (collateral)
“VAN”
- Intercostal Vein, Artery and Nerve superiorly,
- Between 2nd and 3rd layer (Internal and innermost intercostal muscles)
- Protected by costal groove
- In case of lung failure and fluid inside thoracic cavity, insert chest tube placement ABOVE rib
- NAV located inferiorly for collateral
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Describe the arterial system of the thoracic wall
- Anterior
Aorta
- sublcavian artries
- internal thoracic arteries
- anterior/posterior intercostal arteries (linked via anastomosis)
- musculophrenic artery/superior epigastric artery
+ Subcostal arteries (rib 11/12), directly from the aorta
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Describe the venal system of the thoracic wall
Anterior
- Superior epigastric + Musculophrenic
- Internal thoracic veins
- Anterior intercostal veins
- Brachiocephalic trunk
- SVC
Posterior
- Left posterior intercostal vein
- Hemiazygos vein
- Bridge
- Azygos vein
- Right posterior intercostal vein
- SVC
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Nervous system of the thoracic wall?
- Ventral rami
- Intercostal nerve
- Lateral cutaneous nerve
- Anterior cutaneous nerve
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