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Anatomy of Systems > The Chest Wall > Flashcards

The Chest Wall Flashcards

1
Q

What is the role of the extrinsic muscles

A

Helps with breathing, external to the ribs

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2
Q

Extrinsic muscles of the chest wall

A

Pectoralis major

Serratus anterior, attached to the rib and surrounded by deep fascia

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3
Q

Layers of the chest wall

A 
Skin
Superficial fascia
Deep fascia
Serratus anterior attaches to the rib
Rib

External intercostal muscles
Internal intercostal muscles
Neuromuscular bundle
Innermost intercostal muscles

Endothoracic fascia
Parietal pleura
Pleural cavity
Visceral pleura
Lung
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4
Q

How much fluid can fill the pleural cavity

A

10-20ml

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5
Q

Describe the structure of the sternum

Function of each section

A

Jugular notch on manubrium sterni

Sternal angle between manubrium sterni and body
Sternal angle and manubrium sterni have 2ndary cartilaginous joint, acts as a hinge as the sternum rises
Manubrium sterni helps breathing

Xiphisternum

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6
Q

The types of joints present between the thoracic cage and the joint between the ribs
Possible movements

A

1st sternocostal primary cartilaginous, v little movement
2nd-7th sternocostal synovial joints, breathing movements
8th-10th chondrochondral synovial joints for breathing movements

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7
Q

Which ribs are true, false, free floating

A

1-7 true, attach to sternum and vertebrae
8-10 false, only attach to vertebrae and rib above
11-12 false, free floating, only attach to vertebrae

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8
Q

Describe the angle of the ribs in an adult

A

Posterior higher than anterior

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9
Q

What muscles support the ribcage and keep it up

What are their functions

A

Sternocleidomastoid

  • lifts up sternum
  • lifts up ribcage
  • not really used in breathing

Scalenes anterior, medius, posterior
-attach to R1, R2
lifts up chest wall
prevents ribcage from dropping down

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10
Q

How do baby ribcages differ from adult ribcages

What happens as a result

A

Adult

  • more angled downwards
  • shorter distance between bottom ribs

Baby

  • more horizontal
  • greater distance between bottom ribs

As a result, babies can’t elevate the chest wall, rely on diaphragm for diaphragmatic breathing
Cannot breath thoracically

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11
Q

Describe the osteology of typical ribs

A

Sup and inf demifacet, synovial attachment to vertebrae
Interarticular crest in between

Neck

Articular and non articular part of tubercle, attach to transverse process

Shaft

Subcostal groove houses neuromuscular bundle

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12
Q

Location of ligaments found between ribs and vertebrae

A

Costotransverse ligament between rib and transverse process

Lateral costotransverse ligament between rib and the lateral part of the transverse process

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13
Q

Describe the osteology of the 1st atypical rib

A
  • Short, strong, flat, v curved
  • Tubercle for scalenus anterior
  • Single facet on head
  • Grooves for subclavian vessels for upper limbs
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14
Q

Describe the osteology of the 2nd atypical rib

A

Tubercle for scalenus posterior and serrates anterior attachment

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15
Q

Describe the osteology of the 10th atypical rib (occasionally)

A

May be a false free floating rib, only articulates with T10

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16
Q

Describe the osteology of the 11th, 12th atypical rib

A

No tubercles, no muscle attachments

No sternal attachments

17
Q

Describe the locations of the facets and articulations on the thoracic vertebrae

A

Facet for rib tubercle on lateral part of transverse process
Pars interarticularis between lamina and pedicle on transverse process (for sup, inf spinous)
Articular facet, for rib head (costovertebral joint here)

18
Q

How do the costovertebral joints in the upper ribs help with the expansion of the chest cavity

A

Axis of rotation along transverse process and body

Ribs rise up and forwards in a pump handle fashion

19
Q

How do the costovertebral joints in the lower ribs help with the expansion of the chest cavity

A

Different axis of rotation to the upper ribs

Rise up and out in a bucket handle fashion

20
Q

What is the 3rd method of expanding the chest cavity

A

Via the depression of the diaphragm

21
Q

Describe the arterial vasculature of the anterior thoracic wall

A

Aorta
R and L subclavian
Internal thoracic
Superior epigastric and musculophrenic

Anterior intercostals come from internal thoracic

22
Q

Describe the arterial vasculature of the posterior thoracic wall

A

Descending aorta
Thoracic aorta
Posterior intercostals

Lateral cutaneous branch connects intercostals and cutaneous arteries

23
Q

Describe the venous drainage in the azygos venous system

A

Azygos vein on the R side of the vertebrae
Accessory hemiazygos vein drains the top half of the ribs
Hemiazygos vein drains bottom half of the ribs

Both hemiazygos join azygos and cross over at T7

Azygos vein drains into the SVC

24
Q

Describe the blood supply to the pericardium

A

L subclavian
Internal thoracic
Pericardiacophrenic comes off internal thoracic
Ant abdominal wall comes off internal thoracic
Inf phrenic comes off pericardiacophrenics

Bronchial and esophageal arteries come off descending aorta

25
Q

Describe the lymphatic drainage

A

Axillary
Supraclavicular
Great veins

Lower half of the body and left side
Left lymphatic duct

Right arm, right head and chest wall
Right lymphatic duct

26
Q

Describe the lymphatic drainage of the chest wall

A

Cysterna chyli
Up into L subclavian via thoracic duct

Similar structure to azygos system

27
Q

Describe the lymphatic drainage from the lymph nodes in the chest

A

Anterior all drain up into bronchomediastinal trunk
Int thoracic
Bronchocephalic
Tracheobronchial

Posterior all drain into thoracic duct
Tracheobronchial
Post mediastinal
Post intercostals

Diaphragmatic drain both anteriorly and posteriorly

28
Q

Nerve supply of the chest wall
Landmarks on the chest

What nerves aren’t found on the chest

How do dermatomes work here

A

T4, nipple
T10, umbilicus

C5-8, T1 don’t innervate chest wall

Dermatomes overlap so if you want to numb T4, you need to numb T3 and 5

29
Q

Describe the structure of the nerves

What do they supply

A 
Anterior ramus (intercostal nerve)
Posterior ramus (posterior cutaneous)

Anterior cutaneous comes from the intercostal nerve

Lateral cutaneous branch connects cutaneous and intercostals

Supply skin, fascia, deep fascia and intercostals
Collateral nerves branch from anterior ramus, between ribs

Anatomy of Systems (11 decks)

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