thoracic Flashcards
what are the components of thoracic cage?
1- Sternum
2- 12 pairs of rib ( so 24 )
3- Costal cartilage ( 10 for the first 10 rib )
4- 12 thoracic vertebrae and the disks
what are the true ribs count em
1-7
why are they called true ribs?
because their costal cartilage attach to the sternum directly
what are the false ribs, count em up
8-10
why are they called false ribs?
because their costal cartilage is attached to the costal cartilage of the rib above ( 8 will attach to 7th , 9 will attach to 8 , 10 will attach to 9 )
what are the floating ribs count em up
11-12
why are they called floating ribs
because they dont attach to the costal cartilage –> floatinggg not connected anteriorly
what other classification of ribs?
typical
atypical
what are the typical ribs
3-9
what are the characteristics of typical ribs ( what makes them typical) on the posterior END.
1- 2 faucets on the head
2- tubercle on the neck with a faucet
3- Twisted shaft ( twisted shaft means eno the anterior and posterior end should not be on the same level )
whats the neck of a rib?
extension between the tubercle , the head.
what ligament attaches to the neck
costotransverse ligament , smooth articular faucet
whats the ligament that attaches to the transverse process
lateral costotransverse ligament, rough for non articular surface
what does the head of a TYPICAL rib articulate with? ( typical 2 faucets )
the corresponding vertebral body
the body of the vertebrae above.
Example :- 7th rib head will articulate with the 7th vertebrae and 6th vertebrae w hakaza
what does the head of the ATYPICAL rib articulate with? one faucet only on the head
the corresponding vertebrae only
10th rib will articulate 10th vertebrae only
what does the tubercle of the rib articulate with?
the transverse process of corresponding vertebrae
- 4th rib tubercle articulate with the transverse process of the 4th vertebrae
the tubercle of rib has 2 surfaces , define them and what they attach to ?
1- smooth surface this one articulates with the vertebrae transverse process
2- rough surface attaches to the ligament , lateral costo transverse
whats name of the joint between rib head and vertebrae body
Costovertebral joint
whats the name of the joint between rib tubercle and transverse process
costotransverse joint
whats the type of joint in the posterior end of the rib?
ALL are synovial plane
whats angle of the rib?
the point of maximum convexity in the body ,and its the most liable to fractures
whats costal groove?
an area below the inferior border and it protects intercostal vessels
whats are the surfaces and borders of normal rib?
normal rib has :
Upper and lower border
Inner and outer surface
what are the Atypical ribs?
1,2
10-12
what are the borders and surfaces first rib?
upper w lower surface
inner and outer border , THE INNER BORDER IS WITH THE SUPRAPLEURAL MEMBERANE ( dEEP FASCIA )
whats the broadest and most curved rib?
1st rib
what makes the first rib ATYPICAL?
head : one complete faucet which articulate with the T1 only
shaft is not twisted
the shaft is horizental not vertical and its not prone to fractures cuz its protected
what about the tubercle of the first rib?
its regular with the faucet on it articulating with T1 transverse process BUT IT COINCIDES WITH THE NECK.
what tubercle does the first rib has in inner border?
scalene tubercle
what ridge is present on the first rib upper surface?
scalene ridge
what grooves are present on the first rib?
subclavian vessels
what makes the 2nd rib atypical?
it has normal head with 2 faucets –> articulates with the T1 and T2
- normal tubercle faucet
-THE SHAFT IS NOT TWISTED .
what tuberosity does the 2nd rib has?
serratus anterior tuberosity
what makes 10th rib atypical?
it has everything normal EXCEPT :
1 faucet on the head not 2. so it will only articulate with T10
what makes 11th rib Atypical?
it has no tubercle – > no articulation with T11 transverse process
one single faucet on the head –> articulate with t11
- slight angle and groove
- it has NO neck because it has no tubercle
- pointed anterior end cuz no costal cartilage
what makes 12th rib atypical?
- No tubercle –> articulation with T12
- ONE SINGLE FAUCET ON THE HEAD –> ARTICULATE WITH T12
- NO ANGLE AND NO GROOVE
-no neck due to absence of tubercle
- pointed anterior end cuz no costal cartilage
what are the 2 abnormal ribs?
1- Cervical rib –> attach to C7
2 - Lumbar rib –>attach to L1 and its raree
what issue could abnormal rib do?
compress vessels
what are the 3 parts of sternum?
- Manubrium
- Sternal body
- Xiphoid process
whats present on the manubrium?
jugular notch/suprastenral notch
clavicle notch –> sternoclavicular joint –> synovial saddle
1ST COSTAL FACUET –>for the costal cartilage of the first rib -
half faucet 2nd costal –> for the costal cartilage of the 2nd rib
what the vertebral lvl of jugular notch
Jugular notch is on the level of T2
what forms the body of the sternum?
its formed by 4 segments ( sternbrae )
it has faucets for half rib 2 costal cartilage
- FAUCET FOR 3RD RIB COSTAL CARTILAGE
-FAUCET FOR 4TH COSTAL CARTILAGE
-FAUCET FOR 5TH COSTAL CARTILAGE
-FAUCET FOR 6TH COSTAL CARTILAGE - HALF FAUCET FOR 7TH COSTAL CARTILAGE
what do the ridges on the sternum indicate?
fusion of the sternbrae
whats sternal foreman?
incomplete ossification of sternrae resulting in holes in the sternum
wheres the xiphoid process located?
infrasternal subcostal angle
it has HALF FAUCET FOR 7TH COSTAL CARTILAGE
whats the level of xiphoid process in respect to vertebrae ?
xiphoid process is at the T10
what happens to the xiphoid process later on the life?
calcifies and causes a hard lump in epigastrium –> at the age of 40 synostosis
what are the other relations of xiphoid process?
1- central tendon of the diaphragm
2- inferior border of the heart
3- superior limit of the liver
what are the joints in the sternum?
1st joint -> manubriosternal joint AKA STERNAL ANGLE
2nd joint – > xiphisternal joint
3rd type –> sternocostal joints
4th type - costochondral joints
whats the type of manubrium stenral joint
symphesis –> 2nd cartilage
whats the level of manubrium stenral joint
is on the level of 2nd rib and T4 from behind
whats the type of xiphsternal joint?
at first its symphesis –> 2nd cartilage but later it becomes PRIMARY CARTILAGE –> SYNCHONDROSIS/SYNTOSIS
whats the type of sternocostal joint?
between sternum and costal cartilage:
1st one –> primary cartilage
the other 6 –> synovial plane
whats the type of costochondral joint?
all of them are primary cartilage
whats ossification date for the sternum pats?
5 month —> manubrium
6 motn –> 1st sternabrae
7 motnh —> 2nd sternabrae
8 month —> 3rd sternbrae
9 month — > 4th sternbrae
4 year –> xiphoid
what are the costal cartilagE?
cartilage that attach the ribs to the sternum via sternocostal joint and costochondral
whats costal marginal?
space below 7th-10th ribs
what type of cartilage is costal cartilage?
hyaline cartilage
what happens to costal cartilage in old age?
calcify and reduce mobility and appear shadow in xray
whats the relation between scapula and vertebra and ribs?
upper border of scapula = T2 2nd rib
spine of scapula = T3 , 3rd rib
Inferior border of scapular = T7, 7th rib
whats the special use of sternum ?
can be used for bone marrow aspiration because its superficial and it used for diagnosis of LEUKEMIA .
what are the typical T vertebrae?
2-8 vertebrae
whats makes a vertebrae typical?
BODY heart shaped with 2 demi faucets ( articulate with the corresponding rib and the one below , for example T5 articulates with 5 and 6), WHY 2 DEMI FAUCETS? cuz typical rib has 2 heads one for corresponding vertebrae and the one above
-Transverse process –> faucet on transverse process for the corresponding rib tubercle
- Spinous process —> long and pointing inferiorly
whats the shape of the vertebral canal?
circular in shape
what are the atypical vertebrae
1, 9, 10,11,12
why T1 is atypical?
because it HAS ONE FULL FAUCET AND A HALF ( ONE FULL FROM THE FIRST RIB, AND HALF FROM 2ND RIB )
- has normal transverse process with faucet for 1st rib tubercle
why T9 is Atypical?
because it only has 1 DEMI FAUCET from 9th rib ( no other demi faucet because 10th rib doesnt have 2 heads to attach with 9 too )
everything else is normal
why is T10 atypical?
because it only has 1 full faucet from 10th rib
Everything else is normal
why T11 is atypical?
- ONE FULL FAUCET ON from 11th rib
- NO FAUCET ON TRANSVERSE PROCESS CUZ 11 RIB HAS NO TUBERCLE
why is T12 atypical?
like T11 :
one full faucet on body from 12th rib
no faucet on transverse process because 12th rib has no tubercle
whats an intercostal space?
space between 2 ribs and its the space below a rib
how many intercostal spaces do we have anteriorly?
we have 9
how many intercostal spaces do we have posteriorly
we have 11
whats the content of the intercostal space?
- intercostal vessels
- intercostal muscles
- intercostal nerve
- lymphatic
what are the 3 muscles in the thoracic cage?
1- EXTERNAL INTERCOSTAL MUSCLE
2- INTERNAL INTERCOSTAL MUSCLE
3- TRANSVERSE THORACIC MUSCLE
what does the transverse thoracic muscle divide to?
1- Sternocostalis
2- Intercostalis intimi
3- Subcostalis
whats the origin of external intercostal muscle?
lower border of the rib above
whats the insertion of external intercostal muscle?
upper border of the rib below
where are the fibers directed?
downward and forward
whats the extension of external intercostal muscle?
from the tubercle of the rib from behind TO costochondral junction in front ( FROM BEHIND TO FRONT )
what does external intercostal muscle continue as?
anterior/external intercostal membrane
whats the nerve supply for external intercostal muscle?
intercostal nerves
whats the action of external intercostal muscle
elevation of rib during inspiration
Whats the origin of internal intercostal muscle?
costal groove of the rib above
whats the insertion of internal intercostal muscle?
upper border of the rib below
whats the direction of fibers?
downward and backward
whats the extension of internal intercostal muscle?
from lateral margin of the sternum anteriorly to the angle of the rib posteriorly ( FROM ANTERIOR TO POSTER , opposite to external )
whats the continuation of internal intercostal muscle?
posterior/internal intercostal membrane
whats the nerve supply?
intercostal nerves
whats the action of internal intercostal muscle?
-forced exhalation
- depress the ribs and decrease space in chest cavity
whats the origin of sternocostalis muscle?
the lower 1/3 of the sternum and xiphoid process posteriorly
whats the insertion of sternocostalis muscle?
costal cartilage of 2nd to 6th
direction of fibers?
upward and laterally
whats the nerve supply?
intercostal nerves
whats the action of sternocostalis
support the sternocostal joint
whats the origin of intercostalis intimi muscle?
lower border of rib above
whats the insertion of intercostalis intimi
upper border of the rib below
direction of fibers ?
downward and backward but also along middle two forth intercostal space
nerve supply?
intercostal nerves
whats the action of it?
depression of the ribs during forced expiration
origin of subcostalis muscle?
inner sufrace of the rib at its angle
insertion of subcostalis muscle?
2 or 3 ribs below
direction of fibers?
downward and medially
nerve supply?
intercostal nerve
whats the function of subcostalis muscle?
depressses the LOWER ribs during forced expiration
whats the origin of the diaphragm?
multiple origins :
1- costal origin –> lower 6 ribs
2- sternal origin –> xiphoid process
3- vertebral origin –> L1 - L3
4- medial and lateral arcuate ligaments
whats the insertion of diaphragm?
central tendon
whats the nerve supply?
phrenic nerve ( C3,4,5)
whats the function of diaphragm?
-primary muscle of inspiration
-closes the thoracic outlet (below )
- peripheraly - striated muscle
- inspiration
- abdominal straining
- weight lifting
- VENOUS PUMP CUZ VENA CAVA PASSES THROUGH IT
what happens in phrenic nerve palasy?
elevated hemidiaphragm and paradoxical movement
- when its contracted it will be down so when paral it will be upward.
-will be elevated by stomach in exray.
what are the structures passing through it
I ATE 2 EGGS AT 12
I- inferior vena cava –> ate /8 –> T8
EGGS - ESOPHAGUS –> 2 -> T2
AT –> AORTIA -> 12 —> T12
whats the origin of the internal thoracic artery?
first part of the subclavian artery
whats the course of it?
descends downard and medially behind the clavicle and 1st costal cartilage
- descends and terminates at the 6th intercostal space ( below 6th rib )
what does the intenral mammary artery terminate by dividing into what?
terminates at 6th intercostal space by dividing into
1- superior epigastric
2- musculophrenic
what are the branches of internal mammary artery?
1- preicardiophrenic artery —> runs with the phrenic nerve
2- anterior intercostal arteries –> 2 anterior in each except the last 2
3- perforating arteries
4- musclophrenic
5- superior epigastric
what venae comitantes form the internal mamary artery venae comitantes?
the superior epigastric venae comitantes
musculophrenic venae comitantes
where do the venae comitantes of mamary artery unite to form the internal thoracic vein?
3RD COSTAL CARTILAGE
where does the internal thoracic vein empty/terminate?
brachiocephalic vein
what 2 veins join to form brachiocephalic vein?
jugular vein and subclavian vein
what tributaries?
there are tributaries for each internal thoracic artery branch ( the 5 )
what are intercostal arteries?
we have 11 intercostal spaces ( 9 anterior and 11 posterior )
each space has 2 anterior intercostal arteries and 1 posterior intercostal artery
describe the anterior intercostal arteries?
two small in each space except the last 2 they dont have anterior
anastomose with the posterior
where do the first 6 anterior intercostal come from
internal mamary artery
what about the lower 3?
musculophrenic
what about 10-11?
they dont have anterior intercostal arteries only posterior
describe the poster intercostal arteries?
one in each space
anastomosis with the anterior
where do the first 2 posterior intercostal arteries come from?
superior intercostal artery
what about the lower 9?
descending thoracic aorta
whats special about the LOWER RIGHT 9 posterior intercostal arteries?
they longer than the left ones because the descending aorta is more located to the left.
what forms the posterior intercostal vein?
azygos and hemiazygos veins
what forms the anterior intercostal veins?
internal thoracic vein
whats an intercostal nerve?
ventral rami of spinal nerve of the 12th thoracic nerve
11 intercostal nerves for each intercostal spaces
describe the basic anatomy of the spinal nerve?
you posterior root ( dorsal root ganglion ) and anterior root fuse together to form the spinal nerve and then it divides into ventral (anterior ) rami and dorsal ( posterior ) rami
what are 2 classification of intercostal nerves?
typical
atypical
what are the typical intercostal nerves? and why they are considered typical?
3-6
they are typical becase they are distributed in the chest wall only. and they dont go out
what are the atypical intercostal nerve and why they are not typica?
1
2
lower 5
they are atypical because they are outside the chest wall too not only inside
what are the branches of typical intercostal nerve?
1- ganglionic ( sympathetic trunk )
2- muscular to the intercostal muscles
3- collateral branch –> upper border of the rib below
4- lateral cutaneous –> skin of the side of the chest
5- anterior cutaneous –> skin of the front of the chest
what are the branches of atypical nerve?
same as the normal branches in addition to :
1st intercostal nerve T1 will go and form brachial plexus
2nd intercostal nerve will go the arm
lower 5 they go the abdomen
what does the 2nd intercostal nerve enter the arm as ?
intercostobrachial nerve
whats the a dermatome?
area of skin supplied by a single nerve
sternal angle is diving 2 dermatomes what are they?
C4 FROM ABOVE
T2 FROM BELOW ( t1 is in the arm)
whats herpes zoster?
reactivation of varcille zoster virus and it will cause rash in a single dermatome حزام ناري
what are the possible movements of thorax?
vertical, lateral , anteroposteior direction
what movement is formed by diaphragm?
elevation and depression in vertical dimension
what does elevation and depression of the ribs change?
change the antero posterior and lateral dimensions
water pump is which movement?
antero posterior ( sternum upward and forward ) and its mainly the upper ribs which are attached to the sternum
whats the water bucket handle movement?
lateral dimension, MAINLY INS LOWER RIBS COSTAL CARTILAGE
