Thoracic Wall Flashcards
What thoracic vertebrae are considered atypical
Vertebrae 1, 2, 9, 10, 11, 12
What is the thoracic wall composed of
Bones
Muscles and fascia
Supportive structures
skin
What are the bones of the thoracic wall
vertebrae
ribs
sternum
What are the functions of the thoracic wall
protection of organs
aid in respiration
Support of upper limb
What vertebral level is scapular spine
T3
What vertebral level is inferior angle of scapula
T7
What vertebral level is 12th rib
T12
What will result form dysfunction of the thoracic vertebrae
Impacts ribs and breathing
What thoracic vertebrae are considered typical
2-8
What are the features of vertebrae 2-9 that make them typical
costal demifacets and facet for tubercle of rib
How do ribs articulate with vertebrae in typical scenarios
articulates with 2 vertebral bodies and the facet on transverse process
Where does the rib articulate with the transverse process
tubercle of rib
How is the first vertebrae atypical
full facet on top and demifacet on bottom
How is 9th vertebrae atypical
demifacet on superior and nothing on inferior
How are 10-12th vertebrae atypical
full facets on superior part, nothing on inferior part
Describe the course of ribs in relation to articulation in front and vertebral level
few spinal levels lower in the front than the back as they travel anterior and inferior to meet the sternum
Which ribs are considered typical
3-9
Which ribs are considered atypical
1,2,10,11,12
How are ribs 3-9 typical ribs
2 spots on head for articulation with demifacet
neck has tubercle for articulation with transverse process
Costal groove for VAN
How is rib 1 atypical
strong curve
flat
lacks angle seen in typical ribs
Tubercle for attachment of scalene muscles
2 grooves for subclavian vein, artery, and brachial plexus
What is the clinical relationship of cervical ribs
can compress subclavian vessels and brachial plexus
What are the borders of the scalene triangle
anterior scalene
middle scalene
rib 1
What structures are contained in the scalene triangle
brachial plexus
subclavian artery
Where do the phrenic nerve and subclavian vein run in relationship to the scalene triangle
in front of anterior scalene
What are signs and symptoms of dysfunction the anterior scalene muscle
abnormal tone lifting first rib impacts blood flow to the limb and innervation
What type of joint is the costovertebral articulation
synovial plane
What type of the joint is the articulation between the first rib and the sternum
primary cartilaginous (synchondrosis fibrocartialginous joint)
What type of movement does the rib 1 allow
not a lot of movement; where pump handle movement originates.
When the first rib moves, what occurs
the whole rib cage moves
What type of joints are the sternocostal articulations (except rib 1)
synovial plane
What type of joints are costochondral joints
primary cartilaginous
What type of joints are interchondral joints
synovial plane
What type of joint is the manurial sternal joint
secondary cartilaginous; symphysis
What are the lines of reference regarding the thorax
mid-axillary
mid-clavicular
scapular
What are the intercostal muscle types
external intercostal
internal intercostal
innermost intercostals
What direction are the fibers of the external intercostal muscles
hands in pocket (superior, posterior, inferior anterior)
What direction are the fibers of the internal intercostal muscles
perpendicular to external intercostals (inferior to superior)
What direction are the fibers of the innermost intercostal muscles
same as the internal intercostals
How many ribs do the subcostal muscles span and where are they found
spans 2 ribs
posterior wall of thoracic cage
Where is the transverses thoracis muscle found
posterior side of anterior thoracic wall
What is the function of transverses thoracis
depresses the ribs
What is the innervation of transverses thoracis
intercostal nerves
List the order of layers starting at external intercostals to inside
External intercostals
Internal intercostals
VAN
Innermost intercostals
Endothoracic fascia
In the VAN network of the thoracic wall, list from superior to inferior. Which is most exposed
intercostal vein
intercostal artery
intercostal nerve–most exposed
What is the function of the elevator costarum
elevates the ribs
What is the innervation of elevator costarum
posterior rami
What is contained within the right crus of the diaphragm
Esophageal hiatus– esophagus and vagus nerve pass through
What is the vertebrocostal trigone
weakened spot of the diaphragm where hernias can occur
Why do hernias occur most common at vertebrocostal trigone
no muscle, just fascia
On what side of the diaphragm do hernias occur most often
left side
What will pass under the median arcuate ligament of the diaphragm
aorta
What are the functions of the medial and lateral arcuate ligaments of the diaphragm
allow muscles and other structures to pass from thoracic to abdominal cavity
What innervates the diaphragm
phrenic nerve (C3-C5) (all the motor) intercostals do some sensory on periphery
What passes through the canal hiatus
IVC and phrenic nerve
What level is the caval hiatus
T8
What passes through the esophageal hiatus
esophagus
vagus nerve
left gastric artery
What level is the esophageal hiatus
T10
What passes through the aortic hiatus
Aorta
Azygos vein
Thoracic duct
What level is the aortic hiatus
T12
What are the different parts of the diaphragm
central tendon
right crus
left crus
medial arcuate ligament
lateral arcuate ligament
median arcuate ligament
What structures transverse the diaphragm at TV8
IVC and phrenic nerve
What structures transverse the diaphragm at TV10
esophagus
vagus nerve
left gastric artery
What structures traverse the diaphragm at TV12
aorta
azygos vein
thoracic duct
Where will pain from the diaphragm refer to
C3-C5 dermatomal regions
(Shoulder)
What is the blood supply to the diaphragm
Inferior phrenic arteries (from aorta)
What does the diaphragm do during inspiration
diaphragm contracts, increases volume and decreases thoracic pressure causing air to flow into the lungs
What does the diaphragm do during expiration
diaphragm relaxes decreasing volume and increases pressure causing air to flow out of the lungs
What are the two main respiratory movements of the thoracic cage
Pump handle
Bucket handle
What does the pump handle motion of the ribs allow
increase in AP diameter
What ribs do pump handle motion
those attached directly to ribs
What does the bucket handle motion allow
increases side to side diameter
What ribs do bucket handle motion
ribs 7-12
What are the accessory muscles of respiration
serrates posterior inferior and superior
SCM
Pec minor
Serratus anterior
Scalenes
What are the boundaries of the superior thoracic aperature
rib 1, manubrium, first vertebral body
What are the boundaries of the inferior thoracic aperture
bound by ribs and diaphragm
What is the pattern of arterial support to intercostal spaces
posterior intercostal artery in posterior to sides
anterior intercostals
Where do posterior intercostal arteries come from
posterior aorta
Where do anterior intercostal arteries come from
inferior thoracic artery
Where does the inferior thoracic artery branch from
subclavian artery
What is the first intercostal space supplied by
right supreme intercostal artery
Where does the right supreme intercostal artery come from
costocervical trunk
What supplies the space below the 12th rib
subcostal arteries
What is the venous drainage of the thorax
azygos vein on right will drain into SVC
heme-azygous and accessory semi-azygos on left drain to azygos vein (which goes to SVC)
What occurs when SVC is blocked
congestion in the territory of the SVC
What regions of the body drain to the right jugulovenous angle
right of head, right neck, right UL, and right thorax
What regions of the body drain to the left jugulovenous angle
everything else not drained by the right side
What lymphatic vessel drains into the right jugulovenous angle
right lymphatic duct
What lymphatic vessel drains into the left jugulovenous angle
thoracic duct
Where will the left side of the body drain
into thoracic duct
What is the innervation to the intercostal spaces
intercostal nerves from spinal nerve
Do intercostal nerves contain sympathetics
yes
What would happen if the intercostal nerve was damaged
numbness in dermatomal pattern
weakness in intercostal muscles that the segment innervates
What layers would be traversed to perform an intercostal nerve block
skin
fascia
external intercostal
internal intercostal
Between which muscles are the intercostal VAN found
internal intercostal and innermost intercostal
What structures are at risk with a fractured 1st rib
subclavian artery and vein
