Thoracic Spine Flashcards
Origin of Rectus Abdominus
Pubic Symphysis and Pubic Crest
Insertion of Rectus Abdominus
Xiphoid Process , Costal Cartilages of ribs 5-7
Action of Rectus Abdominus
Trunk Flexion , Compression of Abdominal viscera and Expiration
Origin of Sternocleidomastoid
Sternal head: superior part of anterior surface of manubrium sterni
Clavicular head: superior surface of medial third of the clavicle
Insertion of Sternocleidomastoid
Lateral surface of mastoid process , Lateral half of superior nuchal line.
Action of Sternocleidomastoid
Unilateral contraction ,neck ipsilateral flexion, neck contralateral rotation
Bilateral contraction: Atlantooccipital joint/ head/neck.
extension
flexion
Sternoclavicular joint: elevation
Origin of the Diaphragm
Sternal part: Posterior aspect of xiphoid process
Costal part: Internal surfaces of lower costal cartilages and ribs 7-12
Lumbar part: Medial and lateral arcuate ligaments (lumbocostal arches), bodies of vertebrae L1-L3 (+intervertebral discs), anterior longitudinal ligament
Insertion of the Diaphragm
Central tendon of diaphragm
Action of the Diaphragm
Depresses costal cartilages, primary muscle of breathing (inspiration)
Origin of the Intercostal Muscles
External Intercostals - Inferior Border of a rib ventrocaudally
Internal Intercostals - Inferior border of 1-11 ribs
Innermost Intercostals- Inferior borders 1- 11 ribs
Insertion of the Intercostal Muscles
External Intercostals- Upper border of the rib below
Internal Intercostals- Ventrocranially to superior borders of the ribs and costal cartilages below
Innermost intercostals - Behind the costal grooves.
Action of the intercostal Muscles
Internal Intercostals - Tense the intercostal spaces during deep inspiration and support the breathing mechanism .
External Intercostals - Elevation of the ribs, Inspiratory breathing muscles
Internal and innermost - Lower the ribs ( Expiratory breathing muscles)
State the features of the Thoracic Cage
- Vertebral Column
- Ribs
- Intercostal Space
- Costal Cartilage
- Sternum
- 12 thoracic vertebrae and pairs of ribs
State the Importance of the Thoracic Cage
- Protection to Vital organs
- Provides muscle attachments
- Assists respiration
Describe the curvature of the Thoracic Spine
Kyphotic Spine
Label a Typical Thoracic Vertebrae
- Round body
- Long Slated SP
- Costal facet x4
- Rib facet x2 TP
- Pedicles
- Lamina
- Articular facets more in a vertical plane.
State the 4 Atypical Vertebrae and their reasoning
T1 - Single Facet ( demi facet)
T10- Single Facet ( demi facet)no inferior
T11- Single Facet ( demi facet) no inferior
T12- no costotransverse facet
Explain the Thoracic rule of 3
T123 - TP equal level to SP T456 - TP 1/2 level above SP T789 - TP 1 level above SP T10 - TP 1 level above SP T11 - TP 1/2 level above SP T12- TP equal level to SP
What are the True Ribs?
Upper 7 ribs - Ribs articulating directly with the true sternum
What are the False Ribs?
Remaining 5 ribs - Does not articulate directly to the Sternum , first 3 attach to the costal cartilage of the ribs above
Give the features of a typical rib and label on a diagram
- Head
- 2 demi facets
- Tubercle - articulation with transverse process and non articular surface
- Posterior angle
- Shaft
- Costocondryal junction- Costal cartilage
Describe the Structure of the First Rib
- Flat
- Slopes inferiorly
- Attaches to Manubrium
- Scalene Tubercle
- 2x subclavian grooves
- Rib 2 , similar structure but twice as long
Give the contents of the Intercostal Space
- Neurovascular Bundle - Intercostal nerve , intercostal artery and vein
- The 3 Layers of Intercostal muscles
What are the three layers of Intercostal Muscle?
- External
- Internal
- Innermost
State 3 clinical features of the Spinal Nerve in the Thoracic Spine
- Spinal canal nerve narrow
- Ventral ramus runs in intercostal space
- Irritation of Thoracic nerve root can produce pain radiating around the chest wall in Sloping direction - path of ribs
What are the joints located between Thoracic Vertebrae called? + type of joint
- Facet / Zygopophyseal Joints
- Synovial Plane
What are the joints located between ribs and vertebrae called? + type of joint
- Costovertebral joints
- Costotransverse Joints
- Synovial plane
What are the joints located between cartilage and ribs called? + type of joint
- Costochondral Joint - Primary cartilaginous
- Interchondral Joint - Synovial plane
What are the joints of sternum called?
Sternocostal Joints
What type of articulation occurs between Rib 1 and the Manubrium?
- Primary cartilaginous joint in which hyaline cartilage unites the first rib to manubrium of the sternum.
What type of joints are other true ribs of the Sternum?
- Synovial plane joints of costal cartilage
Briefly describe the movements available in the Thoracic Spine
- Relatively less mobile than cervical and lumbar
- Rotation greatest range
- Flexion and lateral Flexion are more restricted due to SP and orientation of the facets
What accessory movements would you demonstrate in your OSCE?
- Central PA - Spinous process
-Unilateral PA - Transverse process
-Unilateral PA - Rib angle
Grades I , II , III,IV and V
What type of joint is an Intervertebral joint?
- Secondary cartilaginous vertebral end plate , consisting of hyaline cartilage
Give the Structure of Nucleus Pulposus
- Semi-fluid - Mucoid material
- 88% water
- deformed under pressure
- Transmit pressure in all direction
Give the Structure of Annulus Fibrous
- Ring of fibres
- 60-70% of water
- Collagen fibres layered in sheets of lamelle
- Thicker centrally - Ant
- Thinner - post
- Resist Buckling
Give the Structure of the Sternum
- Manubrium - Manubriosternal Joint
- Body - Sternoclavicular Joint
- Xiphoid process- Xiphisternal Joint
- Attachment of ribs
What is Pump Handle?
- Anterior end of the ribs move forward and upwards with anterior movement of the sternum
What is Bucket Handle?
- Rotation of the ribs and increase in transverse diameter
Where does the message for respiration come from in the brain?
Medulla Oblongata
What muscles aid respiratory stress during inspiration / forced inspiration ?
- sternocleidomastoid
- pect minor and major
- serratus anterior
- lat Dorsi
- quadratus lumborum
- scaleni
What are the muscles of forced expiration?
Lat dorsi
Rectus abdominus
