Thoracic Flashcards
Characteristics of a true rib
1-7,
Attach directly to the sternum,
Own cartilage connects to the sternum
Characteristics of a false rib
8-10,
Indirect sternal attachment,
Cartilage connects to the cartilage of the rib above
Characteristics of a floating rib
11-12,
No sternal attachment
Characteristics of a typical rib
3-9,
Has a head, neck, tubercle, and body
Characteristics of an atypical rib
1, 2, 10-12;
Has additional factors that make the rib atypical
Characteristics of 1st rib
Shortest and broadest,
Only attaches to T1,
has grooves for subclavian artery and vein
Characteristics of 2nd rib
Longer than first,
has tuberosity for attachment of serratus anterior
Characteristics of 11th and 12th ribs
short,
have no neck or tubercle,
Head only for 1 attachment
3 spaces of the thoracic cavity
Mediastinum, right and left pulmonary cavities
What is located in the mediastinum cavity?
Thoracic viscera besides lungs,
(Heart and major vessels and tubes)
What is located in the right and left pulmonary cavities
The right and left lungs
What is the function of the thoracic cage?
Provide protection;
Resist negative pressure from inspiration; provide attachment for upper limb muscles; attachment for muscles of neck, abdomen, back, and respiration
What are intercostal spaces?
Separate ribs from each other;
11 spaces and 11 intercostal nerves;
(+ subcostal nerve)
How are intercostal spaces named?
Named by the rib superior to them
What lives in intercostal spaces?
Intercostal muscles, membranes, blood vessels, and nerves
Which ribs are true ribs?
1-7
Which ribs are false ribs?
8-10
Which ribs are floating?
11 and 12
What are the normal features of a vertebrae?
Body,
2 pedicles,
2 lamina,
vertebral arch,
2 Transvers process,
Spinous process,
Superior/inferior facets,
Zygapophysial joint
What are the unique features of thoracic vertebrae?
Bilateral costal facets
-superior and inferior
Costal facets on transverse process
Long slanting spinous processes
What are the 3 parts of the sternum?
Manubrium
Body
Xiphoid
What structure is the xiphisternal point a marker for?
Marks inferior limit of central part of thoracic cavity
What structures is the infrasternal angle a marker for?
Marks midline for superior limit of the liver
central tendon of the Diaphragm
Inferior boarder of the heart
What are the contents of the Superior Thoracic Aperture?
Trachea
Esophagus
Nerves and vessels supplying and draining head, neck, and upper limbs
What is contained in the Inferior Thoracic Aperture?
Diaphragm
- separates thoracic and abdominal cavities
Intervertebral Joint
T1-T12
Articulation: adjacent vertebral bodies bound by intervertebral disc
Costovertebral
Joints of heads of ribs - number of rib is determined by vertebrae inferior to it
A: Head of each rib w/ superior demi- or costal facet of vertebral body of same number rib and inferior demi- or costal facet of vertebral body superior to it and intervertebral disc b/w them
C: Heads of 1st, 11th, and 12th ribs (sometimes 10th) articulate ONLY w/ vertebral body of same number rib
Costochondral
Sternal end of rib attaching to cartilage coming from sternum
A: Lateral end of costal cartilage w/ sternal end of rib (Rib and Transverse Process)
C: No movement normally occurs here
Interchondral
Cartilage that attaches the 6th, 7th, 8th, 9th, and 10th ribs together
A: b/w costal cartilages of 6th & 7th, 7th & 8th, and 8th & 9th ribs
C: articulation b/w costal cartilages of 9th & 10th ribs is fibrous
Sternocostal (1st)
Attachment of first rib to the manubrium of the sternum
A: articulation of 1st costal cartilages w/ manubrium of sternum
Sternocostal (2nd - 7th)
Attachment of the 2nd-7th ribs to the body of the sternum
A: 2nd - 7th pairs of costal cartilages w/ sternum
C: Articular cavities usually absent, fibrocartilage covers articular surfaces
Sternoclavicular
Clavicle attachment at the manubrium of the sternum
A: Sternal end of clavicle w/ manubrium and 1st costal cartilage
C: joint is divided into 2 compartments by articular disc
Manubriosternal
Joint between the manubrium and body of the sternum
A: b/w manubrium and body of sternum
Xiphisternal
Joint between body of the sternum and xiphoid process
A: b/w xiphoid process and body of sternum
What do the manubriosternal and xiphisternal joints do in older individuals?
Fuse together and become synostoses
Which ribs move in a “pump handle” fashion?
Ribs 1-6
What movement do the inferior ends move in and around what axis do “pump handle” ribs move around?
Anterior and posterior type movement and around a transverse axis
What ribs move in a “bucket handle” fashion?
Ribs 7-10
What kind of movement do the ribs of the “bucket handle” engage in?
Lateral movements that are more so up and out
What do the “pump handle” and “bucket handle” movements help with in the thoracic cage?
They increase diameter and volume of the thoracic cavity
What are axio-appendicular muscles?
They attach to or cover the thoracic cage
Also move the upper limb BUT can also move bones in thoracic cage
What are the main muscles of the thoracic cavity?
Serratus Posterior Superior
Serratus Posterior Inferior
Levator Costarum
What are the major muscles for inspiration?
Diaphragm and external intercostals
Innervation of the Diaphragm
Phrenic Nerve (C3-C5)
Sensory to Peripheral parts - Intercostal nerves 6-11
Openings in Diaphragm
Opening for Vena Cava
Aortic Hiatus
Esophageal hiatus
Functions/ movements for Diaphragm
Contracts (descends) during inspiration
Which dome is higher on the Diaphragm?
Right
Due to liver directly inferior and heart presence on left side of thoracic cavity
What is innervated by the Anterior rami of the 12 pairs of thoracic nerves?
Usually muscles under dermatomes anteriorly
T1 - T11: Intercostal Nerves
T12: Subcostal nerve
What is innervated by the Posterior rami of the 12 pairs of thoracic nerves?
Joints
Deep back muscles (myotomes)
Skin of the back
Dermatome landmarks of the thoracic region (Anterior & Posterior)
Posterior - lines up with corresponding vertebrae
Anterior - Runs inferiorly
Common spots anteriorly:
T2 - Subclavicular region
T5 - Nipple region
T10 - Umbilical region
What are the atypical intercostal nerves
T1 & T2 (sometimes T3)
Why is T1 an atypical intercostal nerve?
Splits into superior and inferior parts
Superior: joins brachial plexus
Interior: becomes first intercostal nerve
Why is T2 (& sometimes T3) an atypical intercostal nerve?
T2 is considered the Intercostobrachial Nerve
- supplies skin and cutaneous tissue of axilla floor
T3 sometimes gives rise to a second intercostobrachial nerve
Where does the vasculature to the thoracic cage come from?
Thoracic aorta
Subclavian artery
Axillary artery
What is the difference between Mammary glands and Mamillary bodies?
Mammary glands: milk producing glands of the breasts in women
Mamillary bodies: pair of round, small bodies located on the undersurface of the brain in diencephalon
Flow of lymph from the breast to venous circulation?
Nipples/Areola/Lobules -> subareolar lymphatic plexus -> 1) 75% to axillary lymph nodes, 2) 25% to parasternal lymph nodes, 3) abdominal nodes ->
1) -> clavicular lymph nodes -> subclavian lymphatic trunk
2) -> Bronchomediastinal lymphatic trunk
ALL lead either to -> Jugular lymphatic trunk or Right/Left venous angles to R/L Brachiocephalic veins
*could also go to other breast
Important landmarks for palpation on thorax
Clavicles
Sternum
Jugular notch
Manubrium
Sternal angle
Xiphoid process
Costal Margins
Ribs/intercostal spaces
Difference between “slipping rib” or “rib separation”?
Slipping rib: displacement of costal cartilage from sternum
- (sternocostal joint or interchondral joints)
Rib separation: Dislocation of costochondral junction b/w rib & its costal cartilage
-usually ribs 3-10 and tears perichondrium and periosteum
Dsypnea
Difficulty breathing
Leaning on knees usually helps to fix pectoral girdle and allow muscles to expand thorax by acting on rib attachments
Cause and Effect of Thoracic Outlet Syndrome
Cause: Neurovascular structures are compressed when passing through Superior Thoracic Aperture
-usually involves structures outside of superior thoracic aperture like pec. minor & costoclavicular space
Effect: Symptoms - pain, paresthesias (pins and needles) in upper arms
What happens to the paralyzed side of the diaphragm during breathing?
Inspiration: ascends due to pressure of abdominal viscera coming from other side of diaphragm
Expiration: Descends due to positive pressure in lungs
How does Herpes Zoster happen?
(AKA Shingles)
Viral disease of spinal ganglia
usually occurs in 60yrs or older individual
Why does Herpes Zoster appear in these locations?
Viral infection is present in the spinal ganglia that these dermatomes supply
Become present on the skin as a result
