The Thoracic Wall Flashcards
thorax
part of body b/n neck & diaphragm
mid-clavicular line
imaginary line running vertically downward from the midpoint of the clavicle
mid-axillary line
imaginary line running vertically downward from mid-axilla
manubrium:
part of the ___
lies at the level of ___
jugular (suprasternal) notch: ___
articulates with the ___
lower border articulates with the ___
rib 2 lies at the ___
sternum
T3 - T4
concave center of the upper border
clavicles & the 1st & upper part of the 2nd rib
body (manubriosternal joint, sternal angle of Louis)
manubriosternal joint
body (part of the sternum):
lies at the level of ___
articulates with ___
rib 7 lies at the ___
T5 - T9
ribs 2-7
xiphosternal joint
xiphoid process:
part of the ___
lies at the level of ___
sternum
T10
true ribs
vertebrosternal
upper 7 pairs
attached anteriorly to the sternum by costal cartilages
false ribs
lower 5 pairs
vertebrochondral ribs (8, 9, 10) - attached to each other & to 7th rib by their costal cartilages (connection to sternum is indirect)
free/floating ribs (11 & 12) - have no anterior attachment
typical ribs
ribs 3-9
typical ribs:
head
two facets for articulation w/ the corresponding vertebral bodies & the body above
typical ribs:
tubercle
facet for the transverse process of the corresponding vertebra
typical ribs:
neck
constriction b/n head & tubercle
typical ribs:
shaft/body
thin, twisted, contains a costal groove along the inferior border
typical ribs:
costal groove
contains (superior to inferior): VAN
- intercostal vein
- intercostal artery
- intercostal nerve
typical ribs:
costal angle
where the shaft bends sharply forward
atypical ribs:
first rib
important b/c ___
___ than other ribs
almost ___
___ for first vertebral body
scalene tubercle: ___
- subclavian vein crosses rib ___ to scalene tubercle
- subclavian artery & inferior trunk of brachial plexus cross rib ___ to scalene tubercle
of its relationship to the brachial plexus & large vessels of the arm
shorter & wider
horizontal
head single facet
insertion of the scalenus anterior muscle (near inner border)
- anterior
- posterior
atypical ribs:
second rib
main atypical feature is a rough area on its upper surface, the tuberosity for the serratus anterior muscle
atypical ribs:
10, 11, & 12
single facet of head for bodies of corresponding vertebrae
atypical ribs:
11 & 12
no tubercles or facets for transverse processes
intercostal muscle nerve supply
intercostal nerves
external intercostal muscles:
pass ___ from the rib above to the rib below
conform to the ___ muscles of the ___
extend from the ___ posteriorly to the ___ anteriorly
replaced anteriorly by the ___
downward & forward
external oblique, abdomen
rib tubercle, costochondral junction
external intercostal membrane
internal intercostal muscles:
pass ___ from rib above to rib below
conform to the ___ muscles of the ___
extend from ___ anteriorly to ___ posteriorly
replaced posteriorly by the ___
downard & backward
internal oblique, abdomen
sternum, angles of ribs
internal intercostal membrane
innermost intercostal layer:
___ than the other two intercostal muscles
best distinguished by the fact that they ___
the ___ of both the thoracic & abdominal walls lies b/n the middle & deepest layer of muscles
less well developed
are separated form the internal intercostal muscles by the neurovascular bundles
neurovascular plane
innermost intercostal layer:
innermost intercostal muscles (intercostalis intimi)
similar to internal intercostal muscles
innermost intercostal layer:
subcostal muscles:
pass from ___
usually span ___
parallels direction of the ___
inside angle of one rib to rib two levels inferior
two intercostal spaces
internal intercostal muscles
innermost intercostal layer:
transversus thoracis:
___ fan out from the ___
continuous inferiorly w/ the ___
4-5 slips of muscle, inferior part of sternum to costal cartilages 2-6
transversus abdominus muscle
intercostal nerves:
___ of the first ___ nerves
subcostal nerve: ___
after giving off the ___, the ___ continues in the direction of the original spinal nerve
each intercostal nerve enters the space b/n the ___ & the ___, then continues forward between the ___ & the ___
ventral rami, 11 thoracic
ventral ramus of T12 lies below 12th rib
dorsal ramus, ventral ramus
parietal pleura, internal intercostal membrane, internal intercostal muscles, innermost layer
atypical nerves:
first intercostal nerve:
represents ___
major part of the ___ joins the ___
only a small portion of the ventral ramus of T1
ramus, brachial plexus
atypical nerves:
second intercostal nerve (sometimes also third intercostal nerve):
lateral cutaneous branch (intercostobrachial nerve): ___
in coronary artery disease, ___ is referred along this nerve to the medial side of the arm
joins the medial cutaneous nerve of the arm & helps supply the skin of the axilla (armpit) & upper medial arm
pain
atypical nerves:
7th - 11th intercostal nerves:
leave the ___ & continue into the ___
continue in the ___
intercostal spaces, abdominal wall
same plane (b/n the internal oblique & transversus abdominus muscles)
atypical nerves: subcostal nerve (T12)
follows course of 7th-11th intercostal nerves
intercostal arteries
each space contains one large posterior intercostal artery & two small anterior intercostal arteries
posterior intercostal arteries:
first two spaces: ___
lower nine spaces: ___
continue into the ___
branches of the supreme intercostal artery (which itself is a branch of the costocervical trunk of the subclavian artery)
direct branches from the thoracic aorta
abdominal wall w/ the corresponding nerves
anterior intercostal arteries:
upper six spaces: ___
lower anterior intercostals & subcostal artery: ___
branches of the internal thoracic artery, anastomose laterally w/ the posterior intercostal arteries
branches of the musculophrenic artery (one of the terminal branches of the internal thoracic artery), continue into abdominal wall w/ corresponding nerves
internal thoracic artery (internal mammary artery):
branch of the ___
descends in the ___
divides behind the ___ into two terminal branches: ___ & ___
subclavian artery in the root of the neck
thorax just lateral to the sternum, anterior to the transversus thoracis muscle
6th costal cartilage, superior epigastric artery, musculophrenic artery
branches of the internal thoracic artery
upper six anterior intercostal arteries
pericardiophrenic artery
perforating branches
internal thoracic artery (internal mammary artery):
pericardiophrenic artery
runs w/ phrenic nerve
supplies the pericardium, diaphragm, & part of the pleura
internal thoracic artery (internal mammary artery):
perforating branches
pass to the skin w/ the anterior cutaneous branches of the intercostal nerves
contribute to the blood supply of the breast & enlarged in women during lactation
veins:
all ___ are accompanied by corresponding veins
the posterior intercostal veins empty into the ___ veins
anterior intercostal veins: ___
internal thoracic vein: ___
arteries
azygous & hemiazygous
drain into the musculophrenic vein or the internal thoracic vein
drains into the brachiocephalic vein
