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ORG ANA LEC > Thoracic Wall > Flashcards

Thoracic Wall Flashcards

1
Q

Thorax is also known as

A

breast plate or chest

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2
Q

Location of the Thorax

A

between neck and abdomen

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3
Q

Shape of Thorax

A

flat in front and back and round at the sides

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4
Q

Boundaries

A

anterior: sternum and costal cartilages
posterior: thoracic part of vertebral column
superior: communicates with the neck; superior thoracic aperture: T1, R1, manubrium sterni
inferior: separated by diaphragm; inferior thoracic aperture: T12, R12, end of R11, costal margin, xiphoid process of sternum

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5
Q

Functions of the Thorax

A

houses and protects the lungs and heart
acts as a conduit for structures passing between neck and abdomen
principal role in breathing
provides support for UE

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6
Q

Lines of Orientation

A
  1. midsternal line: medial line over sternum
  2. midclavicular: vertical line from midpoint of clavicle
  3. anterior axillary line: vertical line at anterior axillary fold
  4. midaxillary line: line between anterior and posterior axillary fold
  5. posterior axillary line: vertical line at posterior axillar fold
  6. vertebral line: vertical line down the vertebral column/ spine
  7. scapular line: vertical line down on posterior wall of thorax passing through the inferior angle of scapula (T7)
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7
Q

Anterior Spaces

A

infraclavicular: below
supraclavicular: above
precardia: in front of heart
traube’s: overlying stomach

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8
Q

Posterior Spaces

A

infrascapular: below
interscapular: between
suprascapular: above

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9
Q

Osteology of Thoracic Wall

A

thoracic vertebra, ribs, intercostal spaces, sternum, costal cartilages

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10
Q

2 Divisions of the Thoracic Cavity

A

mediastinum: heart
thoracic pleurae: lungs

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11
Q

Osteology of Thoracic Cage

A

parietal pleura: inner surface of chest wall
pleural cavity: membranous sac
visceral pleura: covers the lungs

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12
Q

Osteology of Sternum

A

manubrium
body
xiphoid process

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13
Q

Manubrium

A

articulates with clavicle (clavicular notch) and costal cartilages (costal notch)
opposite T3-4

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14
Q

Body of Sternum

A

articulates with 2nd-7th costal cartilages

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15
Q

Xiphoid

A

hyaline cartilage that becomes ossified

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16
Q

Sternal Angle of Louis

A

opposite T4

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17
Q

Xiphisternal Joint

A

opposite T9

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18
Q

Importance of Sternal Angle of Louis

A
  1. ribs are counted from this level downwards (2nd rib lies here)
  2. separates superior and inferior mediastinum
  3. marks the end of the ascending aorta, the beginning and end of the aortic arch, and the beginning of the descending arch
  4. trachea divides into 2 principal bronchi at the carina
  5. azygous vein arches over the roof of right lung and opens in SVC
  6. pulmonary trunk divides into 2 pulmonary arteries below this level
  7. thoracic duct crosses from right to left side and reaches left side at the level of the sternal angle
  8. marks the upper limit of the base of the heart
  9. cardiac plexus situated at the same level
  10. found opposite T4-T5
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19
Q

True Ribs

A

1-7
directly attached to sternum

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20
Q

False Ribs

A

8-10
indirectly attached to sternum (attach anteriorly to each other and to the 7th rib by the costal cartilages)

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21
Q

Floating Ribs

A

Rib 11 and 12
no attachment at all

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22
Q

Osteology Typical Ribs

A

ribs 3-9
superior border: round and smooth
inferior border: sharp and thin with costal groove for neurovascular bundle
anterior end: attachment of costal cartilage

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23
Q

Parts of a Typical Rib

A

head
neck
tubercle
shaft
costal groove
angle
sternal end

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24
Q

Head

A

posterior vertebral end
2 articular surfaces separated by a crest
superior surface: articulates with the inferior articular facet on the body of the vertebra above
inferior surface: articulates with the superior articular facet of its own vertebra

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25
Q

Neck of the Rib

A

flat and slightly constricted
separates head and tubercle

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26
Q

Tubercle

A

prominence in the outer posterior surface
articular part: medial oval facet for articulation of transverse process of associated vertebra
non-articular part: roughened by ligament

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27
Q

Shaft of Ribs

A

long, thin, flat, and twisted
superior border: smooth and round
inferior border: sharp and thin

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28
Q

Costal Groove

A

at the inferior internal surface of the shaft of rib

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29
Q

Angle

A

where the rib sharply turns

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30
Q

Sternal End

A

where the costal cartilage is attached

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31
Q

Atypical Ribs

A

R1,R2,R10,R11,R12

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32
Q

Rib 1

A

relation to the lower nerves of brachial plexus and subclavian artery and vein
1. attachment to only T1
2. small and flat
3: has a scalene tubercle (separates two smooth grooves crossing the shaft)
- superior: subclavian artery
-inferior: subclavian vein
4. has a subclavian groove: anterior groove- subclavian vein; posterior groove- lower trunk of brachial plexus and subclavian artery

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33
Q

Rib 2

A

flat but twice as long as first rib (shorter and thinner)
articulates with the vertebral column in a way similar to typical ribs

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34
Q

Rib 10

A

single facet for articulation to T10

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35
Q

Rib 11 to 12

A

articulates with the bodies of their own only (T11 and T12)
no tubercles or necks
short, little curve, pointed anteriorly

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36
Q

Costal Cartilage

A

hyaline cartilage connecting upper seven ribs to the sternum and 8th to 10th ribs to the cartilage immediately above
cartilages of 11th to 12th rib end at the abdominal wall
helps in elasticity and mobility of the wall

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37
Q

Facets of the Thoracic Vertebrae

A

transverse costal facets: articulation with tubercle of rib
costal facts: posterolateral aspect of the body; also called demifacets

38
Q

Joints in the Thoracic Region

A

sternal joint
xiphisternal joint
costosternal joint
costovertebral joint

39
Q

Sternal Joint/ Manubriosternal Joint

A

cartilaginous
T4-T5
attachment of 2nd costal cartilage
separates superior and inferior mediastinum

40
Q

Xiphisternal Joint

A

cartilaginous
T9

41
Q

Costovertebral Joint

A

synovial plane joint
single synovial plane joint: rib 1,10-12

42
Q

Joint of Tubercle and Rib

A

tubercle and transverse process
synovial
absent in 11th-12th rib

43
Q

Rib to Costal Cartilage

A

cartilaginous

44
Q

Costal Cartilage to Sternum

A

1st rib: cartilaginous
2nd-7th: synovial
6th to 10th: synovial (articulates with each other)

45
Q

Thoracic Outlet/ Superior Thoracic Aperture Boundaries

A

communicates with root of the neck
T1, medial edges of rib 1 and costal cartilage, superior margin of manubrium sterni

46
Q

Thoracic Outlet Structures that Pass

A

Esophagus
Trachea
Vessels and Nerves
Apices of the Lungs and Pleurae

47
Q

Inferior Thoracic Aperture Boundaries

A

large and expandible
communicates with the abdomen
closed by diaphragm
anterior: xiphisternal joint
posterior: 12th thoracic vertebrae
laterally: costal margin

48
Q

Thoracic Outlet Syndrome

A

compression of lower nerves of brachial plexus (C8 and T1), and subclavian artery and vein

49
Q

Causes

A
  1. cervical rib: extra
  2. scalene syndrome: between anterior and middle scalene
  3. costoclavicular syndrome: between 1st rib and clavicle
  4. hyperabduction syndrome: beneath pectoralis minor
50
Q

Allen’s Test

A

flex elbow at 90 degrees, extend horizontally, rotated laterally
palpate for radial pulse while turning head opposite tested hand

51
Q

Adson’s Test

A

abduction, extension, and external rotation
rotate head toward involved side and take deep breath and hold it while palpating for radial pulse

52
Q

Costoclavicular Maneuver

A

shoulder down and back and exaggerated “at attention” posture
backpack or heavy jacket syndrome

53
Q

Intercostal Space

A

between adjacent ribs
costal groove lies the intercostal VAN

54
Q

Structures most pronounced in lateral aspect of thoracic wall in the Intercostal Space (superficial to deep)

A

skin
superficial fascia
deep fascia
intercostal membrane
endothoracic fascia
extrapleural fatty layer
parietal pleura
pleural cavity
visceral pleura
lungs

55
Q

Muscles of Respiration

A

external intercostals: most superficial; downward and forward
internal intercostals: intermediate; downward and back
innermost intercostal: deepest layer; incomplete muscle layer; related to endothoracic fascia and parietal pleura

56
Q

Action of Intercostal Muscles

A

prevent sucking in or blowing out of the lungs during changes in the intrathoracic pressure

57
Q

Inspiration

A

1st rib is fixed by scaleni muscle
2nd to 12th rib elevates towards 1st by intercostal muscles

58
Q

Expiration

A

12th rib is fixed by quadratus lumborum and oblique muscle of the abdomen
1st to 11th rib depresses by intercostal muscles

59
Q

Pump Handle Effect

A

1st to 7th rib
sternum raises; increases diameter
ribs depresses; decreases diameter
increases anteroposterior diameter

60
Q

Bucket Handle Effect

A

8th to 10th rib
increases transverse diameter in the frontal plane

61
Q

Caliper Motion

A

11th to 12th rib
increases inferior vertical diameter

62
Q

Piston Action

A

diaphragm
increases vertical diameter

63
Q

External Intercostals (11)

A

superior attachment: inferior margin of the rib above
inferior margin: superior margin of the rib below
nerve: intercostal nerves
action: stabilize rib cage; active during inspiration; supports intercostal space; moves ribs superiorly when 1st rib is fixed (increases anteroposterior and transverse diameter)

64
Q

Internal Intercostals (11)

A

superior attachment: lateral edge of the costal groove of the rib above
inferior attachment: superior margin or rib below deep to attachment of related eternal intercostal
nerve: intercostal nerves
action: most active during inspiration; stabilize rib cage; depresses ribs when lower ribs are fixed

65
Q

Innermost Intercostal (incomplete layer)

A

superior layer: medial edge of the costal groove of the rib above
inferior layer: internal aspect of the superior margin of the rib below
nerve: intercostal nerves
Action: assists internal and external intercostals

66
Q

Subcostales

A

superior attachment: internal surface (near angle) or the lower ribs
inferior attachment: internal surface of 2nd or 3rd rib below
action: depresses ribs

67
Q

Transversus Thoracis

A

superior attachment: inferior margin and internal surfaces of the costal cartilages of the 2nd and 6th rib
inferior attachment: internal aspect of the deep surfaces of body of sternum, xiphoid, and costal cartilages of 4th-7th rib
action: depresses costal cartilages; holds internal thoracic vessels to the walls

68
Q

Diaphragm

A

superior attachment: xiphoid, costal cartilages of lower 6 ribs, 1st to 3rd lumbar vertebrae
inferior attachment: central tendon
nerve: phrenic nerve
action: most important in respiration, assists in pulling ribs downward, increases vertical diameter by pulling down central tendon, abdominal strain in weightlifting

69
Q

Levatores Costarum

A

origin: tip of transverse process of C7 to T11
insertion: rib below (vertebra of origin) near the tubercle
nerve: posterior rami of thoracic spinal nerves
action: raises ribs

70
Q

Serratus Posterior Superior

A

origin: lower cervical and upper thoracic spines
insertion: upper ribs
nerve: intercostal nerves
action: proprioception; raises ribs (inspiratory muscle)

71
Q

Serratus Posterior Inferior

A

origin: lower thoracic and upper lumbar spines
insertion: lower ribs
nerve: intercostal nerve
action: proprioception; depresses ribs (expiratory)

72
Q

Diaphragm Attachments

A

xiphoid process
costal margin
ends of ribs 11 and 12
lumbar vertebrae
ligaments that span across structures of the posterior abdominal wall

73
Q

3 Main Parts of the Diaphragm

A
  1. sternal part: arising from xiphoid process
    2: costal part: arising from deep surfaces of lower six ribs and costal cartilages
    3: vertebral part: arising from vertebral column
74
Q

Right and Left Parts of the Diaphragm

A

right crus: comes from L1-L3
left crus: comes from L1-L2
right diaphragm: reaches upper border of 5th rib
left diaphragm: reaches lower border of 5th rib

75
Q

Central Tendon

A

muscle fibers of the diaphragm converge in the center
where the pericardium is situated
at the level of xiphisternal joint (T9)

76
Q

Openings of the Diaphragm

A

caval opening
esophageal opening
aortic opening

77
Q

Caval Opening

A

central tendon
inferior vena cava
terminal branches of right phrenic nerve
at T8

78
Q

Aortic Opening

A

abdominal aorta
thoracic duct
azygous vein
anterior of 12

79
Q

Esophageal Opening

A

esophagus
vagus nerve
esophageal branch of left gastric vessel
lymphatics from lower esophagus
at the level of T10

80
Q

Other openings of the Diaphragm

A

crura: greater, lesser, and lowest splanchnic nerves
medial arcuate ligament: sympathetic trunk
between sternal and costal margin: superior epigastric vessel
left dome: left phrenic nerve

81
Q

Nerve Supply and Action of Diaphragm

A

phrenic nerve (C3-5)
muscle of inspiration
increases intra abdominal pressure
acts as thoracic pump

82
Q

Arterial Supply of Diaphragm

A

branches of internal thoracic arteries: pericardiophrenic and musculophrenic arteries
thoracic aorta: superior phrenic
abdominal aorta: inferior phrenic

83
Q

Venous Supply of Diaphragm

A

brachiocephalic
azygos system
abdominal veins

84
Q

Neurovascular Bundle

A

vein, artery, and nerves (superior to inferior)
found between middle and innermost layer

85
Q

Venous Drainage of Neurovascular Bundle

A

right: superior intercostal azygous vein
left: superior thoracic brachiocephalic

86
Q

Arterial Supply of the Neurovascular Bundle

A

anterior intercostal arteries from lateral branches of internal thoracic artery

87
Q

Intercostal Nerves

A

posterior rami of T1-T11
carries somatic motor innervation to thoracic wall, sensory innervation to skin and parietal pleura, and post ganglionic sympathetic fibers to the periphery

88
Q

Subcostal Nerve

A

anterior rami of T12

89
Q

Innervating Regions of Intercostal Nerve

A

anterior ramus of T1: brachial plexus
lateral cutaneous branch of 2nd intercostal: sensation to upper arm
lower intercostal nerve: muscle, skin, peritoneum of abdominal wall

90
Q

RATPLANTS

A

rib (2nd)
aorta (arch)
trachea (bifurcation)
pulmonary trunk (bifurcation)
left recurrent laryngeal
azygous vein
nerves - cardiac plexus
thoracic duct
separation of inferior and superior mediastinum

ORG ANA LEC (3 decks)

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