Superficial Thorax Flashcards
What are the boundries of the thorax
- between the neck and abdomen
- contains heart and lungs
- diaphragm separates abdominal cavity
what makes up the thoracic wall
vertebrae
ribs
sternum
muscles
what type of fascia is seen in the thorax
- superficial
- deep
what is special about the superficial fascia of the thorax
it is just like the hypodermis elsewhere
what is special about the deep fascia of the thorax
it is named for the muscles or structures beneath and is thin
exp.
- pectoral fascia
- clavopectoral fascia
- endothoracic fascia
how many vertebrae are found in the thorax
12 thoracic vertebrae and their discs
** should really reveiw the thoracic v. from the back section
how many pairs of ribs?
there will be 12 pairs of ribs with their costal cartilage a long with the sternum
how many true ribs
the 1st 7
how many are false ribs
8-10
how many are floating ribs
11 and 12
what ribs are typical
ribs 3-9 are typical
what does a typical rib contain
- head
- neck
- tubercle
- body
what is found on the head of the rib
2 facets separated by crest of head
what is found on the tubercle of the rib
- articular part
- nonarticular part
what is the articular part of the tubercle of the rib
this articulated with the transverse process of the lower of the two vertebrae to which the head is connected
what is the non articular part of the tubercle of the rib
for attachment to the ligament of the tubercle
what are the atypical ribs
ribs 1, 2, 10, 11, 12
what makes rib 1 atypical
- broadest, shortest, widest rib
- 2 grooves ( 1 for subclavian a. and one for sublavian v.)
- separated by scalene tubercle
what is an attachment site for anterior scalene m
the scalene tubercle on the 1st rib
what makes rib 2 atypical
- articulates with sternum at level of sternal angle
- head has 2 facets to articulate with bodies of T1 and T2
- tubersoity for serratus anterior
what makes 10 rib atypical
only has 1 facet
what makes 11, 12th ribs atypical
they only have 1 facet and they are short wiht NO necks or tubercles
what are part of the sternum
- manubrium
- sternal angle
- xiphoid process
what can be found on the manubrium
- level of T3 or T4
- jugular notch
where can the sternal angle be foudn
level of T4 or T5
where can the xiphoid process be found
- anterior limit of thoracic
- midline indicator
- inferior border of heart
how are the intercostal spaces between the ribs named
they are named for the rib of the superior border of the space
what is filled within these spaces
intercostal muscles
how many intercostal spaces are there
there are 11 intercostal spaces that are filled with muscles, vessels and nerves
what is below the 12th spaces of the ribs
this is the subcostal space with subcostal nerve
what is deep to the intercostal muscles
the nuerovascualr bundles
what is a neurovascular bundle
this is an intercostal vein, artery and nerve arranged in that order form above downward ( superior in the space)
what type of joint is the costovertebral joint
synovial plane joint
what does the costovertebral joint do
joints head of ribs
- the head of each rib articulates with the demifacets of 2 adjacent vertebrae
what is the intra articular ligament
this attaches head to intervertebral disc and works with the costovertebral joint
what is the radiate ligament
attach head to vertebral bodies and disc between and works with the costovertebral joint
which ribs do not have the intra articular legament
rids 1, 11, 12 AND MAYBE 10 articulate with only one body so they do not need this ligament
what type of joint is the costoransverse
synovial plane joint
what doe the costotransverse joint do
facet of the rib tubercle articulates transverse process of its own vertebra
what is the costotransverse ligament
this connect the neck of rib to the transverse process
what is the lateral costotransverse ligament
this connects the tubercle- nonarticular part to transverse process
what is the superior costotransverse ligament
this connects neck to transverse process superior to it
what does the space between the costotransverse ligmanets allow
they allow passage of spinal ns.
where can the sternocostal joint be found
in the first 7 ribs costal cartilages
what type of joint is the sternocostal joint of the 1st RIB
primary cartilaginous joint ( snychondrosis)
what type of joint is the sternocostal joint of the 2nd to 7th RIBS
synovial plane joints
what ligamnet is used in with the sternocostal joints
anterior and posterior radiate sternocostal ligaments
what does the sternocostal ligament do
strengthen the joints of the first 7 ribs
what type of joint is the costochondral joint
primary cartilaginous joint
**slide 14 for picture
what type of joint is the interchondral joint
synovial plane joint
**slide 14 for picture
what type of joint is the sternoclavicular joint
saddle type synocvial joint
**slide 14 for picture
what type of joint is the manubriosternal joint
secondary cartilaginous joint
**slide 14 for picture
what type of joint is the siphisternal joint
primary cartilaginous joint
**slide 14 for picture
how does the thorax move during inspiration
the sternum and anterior ends of the ribs rise
– this increase anterior and posterior diameter of the thorax
what are some accessory muscles of respiration
scalenes, scm, serratus anterior , pec Major and minor … and a lot more see slide 16 for the whole list
what are some muscles that elevate ribs and expand thoracic cavity
- pec Major
- pec minor
- serratus anterior
what fixes the ribs
scalenes muslces
what are the levator costarum
brevis and longs
- deep posterio muscles
- vertebral movement and proprioception
what are the serratus posterior m
- there is a superiro and posterior and they may have proprioceptive fx
what are the intercostal mm
there are
- external
- internal
- innermost
what are the external intercostal mm
replaced anterio by external intercostal membrane and internal intercostalm
what are the internal intercostal mm
posterio replaced by interna intercostal membrane and they extend to about the angle of the ribs
what are the innermost intercostal mm
deeper part of internal interocstal mm separated from internal intercostals by intercostal nn and vessels
what are the subcostal mm
lower posterior thoracic wall
- cross 1 or 2 spaces
- thought to be part of the innermost intercostal m – run in same direction as internal intercostals
what is the transverse thoracis
this is in the anterior thorax
- 4 or 5 slips
- sternum to costal cartilage
- may be proprioceptive
where do the thoracis nerves leave the spinal cord
they leave the intervertebral foramen and then divide into anterior and posterior primary rami
what becomes the intercostal nn
the anterior rami of T1-11
what is the T12 nerve
this is the subcostal n
what are typical intercostal n.
3 to 6 intercostal spaces
what is the path of the typical intercostal n.
they enter intercostal space posteriorly THEN near the angle of ribs n pass between internal and innermost intercostals THEN run inferior to intercostal arteries THEN continues aroudn on an anterior course giving off branches
what are branches of the intercostal nerves
- rami communicantes
- collateral branches
- lateral cutaneous branches
- anterior cutaneous branches
- muscular branches
where does the collateral branches arise
they come form near angles of ribs
– then run parallel to main nerve on upper border of rib below and then terminates as lower anterio cutaneous nerve
what does the collatera branches supply
intercostal mm and parietal pleura
where does the lateral cutaneous branches arise
beyond the angles of ribs
– THEN they divdie into anterior and posterior branches
what does the lateral cutaneous branches supply
skin on anterior and posterio lateral aspect of thoracic annd abdominal wall
what does the anterior cutaneous branches divide into
meidal and lateral branches
what does the muscular branches supply
intercostal, subcostal, transverse thoracic, levatores costarum and serratus posterior m.
what is an atypical intercostal n.
T1, T2, T7-T11
what does the atypical T1 intercostal n divide into
large superior part
small inferior part
anterior cutaneous branch of thorax
NO ( most of the time) lateral cutaneous branch
what does the T1 intercostal n end as
the anterior cutaneous branch BUT this occasionally is missing
what doe the T1 intercostal n large superior division joint
brachial plexus
what doe the T1 intercostal n small inferior division joint
becomes the 1st intercostal n
What does the T2 intercostal n give rise to
the intercostobrachial n ( which is a large lateral cutaneous branch)
what is the intercostobrachial n path
this is the atypical T2 n.
- leaves at the angle and innervates skin of the axilla and communiates with the medial brachial cutaneous n to medial arm
what does the T7-11 intercostal n do
the lateral cutaneous branches then supply abdominal skin and muscles as the thoracoabdominal nn
what are dermatomes
segmental innervation of thoracic wall
what are main arterial feed of the thoracic wall
- thoracic aorta
- subclavina artery
- axillary artery
how many arteries does each intercostal space have
they have 3
1 large posterior intercostal a
2 anterior intercostal aa
(10th and 11th DO NOT follow this)
where does the posterior intercostal a of the 1st 2 spaces come from
they are branches of supreme intercostal a which is the branch off of the costocervical trunk of subclavian
where does the posterior intercostal a of the 3rd to 11th and subcostal a come from
they come from the descending thoracic aorta
where does the anterior intercostal a of the 1st 6 space come from
they come from internal thracic a which is a branch of the subclavian a
what does the internal thoracic a divide into
- superior epigastric a ( to umbilicus )
- musculophrenic a
where does the anterior intercostal a of the 7-9 spaces come from
musculophrenic a
where does the anterior intercostal a of the 10-11 spaces come from
there are no anterior intercostal aa in these spaces is is supplied by posterior intercostal a
where does the intercostal vv come from
they come from the anterior inercostal vv and run with their ateries
where does the internal thoracic vv come from
they company vv of the artery
where does the posterior intercostal vv going to of the 1st 3 or 4 spaces
they are going to the supreme intercostal vein then drain into brachiocephalic vein
where does the posterior intercostal vv going to of the 4 maybe to 5-11 spaces RIGHT side
Right= drain into azygos vein then vena cava
where does the posterior intercostal vv going to of the 4 maybe to 5-8 spaces LEFT side
left ( 5-8)= drain into accessory hemiazygos
where does the posterior intercostal vv going to of the 4 maybe to 9-11 spaces LEFT side
left ( 9-11)= drain into hemiazygos veins
what forms the azygos and hemiazigos
formed by the union of ascending lumbar vv with subcostal vv
where does the azygos vein get blood from
posterior wall of thorax and abdomen to superior vena cava
- run up the right side of thoracic vertebral column
- arches over the right main bronchus at the root of lung ( T5-6 level )
where does the hemiazygos drain into
drains the lower left thoracic region INTO azygos
where is the hemiazygos path
runs superiorly next to thoracic vertebrae at the level of T8 or 9 crosses midline to enter azygos vein
where does the accessory hemiazygo drain
this drians the 5-8th intercostal spaces on left side INTO azygos or brachiocephalic v
where does the accesoory hemiazygos path
–descends next to the thoracic vertebrae and crosses midline at T8 to enter azygos vein
