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Thoracic Wall > Muscles (VAN) Thoracic Wall > Flashcards

Muscles (VAN) Thoracic Wall Flashcards

1
Q

clavicles

A

near manubrium of sternum

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2
Q

sternum

A

T2-T10 vertebral level

  • manubrium
  • body of sternum
  • Xyphoid process
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3
Q

manubrium

A

T3-T4 vertebral level

  • anterior to arch of aorta and beginning portion of superior vena cava
  • Jugular notch at T2 vertebral level
  • Sternal angle (manubriosternal joint) where 2nd rib attaches
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4
Q

sternal body

A

T5-T9 vertebral level

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5
Q

Xiphoid process

A

T10 vertebral level

  • articulates with rib 7
  • Xiphisternal joint at T9
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6
Q

costal margins

A

joined costal margins of 7-10 ribs

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7
Q

true ribs (vertebrocostal)

A

1-7

-attach directly to sternum

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8
Q

false ribs (vertebrochondral)

A

8-10

-indirectly to sternum

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9
Q

floating ribs (free, vertebral)

A

11-12

-no sternal connection

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10
Q

head of rib

A

articulates with superior costal face of same numbered vertebrae and inferior costal facet of vertebrae superior to rib (rib 2 articulates with T2 and T1)
-leads to bucket-handle and pump-handle movement

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11
Q

tubercule of rib

A

b/w neck and body

-articulates with transverse process of same numbered vertebrae

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12
Q

costal groove of rib

A

inferior border of rib, protects neurovascular bundle

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13
Q

first rib

A

groove on superior surface for subclavian v. and a. separated by (anterior) scalene tubercule

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14
Q

fracture ribs

A

usually 3-8 just anterior to angle of rib

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15
Q

dislocation of rib

A

costal cartilage dislocation from sternum (sternocostal joint)
-interchondral joints displaced

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16
Q

superior thoracic aperture

A
  • surrounded by T1 vertebrae, 1st pair of ribs, and superior border of manubrium (T3 so two levels lower than posterior border)
  • inlet: food, venous blood, vagus nerve, phrenic nerve
  • outlet: neurovascular structures to head and upper limb
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17
Q

inferior thoracic aperture

A

thoracic outlet

  • surrounded by T12 vertebrae, 11th/12th ribs, costal margins, xiphisternal joint
  • food, vagus nerve, arterial blood in aorta
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18
Q

anterior scalene

A
  1. C3-C6 to scalene tubercule of rib 1
  2. fix ribs 1 and 2 in forceful inspiration
  3. C3-C6 spinal nerves
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19
Q

middle scalene

A
  1. C3-C7 to rib 1
  2. fix ribs 1 and 2 in forceful inspiration
  3. C3-C6 spinal nerves
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20
Q

posterior scalene

A
  1. C5-C7 to rib 2
  2. fix ribs 1 and 2 in forceful inspiration
  3. C3-C6 spinal nerves
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21
Q

pectoralis major

A
  1. clavicle, sternum to 7th rib, costal cartilages, bicipital groove of humerus
  2. adducts arm, forward, and rotates medially
  3. medial pectoral (C8-T1 spinal nerves) and lateral pectoral nerves (C5-C7 spinal nerves)
  4. pectoral branch of thoroacromial a. and internal thoracic a.
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22
Q

serratus anterior

A
  1. ribs 1-9, vertebral border of scapula
  2. protracts and rotates scapula
  3. long thoracic nerve (C5-C7 spinal nerves)
  4. lateral thoracic artery
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23
Q

subclavius

A
  1. upper part of rib 1 to clavicle (costoclavicular space)
  2. pulls clavicle down and forward
  3. C5-C6 spinal nerves from brachial plexus
  4. clavicular branch of throacromial a.
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24
Q

pectoralis minor

A
  1. ribs 3-5, coracoid process of scapula
  2. pulls scapula forward and down
  3. medial pectoral nerve (C8-T1 spinal nerves)
  4. thoroacromial a. intercostal arteries, lateral thoracic artery
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25
Q

external intercostals

A
  • tubercules of ribs to costochondral junction
  • elevate ribs and sternum (inspiration)
  • intercostal nerves
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26
Q

internal intercostals

A
  • sternum to angles of ribs
  • replaces posteriorly with internal intercostal membrane
  • depress ribs and sternum (expiration)
  • intercostal nerves
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27
Q

innermost intercostals

A
  • separated from inner intercostal muscles by intercostal nerves and vessels
  • later-most segment of intercostal spaces
  • intercostal nerves
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28
Q

flail chest

A

paradoxical motion fie to segment of thoracic wall moving freely
-at least 3 ribs broken in 2+ places

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29
Q

supreme intercostal artery

A
  • branch of costocervical trunk of subclavian artery

- supplies 1st and 2nd posterior intercostal arteries

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30
Q

thoracic aorta

A

supplies 3rd-11th and subcostal (12th) posterior intercostal arteries

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31
Q

posterior branch of posterior intercostal arteries

A

spinal cord, vertebral column, back muscles, skin

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32
Q

collateral branch of posterior intercostal arteries

A

crosses intercostal space to superior border of rib

33
Q

internal thoracic artery

A

supplies anterior intercostal arteries (2 per ICS, 1-9)

  • go to intercostal muscles, overlaying skin, parietal pleura
  • inner surface of thoracic wall lateral to sternum
34
Q

subclavian

A

into thorax posterior to clavicle

  • inner surface of thoracic wall lateral to sternum
  • branches into costocervical trunk (into supreme intercostal artery) and interior thoracic arteries
35
Q

cutaneous branch of internal thoracic artery

A

perforate muscles and supply anterior midline

36
Q

musculophrenic branch of internal thoracic artery

A

terminal, along costal cartilage, supplies lower anterior intercostal arteries (7-9)

37
Q

superior epigastric branch of internal thoracic artery

A

terminal branch

38
Q

superior vena cava

A

venous plexuses to posterior intercostal veins to azygous venous system to superior vena cava

39
Q

brachiocephalic vein

A

first posterior intercostal vein drains into this

40
Q

superior intercostal vein

A

2-3 posterior intercostal veins drain into this

  • R superior intercostal v. into azygous into superior vena cava
  • L superior intercostal v. into L. braciochephalic vein into superior vena cava
41
Q

internal thoracic vein

A

into anterior intercostal veins

42
Q

thoracic spinal nerves

A

12 pairs

43
Q

intercostal nerve

A

anterior rami T1-T11

44
Q

subcostal nerve

A

anterior ramus T12

45
Q

posterior rami

A

supply joints, deep back muscles, skin of back

46
Q

rami communicantes branch of intercostal nerves

A

sympathetic nerves to vessels, glands, smooth muscles

47
Q

collateral branches of intercostal nerves

A

arise near angle of rib and go along superior superior margin of their inferior rib to supply intercostal membranes and parietal pleura

48
Q

muscular branches of intercostal nerves

A

supply intercostal, subcostal, transversus thoracis, levatorres coststum, serratus posterior muscles

49
Q

lateral cutaneous branches of intercostal nerves

A
  • along midaxillary line
  • divide into anterior and posterior to supply skin of lateral and thoracic abdominal walls
  • 4-6 supply lateral mammary nerve
50
Q

anterior cutaneous branches of intercostal nerves

A
  • parasternal line
  • into medial and later branches
  • supply anterior skin of thorax and abdomen
  • 4-6 supply medial mammary nerve
51
Q

intercostal nerve block

A

anesthetic around intercostal nerve and collateral branches

-two or more nerves anesthetized to completely lose sensation

52
Q

chest tube

A

drainage tube inserted in intercostal space immediately superior to rib

  • to evacuate a pneumothorax: anterosuperiorly
  • fluid collections: posteroinferiorly
53
Q

thoracic outlet syndromes

A

compression of neurovascular structures

54
Q

anterior scalene syndrome

A

brachial plexus and subclavian artery between anterior and middle scalene

55
Q

costoclavicular syndrome

A

brachial plexus and subclavian artery and vein between first rib and clavicle

56
Q

pectoralis minor syndrome

A

-most common

brachial plexus and axillary artery and vein between pectoralis minor and rib cage

57
Q

compression of sensory nerves

A

tingling, numbness, loss o sensation, pain

58
Q

compression of motor nerves

A

muscle weakness

59
Q

artery compression

A

dec. strength of radial pulse

60
Q

vein compression

A

swelling of upper limb

61
Q

cervical ribs

A

supernumary ribs arising from C7 that may compress subclavian artery

62
Q

retromammary space

A

plane between mammary glands and pectoral fascia

63
Q

pectoral fascia

A

superficial to pec. major, part of bed of breast

64
Q

boundaries of breast

A

rib 2-6, nipple and level 4 ICS

65
Q

axillary process (Tail of Spence)

A

angles towards axilla and may be confused as tumor when enlarging during menstrual cycle

66
Q

lactiferous ducts

A

lobules to lobes to single duct

67
Q

lactiferous sinus

A

dilated portion of lactiferous duct deep to areola, opens to nipple

68
Q

sensory ligaments of breast

A

attatches mammary gland to skin, supports its lobes and lobules, runs between skin and deep fascia, well developed in superior part

69
Q

polymastia

A

supernumary breast that may appear along embryonic mammary crest

70
Q

polythelia

A

accessory nipples

71
Q

nerves of breast

A

medial and lateral mammary branches from the anterior and lateral cutaneous branches of intercostal nerves 4-6

  • pass through pectoral fascia
  • sympathetic fibers go to blood vessels and smooth muscle
72
Q

subareolar lymphatic plexus

A

afferents from nipple, areola, lobules of gland

73
Q

axillary lymph nodes

A
  1. anterior/pectoral nodes
  2. afferents from lateral breast quadrant
  3. efferents to clavicular nodes (infa and supra) then to subclavian lymph trunk
74
Q

parasternal nodes

A
  1. along internal thoracic vessels
  2. affterents from medial breast quadrants, medial chest wall, upper abdominal wall, upper surface of liver
  3. efferents to bronchomediastinal trunk
75
Q

abdominal nodes (Phrenic nodes)

A
  1. along upper diaphragam
  2. afferents from inferior breast quadrant, liver, abdominal wall, diaphragm
  3. efferents to parasternal and posterior mediastinal nodes
76
Q

breast cancer

A
  1. near nipple
  2. lactiferous ducts/sinus
  3. gland tissue (dimples caused by shortening of suspensory ligaments
77
Q

edema in breast cancer

A

excess fluid in subQ tissues cases nipple deviation and thickened appearance of skin

78
Q

Peau d’orange in breast cancer

A

puffy, orange peel pore like skin

79
Q

mammogram

A

1/9 develop breast cancer, so radiographic exam scans breasts
-carcinoma appears as large jagged density

Thoracic Wall (1 decks)

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