Thoracic Wall Flashcards by Katia Lynn

Jugular notch

level of T2 vertebra; trachea is palpable

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Sternal angle

sight of articulation of rib 2; level of T4 vertebra

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Nipple

marks T4 dermatome; approximate location of dome of diaphragm

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Xiphoid process

inferior aspect of sternum; anterior attachment point of diaphragm

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Sternum 3 parts

manubrium, body, xiphoid process

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Name ribs

12 pairs
1. True ribs (1-7) attach directly to sternum
2. False ribs (8, 9, usually 10) indirect attachment to sternum via cartilage above
3. Floating ribs (sometimes 10, 11, 12) end in abdominal mm

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Superior thoracic aperture

Consists of:
- body of t1 vertebra
- first pair of ribs & costal cartilages
- manubrium of sternum

Structures passing through:
- trachea
- esophagus
- nerves & vessels to head, neck, & upper limbs

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Thoracic outlet syndrome

impact to subclavian artery and brachial plexus
- compression of structures
-can be due to inflammation, common in pregnant women
- BOTH the nerve and blood supply affected
-S/S: swelling

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Inferior thoracic aperture

Consists of: body of T12 vertebra, rib pairs 11 & 12, costal margins, xiphisternal joint
-Closed in life by diaphragm

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Costochondral joint

lateral end of costal cartilage with sternal end of rib
-Cartilaginous

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Interchontral joint

Costal cartilages of 6 & 7, 7 & 8, and 8 & 9 ribs
-Synovial- plane

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Sternocostal joint

1st costal cartilage & manubrium; 2-7 pairs costal cartilages & sternum
-1st: synchondrosis (ossified as we age)
-2-7: synovial- plane (allows for slight gliding action)

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Intervertebral joint

Adjacent vertebral bodies
-symphysis

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Costovertebral

Joints of head of rib: head of rib with sup. & inf. demi facets of vertebral body

Costotransverse: tuberacle of rib w. transverse process

Synovial; plane

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Upper 6 rib movement

pump-handle movement
-Transverse axis for rib rotationR

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Ribs 7-10 movement

Bucket-handle movement
- Costotransverse joint allows for elevation and depression (sliding action)

External intercostal mm.

“hands into pockets”
Inn: intercostal nn. (T1-T11)
Function: elevate rib during forced inspiration

Internal intercostal mm.

Inn: intercostal nn.
Function:
-Interosseous part- depress
-Interchondral part- elevate
-During forced respiration

Innermost intercostal mm.

Inn: intercostal nn.
Function: likely acts with internal intercostal (depresses ribs)

Subcostal mm.

Inn: intercostal nn.
Function: similar to internal intercostal (depresses weakly)

Transversus thoracis mm.

Inn: intercostal nn.
Function: weakly depresses ribs

Inspiration

Main muscle= diaphragm
- moves down causing a decrease in intrathoracic pressure, increase in space
- air is drawm in

Expiration

diaphragm moves up
passive, elastic recoil of lungs
muscles relax causing an increase in intrathoracic pressure (decreased space)
-Air rushes out
-Intra-abdominal pressure decreased

Subclavian Artery branches

First part
1) vertebral a.
2) thyrocervical trunk
3) internal thoracic aa.
Second part
4) costocervical trunk
Third part
5) Dorsal scapular (anatomical variation)- to rhomboids and levator scapulae

Posterior intercostal aa.

Supreme a. (to intercostal spaces 1&2) - Costocervical trunk of subclavian a. - 9 pairs from thoracic aorta

Anterior intercostal a

from internal thoracic artery off subclavian a. - Anastamosis--> collateral branch -Anastamosis location can vary - inferior border of rib above

Collateral aa.

branches of intercostal aa. -superior boarder of rib below

Superior thoracic a.

First branch of axillary a.

Lateral thoracic a.

Axillary a. branch

Internal thoracic aa. terminal branches

1. Superior epigastric a. 2. Musculophrenic a. --> blood supply to diaphragm

Intercostal vv.

- drain posteriorly into the azygos system which drains into the superior vena cava -drains anteriorly into the internal thoracic v. which brains into the brachiocephalic vv. --> come together to form SVC Right--> azygos Left --> accessory (above t6-t8) + hemizygous (below t6-t8) - Go into azygous--> SVC

Intercostal nerves

Ventral rami of spinal nn. t1-t11 Branches: - lateral cutaneous branch - anterior cutaneous branches Ventral ramus t12 spinal n.= subcostal n. (part of lumbar plexus)

Clinical correlation: Herpes Zoster

Classic dermatomally distributed skin lesion-shingles -viral disease of spinal ganglia -usually a reactivation of varicella-zoster or chickenpox virus -S/S: sharp burning pain in the dermatome, skin becomes red, vesicular eruptions and possible muscle weakness in the same myotome

Intercostal spaces

Contains: -intercostal mm: external, internal, innermost -intercostal n. -Intercostal aa. -intercostal vv. -Lymphatics Top to bottom: VAN NAV

Clinical correlation- intercostal nerve block

Rib fracture patients, after thoracic surgery Percutaneous procedures: insertion of chest tubes, thoracentesis, pericardiocentesis -Intercostal bundle located along inferior boarder of superior rib -Collateral bundle located along superior boarder of inferior rib

Pleural cavities

Superiorly extend above rib 1 into the root of neck inferiorly extend to jsut above costal margin medial wall is mediastinum contain lungs

Mediastinum

Superior Inferior: anterior, middle, posterior

Serous membranes of thoracic viscera

Viscera covered with serous membrane 1. Parietal layer- lines walls of cavity 2. Visceral layer- adheres to surface of organ Small layer of serous fluid between parietal and visceral layer--> reduces friction