Thoracic Wall Flashcards
Where is the caval opening?
T8
Where is the esophageal hiatus?
T10
Where is the aortic hiatus?
T12
What is the orientation of the transverse process?
Coronal to sagittal planes from superior to inferior
What are the special thoracic vertebrae?
T1 - one full facet for 1st rib
T9~T12 - no superior demifacet fot T10
T11/T12 - no articular facets on the transverse process
Which ribs dont have demifacets?
I, X, XI, XII
Which ribs have one articular facet in the head?
Rib I, X, XI, and XII
Which ribs have no tubercle in the neck?
Rib Xi and XII
Which rib had a broadened upper surface and impressions?
Rib I
Where is the sternal angle?
2nd rib
Where is the xiphosternal joint?
7th rib
What are the parts of the sternum?
Manubrium, Body, Xiphoid process
How is the intervertebral foramen formed and which structure course through this foramen?
formed by pedicles, spinal nerves go through
What is the costovertebal joint?
Head of ribs and demifacets of vertebral body
What are costotransverse joints?
Rib neck and facet on the transverse process
What is the superior costotransverse ligament?
Superior transverse process to inferior rib neck
What is the lateral/costotansverse ligament connecting
same level trransverse process and rib neck
What are the true ribs?
rib I, Rib II, Rib III~VI, Rib VII
What are the false ribs?
Ribs VIII~X, Rib XI and XII
How many intercostal spaces are there?
11
What is the motion of the upper ribs?s
Pump handle
What is the motion of the lower ribs?
Bucket handle
Which ribs have no articulation anteriorly?
Ribs XI and XII
Which rib articulates with the sternal angle anteriorly?
rib II
C1 only has ______ so it has no dermatome
Somatic motor
What are the visceral organs?
Lungs, heart, and others
What is the parasympathetic innervation of the thorax?
Vagus nerve, CN X
Where is the recurrent laryngeal nerve?
L around aortic arch around ligamentum arteriosum
What is the sympathetic innervation of the thorax?
T1-T4 level
What is the blood supply for the superior Intrinsic thoracic wall?
Supreme intercostal artery, branch from costocervical trunk
What is the blood supply for the intrinsic posterior thoracic wall?
Posterior intercostal artery, branches from aorta
What is the blood supply for the anterior intrinsic thoracic wall?
Internal thoracic artery, branch from subclavian artery
Where is the subclavian artery?
Midpoint of clavicle/lateral border of 1st rib
Where is the axillary artery?
Inferior border of teres minor
What are the extrinsic thoracic wall muscles?
Mnemonics: Screw The Lawyer, Save A Patient
Part 1: Superior thoracic artery
Part 2 (deep to pec minor):
Thoracoacromial artery/trunk
Lateral/long thoracic artery
Part 3: Subscapular artery
Anterior circumflex humeral artery
Posterior circumflex humeral artery
Blood drainage of the internal thoracic vein and superior intercostal vein?
to brachiocephalic vein
Where does the right thorax drain?
Intercostal veins to azygos vein then to SVC
Where does the left thoracic wall drian?
Intercostal veins to accessory hemiazygos and hemiazygos veins, then to azygos vein
Which of the following combination of motions of different ribs is correct?
a. Rib II, mainly pump handle; Rib VII, mainly bucket handle.
b. Rib II, mainly bucket handle; Rib VII, mainly pump handle.
c. Rib V, mainly pump handle; Rib XI, mainly bucket handle.
d. Rib V, mainly bucket handle; Rib XI, mainly pump handle.
a. Rib II, mainly pump handle; Rib VII, mainly bucket handle.
Pectoralis major origin
Medial ½ clavicle, sternum and costal heads (VI/VII rib costal cartilage)
Pectoralis major insertion
Lateral lip of intertubercular crest/bicipital groove of humerus: inversion attachment
Pectoralis major innervation
Lateral pectoral nerve (C5~T1), medial pectoral nerve (C8, T1); pectoral branch of thoracoacromial trunk
function of pectoralis major
GH joint: FLX vs. EXT, and IR/ADD
Pec minor origin and insertion
Rib III~V
Coracoid process of scapula
What is the innervation of the medial pectoral nerve
Medial pectoral nerve (C8, T1)
What is the pectoralis minor actions?
Scapulothoracic articulation: depression, anterior tilt of scapula
Subclavius origin and insertion
Costal cartilage of rib I
Under surface of distal clavicle
Innervation of subclavius
Nerve to subclavius (C5,C6)
What is the action of the subclavius?
Scapulothoracic articulation: depression of clavicle
What is the origin and insertion of the serratus anterior?
Ribs 1~9
Anterior medial border of scapula
What is the action of the serratus anterior?
Scapular protraction; hold scapula to the thorax; upward rotation of scapula; elevation of rib
What are the three intercostal muscles?
External intercostal muscles, internal intercostal muscles, and innermost intercostal muscles
what is the direction of the external intercostal muscle?
Oblique posterosuperior
what is the direction of the internal intercostal muscle?
Oblique anterosuperior
what is the direction of the innermost intercostal muscle?
oblique anterosuperior
What is the major bundle of the intercostal space?
VAN
Vein, artery, ventral rami of thoracic spinal nerve
muscular/collateral bundle?
superior border of inferior rib, muscular branch, NAV
Where do the major bundle and the muscular/collateral bundle run?
Between internal and innermost intercostals
Which nerve provide parasympathetic innervation for lungs and heart?
Vagus nerve, CN X
Which dome of the diaphragm is higher?
Right dome is higher than left done
What innervates the diaphragm
Phrenic nerve (C3~C5)
What muscles are a part of inspiration?
Primary: external intercostal, membranous internal intercostal, serratus posterior superior
Which muscles are a part of expiration?
Primary: other internal intercostal, innermost intercostals, serratus posterior inferior
Where does the intercostal neurovascular bundle locate and what is the order of structures from superior to inferior for the major and collateral bundles?
Between the internal and innermost intercostals
Major - VAN
muscular - NAV
