Thoracic Wall Flashcards
Where is the thorax?
between the neck and abdomen
What is included in thorax?
thoracic cavity, ribs, sternum, and thoracic vertebral column
lungs, heart, esophagus, and thoracic portion of descending aorta
What structure is at the inferior opening of thoracic cavity?
diaphragm
functions of the thorax:
-protect internal organs
-resist negative pressure created by elastic recoil of lungs
-attach and support upper limbs
-origins for groups of muscles to upper limbs, abdomen, back, neck and head
-include the muscles of breathing
How many sets of ribs are there?
12
Ribs 1-7 are known as:
true ribs
-attach directly to sternum
Ribs 8-10 are known as:
false ribs
-attach to cartilage of ribs superior to them
Ribs 11 and 12 are:
floating ribs
-do not have an anterior attachment
Ribs 7-10 form:
the infrasternal angle
space between ribs and costal cartilages:
intercostal space
Borders of thoracic cavity:
superior: 1st thoracic vertebra, 1st pair of ribs, and superior border of manubrium
inferior- diaphragm
Head of rib
articulates with inferior and superior costal facets of adjacent thoracic vertebrae
neck of rib
attach head to body
Tubercle of rib
articulates with costal facet of transverse process of vertebrae
Supernumerary ribs
extra ribs that are not normally seen
-rudimentary
-fused with first thoracic rib
-fully developed
can cause thoracic outlet syndrome
thoracic outlet syndrome
compression caused by supernumerary ribs in the lower cervical region can cause irritation or injury to the vessels and nerves supplying the shoulder and upper limb
Manubrium of sternum
contains attachment site for rib 1
-superior portion of sternum
body of sternum
notches for attachment of ribs 3-6
sternal angle
at manubriosternal joint
Xiphoid process becomes completely ossified by what age?
40
Types of scoliosis
-congenital scoliosis
-neuromuscular scoliosis
-degenerative scoliosis
-idiopathic scoliosis
What is one cause of sternal malformation?
Failure of fusion between halves of the sternal bars during development
Costovertebral joints
head of rib to bodies of adjacent vertebrae
sternocostal joints
sternum to costal cartilage
1- cartilaginous
2-7 are synovial plane joints
Costotransverse joint
tubercle of rib to transverse process of vertebrae
-1-7 rotate here
-8-10 glide here
11 and 12 do not articulate
Costochondral joint
rib to costal cartilage
interchondral joints
between adjacent costal cartilage
6-9 are synovial
9 and 10 can be fibrous
Teitze syndrome
autoimmune disease that causes symptoms similar to costochondritis
Costochondritis
inflammation of the sternocostal joints
-sharp pain and tenderness
Intercostal muscles
external, internal, and innermost intercostals, subcostal muscles, and transversus thoracis
external intercostals
attach superiorly to inferior border of rib above and inferiorly to superior border of rib below
-run inferio-anteriorly
-elevate ribs
Internal and innermost intercostals
attach superiorly to the inferior border of the rib above and inferiorly to the superior border of the rib below
-run interio-posteriorly
- interosseous part depresses the ribs
-interchondral part elevates the rib
-intercostal neurovascular run between internal and innermost intercostal
subcostal muscles
attach superiorly to internal surfaces of lower ribs near their angles and inferiorly to superior borders of ribs 2 or 3 levels below
-run in same orientation
Transverus thoracis
attach inferiorly on posterior sternum and superiorly on costal cartilages 2-6
-depress ribs
Levatores costrum (origin, insertion, and action)
O- transverse processes
I- rib below between tubercle and angle
A- elevate ribs
Serratus posterior superior (origin, insertion, and action)
O- spines of C7-T3
I-Ribs 2-4
A- elevate ribs
Serratus posterior inferior (origin, insertion, and action)
O- spines of T11-L2
I- ribs 8-12
A- depress ribs
Anterior and Middle scalenes (origin, insertion, and action)
O- transverse processes of cervical vertebrae
I- 1st rib
A-elevate 1st rib during forced or labored inspiration
Posterior Scalenes (origin, insertion, and action)
O- transverse processes of cervical vertebrae
I- 2nd rib
A-elevate 2nd rib during forced or labored inspiration
Muscles that elevate the ribs
-External intercostals
-Interchondral part of internal intercostals
-levatores costrum
-serratus posterior superior
-scalene muscles
Muscles that depress the ribs
-internal intercostals
-innermost intercostals
-subcostal muscles
-transversus thoracis
-serratus posterior inferior
Nerves the innervate upper limb
T1 and T2
What nerves supply the trunk?
T2-T12
What is a thoracotomy?
surgical opening through the thoracic wall to access the lungs, heart, esophagus, diaphragm, and the thoracic aorta
What is a thoracentesis?
Procedure to remove fluid from the space between the lining of the outside of the lungs and the wall of the chest
-do not want to hit a nerve
Order of neurovascular bundle in intercostal space
superior to inferior
vein
artery
nerve
What occurs during inspiration?
expansion of ribs move sternum upward and outward
-chest wall and lungs expand
What occurs during expiration?
ribs and sternum depress
-chest cavity and lungs contract
Arterial sources of intercostal arteries?
aorta and subclavian
Internal thoracic artery
arise from the subclavian artery
-intercostal arteries 1-6 come from this
-descend into thorax and end at 6th costal cartilage (divide into musculophrenic and superior epigastric arteries)
-
What do the musculophrenic arteries give rise to?
intercostal arteries 7-10
Posterior intercostal arteries
two of the posterior intercostal branch off the superior intercostal arteries in the first two intercostal spaces
-remaining are branches from the descending aorta
Posterior intercostal veins
most return blood to azygous vein on the right and hemiazygous/accessory hemizygous on the left
-left superior intercostal drain into subclavian vein
What type of joints are costotransverse joints?
synovial
Where do ribs 2-10 articulate with the vertebral column?
Between two adjacent vertebral bodies
Where does the intercostal neurovasculature run compared to intercostal muscles?
inbetween the internal and the innermost intercostals
What are intercostals nerves branches off of?
Ventral rami of spinal nerves
What are the lateral and anterior cutaneous branches of ventral rami?
Branches that provide sensory innervation to the skin around the thoracic cavity
Another name for t2 nerve:
Intercostobrachial nerve
What nerve is responsible for the referred pain down the arm that is felt during a heart attack?
T2: intercostobrachial nerve
Angle needle is inserted during a nerve block in thoracic region
45 degrees
During thoracentesis do you enter above or below a rib and why?
Above. The intercostal neurovascular bundle is right below so you do not want to hit that
Where do you insert a needle for a nerve block in the ribs?
Right under a rib so you can get into the neurovascular stuff
Inhalation causes the ribs to do what?
Move outward due to muscle contraction
-give more room in the chest cavity for air
Upper ribs move like what?
Pump handle
Ribs 6-10 move like what?
Bucket handle
How do ribs 11 and 12 move?
Like calipers
What gives off anterior intercostal arteries?
Subclavian
What gives off posterior intercostal arteries?
Descending aorta
Where does the superior intercostal vein drain into?
Left subclavian vein
what structure is this?
head of rib
what structure is this?
tubercle of rib
what structure is this?
neck of rib
what structure is this?
shaft of rib
what structure is this?
sternal end of rib
what structure is this?
costal groove
what structure is this?
angle of rib
what structure is this?
jugular notch
what structure is this?
manubrium
what structure is this?
sternal angle
what structure is this?
transverse ridges
what structure is this?
body of sternum
what structure is this?
xiphoid process
what muscles are these?
internal intercostals
what muscles are these?
external intercostals
what muscles are these?
innermost intercostals
what muscles are these?
subcostal muscles
what muscles are these?
transversus thoracis
what muscles are these?
serratus posterior superior
what muscles are these?
serratus posterior inferior
what muscles are these?
levatores costarum
what muscle is this?
middle scalene
what muscle is this?
posterior scalene
what muscles are these?
anterior scalenes
what artery is this?
anterior intercostal a.
what artery is this?
internal thoracic a.
what artery is this?
posterior intercostal a.
