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Y1 - Anatomy of the Thorax > Lecture 2 - Thoracic wall > Flashcards

Lecture 2 - Thoracic wall Flashcards

1
Q

What are the main anatomical terms describing different views of the body?

A

Anterior - towards the front of the body
Posterior - towards the back of the body
Superior - towards the head
Inferior - towards the feet

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2
Q

What are neuroanatomy equivalents to anterior, posterior, superior and inferior?

A

anterior - ventral
posterior - dorsal
superior - cranial/rostral
inferior - caudal

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3
Q

What makes up the thoracic skeleton?

A
  • 12 thoracic vertebrae
  • 12 pairs of ribs and costal cartilages
  • Sternum
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4
Q

Describe the attachments of all 12 ribs.

A
  • Ribs 1-7 attach to the sternum directly so are known as true ribs
  • Ribs 8-10 reach the costal cartilages above so are known as false ribs
  • Ribs 11 and 12 lack the anterior attachment to the sternum so are known as floating ribs
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5
Q

What happens to the ribs during breathing?

A

During inhalation, the ribs move superiorly and anteriorly, increasing the anterograde-posterior dimension of the thoracic cavity. They are also everted (move outwards) to increase the transverse diameter of the thoracic cavity.

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6
Q

What are the main features of the ribs, moving from posteriorly to anteriorly?

A

Head, neck, tubercle.
Costal groove on the underside of the rib on the internal surface.
Costal cartilages are more anterior region.

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7
Q

What parts make up the sternum?

A

Manubrium, body and diploid process.

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8
Q

Where do the costal cartilages attach to the sternum?

A
  • 1st CC attaches to the manubrium
  • 2nd CC attaches to the manubriosternal joint
  • 3rd-7th CC attach to the body of the sternum
  • 8-10th CC do not attach directly and instead to costal cartilages above
  • 11/12th ribs do not have CC
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9
Q

What are the boundaries of the thoracic inlet?

A
  • 1st thoracic vertebrae
  • Manubrium
  • 1st rib
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10
Q

What does the thoracic inlet contain?

A
  • Great vessels of the head and upper limbs
  • Oesophagus
  • Trachea
  • Nerves
  • Lymphatics
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11
Q

What is another name for the thoracic inlet?

A

Superior thoracic aperture

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12
Q

What are the attachments of the diaphragm?

A
  • Attaches to the ribcage along the costal margin (costal cartilages of ribs 7-10)
  • Attached posteriorly to the left and right crus (inferior to the anterior attachment due to oblique angle of inferior thoracic aperture)
  • Xiphoid process
  • Ends of ribs 11 and 12
  • Lumbar vertebrae
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13
Q

What is the general function of the intercostal muscles?

A

To help with stiffening the chest wall to improve the efficiency of breathing movements.

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14
Q

Describe the attachments and direction of external intercostals.

A

Directly anterioinferiorly (towards the front and downwards) from the lower border of the rib above to the rib below, attaching at the tubercles of the ribs posteriorly and costal cartilages anteriorly.

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15
Q

What is the role of external intercostals?

A

Involved in forced and quiet inhalation, moving the ribs superiorly.

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16
Q

What are the three layers of intercostal muscles?

A
  • External intercostals
  • Internal intercostals
  • Innermost intercostals
    (moving posteriorly)
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17
Q

Describe the attachments and direction of the internal intercostals.

A

Attach anteriorly at the sternum, from the lower border of the rib above to the rib below. Fibres directed at right angles to external intercostals so superiorly and medially (or inferiorly and posteriorly)

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18
Q

What is the role of the internal intercostal muscles?

A

Involved in forced expiration, moving the ribs inferiorly.

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19
Q

How are the innermost intercostal muscles structured?

A

Relatively trivial but act with the internal intercostal muscles. Have the same orientation as the internal intercostals (superior and medially)

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20
Q

What does the neurovascular junction do and where is it found?

A

Found between the innermost and internal intercostals. It is involved in providing blood supply, drainage and innervation to the intercostal muscles.

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21
Q

What is the structure of the neurovascular junction?

A

Intercostal vein
Intercostal artery
Intercostal nerve
(in descending order from superior to inferior)

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22
Q

What is the implication of the structure of the neurovascular junction?

A

Vein and artery are protected by the costal groove on the internal surface of the rib however the nerve is exposed, meaning that sometimes it can be damaged when inserting a chest drain, causing loss of function in some cases.

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23
Q

What blood vessels perfuse the intercostal muscles as well as the intercostal muscles?

A

Inferior epigastric and iliac arteries from their inferior position.

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24
Q

Where do the intercostal arteries originate from and where do they extend to?

A

Branch off from the aorta or subclavian arteries and curve around to the anterior thoracic wall.
1st and 2nd - arise from supreme intercostal artery
3rd-11th - arise from the aorta

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25
Q

How does the position of the thoracic aorta affect the left and right intercostal arteries?

A

The thoracic aorta lies to the left of the midline so that the right intercostal arteries cross the midline anterior to the bodies of the vertebrae, meaning that they are longer than the left intercostal arteries.

26
Q

Where does the supreme intercostal artery arise from?

A

A branch of the costocervical trunk which is a branch off of the subclavian artery.

27
Q

Describe the blood supply to the anterior intercostal muscle region?

A

Branches off of the internal thoracic arteries supply the anterior regions of the intercostal muscles (one on each side, posterior to the costal cartilages (1-6)). At the level of the 6th costal cartilage, the internal thoracic arteries split into two separate arteries.

28
Q

Which arteries do the internal thoracic arteries split into and where does these extend to?

A

Superior epigastric artery -continuous inferiorly to the anterior abdominal wall
Musculophrenic artery - passes along costal margin, through diaphragm and into last intercostal space

29
Q

How many intercostal nerves are there?

A

11 pairs of mixed nerves from T1-T11 (sensory and motor) and 1 subcostal nerve (T12)

30
Q

Where is a chest drain inserted?

A

‘safe area/triangle’
- anterior border of latissimus dorsi
- lateral border of pectoralis major
- line superior to the horizontal level of the nipple
- apex below the axilla
Should be in line with the 5th intercostal space and anterior to the mid-axillary line

31
Q

What are the contents of the thoracic cavity?

A
  • Lungs (in pleural cavities)
  • Mediastinum
  • Heart (in pericardial sac)
  • Great vessels
  • Oesophagus
  • Trachea
  • Thymus
  • Thoracic duct and other major lymph trunks
  • Lymph nodes
  • Phrenic and vagus nerves
32
Q

What would different collections from a chest drain indicate?

A

Fluid - pleural effusion
Air - pneumothorax
Blood - haemothorax

33
Q

What is protraction?

A

Anterior movement

34
Q

What is retraction?

A

Posterior movement

35
Q

What is medial rotation?

A

Movement ‘inside’

36
Q

What is lateral rotation?

A

Movement ‘outside’

37
Q

What is dorsiflexion?

A

Towards the dorsum of the foot (top).

38
Q

What is plantar flexion?

A

Towards the plantar surface of the foot (sole).

39
Q

What is circumduction?

A

A ‘cone’ formed by moving the limb in a circular motion.

40
Q

What is radial or ulnar deviation?

A

Movement of the wrist towards either of these bones.

41
Q

What is protanation?

A

Palmar surface points inferiorly.

42
Q

What is supination?

A

Palmar surface points superiorly.

43
Q

What connects the vertebral body and the vertebral arch?

A

Pedicles

44
Q

How many processes are on the vertebrae?

A

2x transverse

1x spinous

45
Q

What does the lamina do?

A

Connects the transverse processes to the spinous processes.

46
Q

How do the ribs attach to the vertebrae posteriorly?

A

Via the head and tubercle (known as the costovertebral joint)

47
Q

What is found in the intervertebral joints?

A

Cartilage and intervertebral discs.

48
Q

What are the intervertebral discs made up of?

A
  • Anulus fibrosus (collagen - limiting rotation)

- Nucleus pulposus (gelatinous - absorbs compression forces)

49
Q

How are different vertebrae joined to one another?

A

Via zygapophysial joints (interior articular process and superior articular process).

50
Q

Describe the structure of the zygapophysial joints in the cervical region.

A

Slope inferiorly from anterior to posterior, which facilitates flexion and extension.

51
Q

Describe the structure of the zygapophysial joints in the thoracic region.

A

Orientated vertically which limits flexion and extension but allows rotation.

52
Q

Describe the structure of the zygapophysial joints in the lumbar region.

A

Joint surfaces are curved and adjacent processes interlock, thereby limiting the range of movement although flexion and extension are still major movements.

53
Q

How do the vertebral facets arrange with the facets on the ribs?

A
  • There are superior and inferior demifacets on the vertebral body for articulation with the corresponding rib
  • Superior costal facet (vb) articulates with part of the head of its own rib
  • Inferior costal facet (vb) articulates with part of the head of rib below
  • Transverse costal facet articulates with tubercle of its own rib
54
Q

Where is the costotransverse joint found?

A

A synovial joint between the tubercle of the rib and the transverse process of its own vertebra.

55
Q

What is a common cause of disc herniation?

A

Degenerative changes in the anulus fibrosus can lead to herniation of the nucleus pulposus.

56
Q

What can disc herniation lead to?

A

Posterolateral herniation can impinge the roots of a spinal nerve in the intervertebral foramen.

57
Q

Which sternocostal joints are synovial?

A

2-7th - they have thin capsules reinforced by surrounding sternocostal ligaments.

58
Q

Which rib marks the xiphisternal joint?

A

7th rib

59
Q

Where is the majority of capacity for lung expansion?

A

In the lower parts of the thorax.

60
Q

Anterior and posterior intercostal arteries are branches off which arteries?

A

Anterior - internal thoracic artery (initially subclavian arteries)
Posterior - aorta

61
Q

What are the functions of pectorals major muscle?

A
  • Abduction
  • Medial rotation
  • Flexion of humerus at shoulder joint
62
Q

If a diaphragm was more flat that usual on an X-ray, what could this indicate?

A

Hyperinflation of the lungs (common in respiratory diseases such as COPD)

Y1 - Anatomy of the Thorax (9 decks)

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