Thoracic cage and mechanics of breathing Flashcards
sternoclavicular joint
synovial joint between clavicle and manubrium of the sternum
sternocostal joints
whats the exception
synovial joints of costal cartilages of the true ribs with the sternum ( only exception is first rib (synchondrosis joint since the cartilage is directly united with the sternum)
costochondral joint
each of your ribs is connected to your breastbone by a piece of cartilage - the point where your rib connects to this cartilage is know as the costochondral joint
manubriosternal joint
symphysis joint ( 2nd cartilage joint) formed by manubrium and the sternal body
xiphisternal joint
where the sternum and xiphoid process meet
structurally it is synchondrosis and function synarthrosis
interchondral joints
articulations formed by the costal cartilages between the 6th to 10th rib
why can’t you palpate the first rib
its covered by the clavicle
what is a false rib
said to be false if it does not attach to the sternum but attach via costal cartilages
11th to 12th rib have no ventral attachment to anchor them so are floating
suprasternal notch/jugular notch
between the clavicle and above the manubrium
what rib is at the level of the sternal angle
2nd rib
Counting ribs from the sternal angle
Counting vertebrae from the C7 spinous process
what is the vertebra felt at the vertebral prominence at the level of the suprasternal notch
C7
at what vertebral level does the suprasternal notch correspond to
T2/3
at what vertebral level does the sternal angle of louis correspond to
T4/5
at what vertebral level does the inferior angle of the scapula
T8
at what vertebral level does the xiphisternum
T9
at what vertebral level does the lowest part of costal margin 10th rib
L3
what is the costal margin and what structure attaches here
medial margin formed by the cartilages of the 7th-10th ribs
diaphragm (Nipples are the height are where diaphragm is)-abdomen starts below nipples
what is the costal angle
is the angle between the left and right total margins where they join the sternum
do the costochondral junctions fully cover the heart
no - some of the heart is left exposed
midline thoracotomy
used in cardiothoracic surgery - split sternum in half with saw - often done to read lung cancer - need to access plural space of the thorax
or to put an artificial pacemaker in
where is the weakest point of the rib
the angle of the rib - mostly likely to be fractures
1 and 2 hardly break as protected by clavicle
11 and 12 can spring out the way
true rib
what ribs
attach to sternum via own costal cartilages 1-7
false ribs
what ribs
connected to sternum indirectly via cartilage from the rib above 8-10
floating ribs
what ribs
cartilage of these ribs ends in the abdominal musculature 11-12
what is a typical rib and what ribs are typical ribs
head contains two articular facets, neck, tubercle and body ( contains costal groove and joins with costal cartilage
3-9
what is an atypical rib and what ribs are atypical ribs
1,2,10,11,12
1st- widest and shortest - contains two grooves subclavian vessels
2nd- two facets and roughed surface
10-12- one facet
which rib contains grooves for the subclavian vessels
1st rib
external intercostals
elevate ribs
internal intercostals
depress ribs
why are chest fractures in children rare
chest wall is elastic
thoracic outlet syndrome
what would be associated with these injuries
disorder where blood vessels or/and nerves in the space between the clavicle and first rib are compressed ( brachial plexus problem, subclavian arteries and veins)
if vein going to have arm turn blue
if artery could be paler and colder intolerance
C8-T1- tingling of nerve - work out ulna)
sports that require competitive movements
the pain of TOS can be confused with what clinical condition and how are they distinguished
confused with pain with angina( chest pain due to an inadequate supply of oxygen to the heart muscle)
distinguished because the pain of TOS does not occur or increase when walking
pain of TOS increase when raising affected arm which does not occur in angina
how could the superior thoracic aperture could be obstructed
extra ribs ( cervical rib) above the first rib abnormal tilt band connecting the spine to the ribs
how many thoracic vertebrae
and what is there main function
12
articulation with the ribs
the costal facet of thoracic vertebrae is on the transverse process which articulate with the tubercle of the rib. which vertebrae are not included in this
T11-12
the spinous processes start inferiorly and anteriorly what are they protecting
the spine
shingles is when the virus sits in the sensory cell bodies of spinal nerve roots - what is a classic symptom of this
pain go along the intercostal nerves - classic transverse pain ( nothing else does this) this is before spots come along
good to ask for chicken pocks
resting ATP is 760mmHg
the intrapleural pressure is 756mmHg what is the alveolar pressure
760mmHg
During inhalation diaphragm lowers increasing size of cavity and air comes in and diaphragm drops - flattened the ATP obviously stays the same the intrapleural pressure drops to 754mmHg what does the alveolar pressure drop to
758mmHg
which side of the diaphragm is higher due to the liver
right side
Right hemidiaphragm at level of 5th rib anteriorly and T9 posteriorly at end of respiration
chylothorax
rare condition where lymphatic fluid leaks into the space between the lung and chest wall - lymphatic flow disorder
when the diaphragm contracts during inspiration it causes it to flattens and moves downwards leading to an increase in vertical diameter of the thoracic cavity –> what nerve innervates the diaphragm
Phrenic nerve C3-5
in quiet breathing what muscles are used
diaphragm
external intercostals stabilise the rib cage
when you increase effort during inspiration what muscles are used
diaphragm
external intercostals lift and expand ribs
accessory muscles
neck- SCM, SA,SM ( pull the rib cage up
shoulder Girdle muscles ( pec minor0, lat dorsi)
sternoclaidomastoid in breahting
elevate sternum
saclenus major and minor muscles
elevate first two ribs and the sternum
pec minor ( when scapula stabilised) and lat doris
pull ribcage outwards - seen in acute asthma and patients in respiratory distress
( 3-5th ribs)
oblique,transversus and rectus abdominaux muscles
pull ribcage downwards
what are the accessory muscles of inspiration that need to be identified with patients with COPD on forced inspiration and expiration
sternocleidomastoid
anterior, middle and posterior scalenes and pec minor(major) and serratus anterior
in quiet expiration breathing what muscles are used
none just elastic recoil of tissues ( chest wall and lungs) - normal exhalation is a passive process
internal and innermost intercostals
what muscles are used in increasing effort expiration
active process so involves
internal intercostals and abdominal wall muscles
What are the accessory muscles of expiration
rectus abdominus
transverse abdominus
these fix costal margin and increase intra-abdominal pressure
external internal obliques
the mechanisms of breathing are described using 2 analogies - what are they
Pump handle movement
Bucket handle movement
what is the pump handle movement
increase the anterograde-posterior AP diameter of the thoracic cavity
upwards movement of the upper ribs over sternum and out
most active muscle group being the intercostals
what is the bucket handle movement
Increases the Transverse Diameter of the Thoracic Cavity.
upwards and outward movement of the middle and lower ribs increase the transverse or lateral diameter of the thoracic cavity
what is poland syndrome
no pec major or rib
can be anything to do with missing structures in the pectoral girdle
if you are going to anethastise go below the rib but if you want to do a chest drain where do you go
above the rib
apical pneumothorax, placement of a chest tube in the 2nd intercostal space should be considered.
what nerves supply the intercostal muscles
segmental thoracic nerves
what muscles are like having your hands in your pockets?
intercostals
C2 lesion would patient need to be on ventilator
yes
Diaphragm is C3,4,5 therefore with a C2 lesion it wont work so patient will need to be on artificial ventilator
C5 lesion would they need to be on ventilator
no- can breath as C3,4 nerve roots are working - wont be able to exercise much as everything below that
T2 lesion
diaphragm will work and allplus with work and can use expiratory muscles and sternocleidomastoid ( 11th cranial nerve) , serratu
Wont be able to use intercostal muscles below that level
L1 lesion or nerve block
everything above - intercostal will work but they will be paraplegic from below even if they increase respiration rate
through what hole does the spinal cord pass through in thoracic vertebrae
vertebral foramen
laminectomy
type of surgery in which a surgeon removes part or all of the vertebral bone( lamina) - this eases pressure on the spinal cord or the nerve root that may because by injury, herniated disk, narrowing of the canal ( spinal stenosis ) or tumours.
Name the nerve that innervates the majority of the muscles associated with this structure in this region of the neck.
recurrent laryngeal nerve - innervates most of the intrinsic muscles of the neck except the cricothyroid
recurrent laryngeal nerve palsy can causes what symptoms
Hoarseness/voice change
Vocal Cord Palsy which leads to hoarseness/voice change- persistent new onset hoarseness is therefore a ‘red flag’ symptom requiring investigation.
what level is hyoid bone
C3
what level is the upper border of the thyroid cartilage
C4
what level is the cricoid cartilage
C6
what level Is the junction of the pharynx and oesophagus
C6
