L5_ The thoracic wall

Question 1

What’s the name of the opening on top of the thoracic cage

Answer 1

superior thoracic aperture (thoracic inlet)

Question 2

What’s the name of the opening under of the thoracic cage

Answer 2

inferior thoracic aperture (thoracic outlet)

Question 3

Where does the ribs attach to the vertebral column

Answer 3

The ribs attach on the demi and costal facet of the vertebrae

Question 4

Describe the costovertebral joint

Answer 4

The head of the rib articulates with the vertebral body at it’s own level and the one above

Question 5

Describe the costotransverse joint

Answer 5

The tubercle of the rib articulates with the costal facet of the transverse process of thoracic vertebrae at it’s own level

Question 6

Name the atypical ribs and what makes them atypical

Answer 6

Rib I

• Short, flat and horizontally oriented
• No costal groove
• articulates only with the vertebral bone at it’s own level

Rib II
- smaller like rib 1

Rib X
- only articulates with vertebral bone at it’s own level

Rib XI and XII

• each articulate with vertebral bone at its own level only
• no tubercles or necks
• short

Question 7

What’s the joint between the manubrium and the sternum?

Answer 7

Manubriosternal Joint (it aligns with TIV and TV)

Question 8

What’s the joint between the sternum and the Xiphoid process?

Answer 8

Xiphisternal Joint (it aligns with TIX)

Question 9

Describe the Costochondral joint

Answer 9

It’s the joint between the rib and the costal cartillage and it is a synchondrosis joint

Question 10

Describe the Sternocostal joint

Answer 10

It’s the joint between the sternum and the rib (costal cartillage). It’s a synovial joint (plane and gliding -> except rib 1 which is synchondrosis joint)

Question 11

Describe the Interchondral joint

Answer 11

It’s the joint betweenn the costal cartillage. It’s a synovial joint

Question 12

What happens in an inspiration?

Answer 12

• The diaphragm drops and gets lower
• More volume in the lungs
• Contraction of the diaphragm

Question 13

What happens in an expiration ? What nerve affects the respiration?

Answer 13

• The diaphargm gets back up
• less volume in the lungs
• relaxation of the diaphragm

It’s the left and right phrenic nerve that affects the respiration

Question 14

Muscles of the thoracic wall

Answer 14

• external intercostal muscles
• internal inercostal muscles
• innermost inercostal muscles
• transversus thoracis

Question 15

External intercostal muscle (origin, insertion, function)

Answer 15

Origin: inferior surface of the superior rib
Insertion: superior surface of the rib below
Function: elevates the ribs in forced inhalation

Question 16

Internal intercostal muscle (origin, insertion, function)

Answer 16

Origin: superior surface of the inferior rib
Insertion: inferior surface of the rib above
Function: depresses the ribs in forced expiration

Question 17

Innermost intercostal muscle (origin, insertion, function)

Answer 17

Origin: superior surface of the inferior rib
Insertion: inferior surface of the rib above
Function: depresses the ribs in forced expiration

Question 18

Transversus thoracis muscle (origin, insertion, function)

Answer 18

Origin: sternum and xiphoid process
Insertion: inner surface of costal cartilages of ribs from II to VI
Functions: depresses the ribs in forces expiration

Question 19

In what order does the neurovascular supply places it self?

Answer 19

VAN
Veines
Artery
Nerve

Question 20

Tell me the trajectory of the neurovascular supply to the thoracic wall (ARTERIES)

Answer 20

1- heart
Anterior
2- subclavian artery
3- Internal Thoracic Artery (comes out of the subclavian artery)
4- anterior intercostal arteries (comes out of the internal thoracic artery
5- Musculophrenic Artery and Superior Epigastric Artery (divides the internal thracic artery in 2)
Posterior
2- arch of the aorta which continues as the thoracic aorta
3- posterior intercostal ateries

Question 21

What happens with the posterior and anterior intercostal arteries?

Answer 21

They do a vascular anastomosis between them to join together. This is helpful for when one part of an artery is blocked because blood can still pass around the blocked area

Question 22

Tell me the trajectory of the neurovascular supply to the thoracic wall (VEINS)

Answer 22

Anterior
1- musculophrenic vein and superior epigastric vein merge together to form the internal thoracic vein
2- the anterior intercostal veines merge together with the internal thoracic vein
3- The internal thoracic vein merge with the braciocephalic vein
4- the braciocephalic vein goes into the SVC that goes into the heart
Posterior
1- The posterior intercostal veines on the left merge with the hemiazygos vein and the posterior intercostal veines on the right merge with the Azygos vein
2- the Hemiazygos vein transfers the blood to the azygos vein
3- The Azygos vein merge into the SVC that goes into the heart

Question 23

Tell me the trajectory of the neurovascular supply to the thoracic wall - anterior rami of thoracic spinal nerve (NERVES)

Answer 23

1- the signal goes out the ventral ramus and travels along the costal groove of the rib
2- the signal branches of into the lateral cutaneous nerve, the intercostal nerve and to the anterior cutaneous nerve

Question 24

Which dermatome is associated with the nipple

Answer 24

T4

Question 25

T6 is associates with which area of skin

Answer 25

The skin over the xiphoid process

Question 26

which dermatome is associated with the umbiliucs

Answer 26

T10