Lec 7 Flashcards
Thoracic cavity (floor and openings)
floor is diaphragm
superior thoracic aperture and inferior thoracic aperture
Bad things about rib one
it can impede vessels and brachial plexus that run close to it
Sternal angle
manubriosternal joint
located at level T5 (or T4/T5 intervertebral disc, but of course on anterior side)
when looking laterally at sternum it is the second indention down
what joint does the tubercle of a rib form
costotransverse joint
synovial joint that forms the connection between the tubercle of a rib and the transverse process of the corresponding thoracic vertebra
7th rib connects to T7 tubercle
Crest of rib
seperates the two articular facets on the head of the rib
articular facts of head articulate with thoracic vertebrae on
where do the ribs articulate posteriorly
articular facts of head articulate with 2 thoracic vertebrae on posterior side
For example, the head of rib 2 articulates with the inferior demifacet of T1 and the superior demifacet of T2
COSTOVERTEBRAL JOINT
Rib angle
region of greatest curvature
True/False/Floating ribs
True ribs 1-7
False 8-10 (join together)
Floating 11, 12 (lats attach)
What vertebral level is the superior scapular angle, root of spine and inferior scapular angle at?
Superior angel of scap - T2
Root of spine T3 (bottom of T3)
Inferior angle of scapula T7
Sternocostal joints
cartilage of rib to sternum
ribs 1-7
first rib connects as a fibrocartilaginous joint and the rest are synovial
Xiphisternal joint (symphysis)
xiphoid process to sternum
cartilaginous joint
Interchondrol
ligaments between coastal cartilages of ribs 6-9/10
Know where the coastal margin is
What is special about the vertebral foramen in thoracic vertebrae
narrow
Where do nerves exit the vertebral column
interverterbral foramen
How to identify thoracic vertebrae
BODY is heart shaped
VERTEBRAL FORAMEN is circular
demifacets on body
superior facets face posterior and lsightly lateral
Different SP on thoracic vertebrae
T1-3 SP faces over body of same vertebrae
T4-6 SP faces downward over intervertebral foramen
T7-9** SP faces downward over inferior vertebral body
T10-12 SP i back to same vertebrae body
Intercostals
MA External intercostals; draws ribs superiorly (increasing space of the thoracic cavity) to assist with inhalation
MA internal intercostals: draws the ribs inferiorly (decreasing space of the thoracic cavity) to assist with exhalation
O: inferior border of the rib above
I: superior border of the rib below
N: thoracic segmental intercostal nerve
What muscles are involved with forced breathing?
Serratus posterior inferior and superior
Serratus posterior superior
SP C7 to T3,
elevates ribs with inhalation
Serratus posterior inferior
SP T12-L3
depresses ribs with exhalation
Thoracic arterial supply (how is it organized)
Posterior and anterior intercostal arteries, thoracic aorta, internal thoracic arteries
Mostly segmental except the internal thoracic arteries that come off subclavian artery
The intercostal arteries and nerves travel in the subcostal groove (between intercostal mm)
*intercostal groove is a sliver of space on the actual rib
Trunk dermatomes
T2 Axillary
T4 nipple
T6 xiphoid process
T10 Umbilicus
They are segmental
Shingles
virus from chicken pox
sensory nerves get inflamed, only affecting dermatomes (not myotomes)
forms rash
The abdominal and pelvic cavities are
continuous
Inguinal ligament
runs from ASIS to pubic tubercle
related to pelvic outlet
Diaphragm insertion
on it self central tendon
but has connection to arcuate ligaments, crural fibers, psoas muscle and QL
Diaphram OINs
MA: draw down the central tendon of the diaphragm and increase thoracic volume during inhalation
O:
- costal attachment; inner surface of lower 6 ribs
- lumbar attachment; upper 2 or 3 lumbar vertebrae
- sternal attachment; inner part of xiphoid process
I: central tendon
N: phrenic nerve C3. C4. C5 keep you alive!
What three structures pass through the diaphragm and at what spinal level
From anterior to posterior and right to left orientation
Inferior vena cava (caval opening) T8
esophagus and vagus nerve T10
aorta and thoracic duct T12
What level does the abdominal aorta split and into what
L4
splits into left and right common iliac artery
lies behind spinal column
Phrenic nerve course
nerve roots C3-5 stay alive!
exits neck anteriorly and travels back behind the great veins at root of enck
travel lateral to each side of heart and in front of vagus nerve
*Innervates each dome of diaphragm
Other functions of the diaphragm
- enhanced venous return from the lower extremities (diaphragmatic pump)
- controls intra-abdominal pressures (spinal stabilization, coughing, valsalca manuever (litfting heavy weight) and child birthing
- parasympathetic relaxation
what makes up the acetabulum
all 3 bones - ilium, pubis, ischium
Quadratus Lumborum
MA: unilaterally; hike pelvis, laterally flex vertebral column, extend vertebral column
Bilaterally; fix the last rib during forced inspiration
SA: 12th rib, tips of lumbar transverse processes
IA: iliolumbar ligament and iliac crest
N: Ventral branches of T12, L1-L4
LATERAL to errector spinae
Hip Flexor muscles (what do they make?)
Psoas major
Iliacus
joint together to form common tendon iliopsoas
Psoas Major
MA: inferiorly flexes hip, superiorly it laterally flexes vertebral column, balance the trunk, when sitting it acts inferiotly w iliacus to flex the tunk
SA: TP of T12-L5 vertebrae, sides of Lumbar bodies and discs between them
IA: less trochanter
N: ventral rami of L1. L2. L3
iliacus
MA: flexes thigh ans stabilizes hip joint; acts with psoas major
SA: iliac fossa, (ala of) sacrum and anterior sacroiliac ligaments
IA: lesser trochanter and psoas tendon
N: Femoral L2-4 NOT ON EXAM
What test can be done for iliopsoas pain? What else is in this region that could be causing the pain?
pain with resisted supine hip flexion
lower right Q pain could also be from appendix, ureters, kidneys, sigmoid colon, pancreas, SI joint
Rectus Abdominis
MA: flex the vertebral (compresses abdominal viscera) column and posterior pelvic tilt (antilordosis)
O: pubic crest and pubic symphysis
I: cartilage of 5-7 ribs and xiphoid process
N: thoraco-abdominal nerves (anterior rami of T6-T12 spinal nerves)
What two tissue structures are associated with the rectus abdominis?
linea alba and rectus shealth (underneath)
External Oblique
MA:
- unilateral; laterally flex vertebral column and CONTRA rotation
- bilaterally; flex vertebral column and compress abdominal contents
O: external surfaces of 5-12 ribs
I: linea alba, pubic tubercle, anterior half of iliac crest
N: Thoraco-abdominal nerves of T7-T11 and subcostal nerve
What muscle starts where the external obliques start but goes opposite way?
serratus anterior
Internal oblique
MA:
- unilaterally; laterally flex vertebral column, rotate vertebral column to SAME side
- bilaterally; flex vertebral column and compress abdominal contents
O: thoracolumbar fascia, iliac crest and inguinal ligament
I: inferior borders of 10-12th rubs, linea, alba, and pecten pubis via conjoint tendon
N: Thoraco-abdominal nerve (anterior rami T6-T12 soinal nerves and first lumbar nerve
Transverse abdominis (dont stress too much on this one)
MA: compresses and supports abdominal viscera
*Antagonist of diaphragm with expiration
O: 7-12th costal cartilages, thoracolumbar fascia, iliac crest, connective deep tissue and lateral inguinal ligament
I: linea alba with aponeurosis of internal oblique, pubic crest and pecten pubis via conjoint tendon
N: thoraco-abdominal nerves (T6-T12) and first lumbar nerve
What two muscles are often target to help fix back pain?
multifidus and transverse abdominas
