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Y2S1 ANATOMY > Thoracic wall > Flashcards

Thoracic wall Flashcards

1
Q

What are the components of the thoracic cage?

A

1) Sternum

2) 12 pairs of ribs

3) Costal cartilages (Hyaline cartilage)

4) 12 thoracic vertebrae and intervertebral discs

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2
Q

How many ribs are there, and what are its classifications?

A

12 pairs of ribs,

1) True ribs: 1-7

2) False ribs: 8-10

3) Floating ribs: 11-12

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3
Q

What are the typical ribs?

A

3-9

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4
Q

What are the components of the typical rib?

A

1) Posterior head:
- Two facets in the HEAD
- Neck
- Tubercle

2) Shaft”
- Twisted shaft
- Outer surface
- Inner surface
- Upper border
- Lower border

3) The anterior end (cup-shaped articulates with the cartilage

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5
Q

Describe the structure of the posterior end of the typical ribs

A

1) Head:

  • Wedge-shaped, contains two articular facets with a crest in between

2) Neck:
- Extends between the head and tubercle
- Provides an attachment for the costotransverse ligament

3) Tubercle:
- Smooth articular facet for the transverse process of the numerically corresponding vertebrae
- Rough part for the attachment of the lateral costotransverse ligament

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6
Q

Describe the structure of the shaft of the typical ribs

A

1) Angle:
- It is the point of maximum convexity of the rib, and its weakest point

2) Costal groove:
- Found in the middle of the inner surface, near the lower margin where it protects the nerves and vessels (vein, then artery then nerve “in this order”)

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7
Q

What are the articulations of the typical ribs?

A

1) Three articulations with the vertebrae, 2 with the head one with the tubercle

2) With the costal cartilage (hyaline cartilage)

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8
Q

Which ribs are considered the Atypical ribs?

A

Ribs:
1, 2, 10, 11, & 12

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9
Q

Describe the characteristics of the first rib

A

1) Shortest, Broadest, and most curved rib

2) Its head has one complete facet (unlike the typical with 2-facets)

3) Its tubercle corresponds to the angle

4) It has a (rough “due to muscle attachment”) upper and (smooth) lower surface and outer and inner borders

5) It has a scalene tubercle on the inner border and a scalene ridge on the upper surface (for the attachment of the scalene muscle)

6) It has grooves on the superior surface for the subclavian vessels

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10
Q

What are the different structures in the first rib?

A

1) Posterior end Head with one facet

2) Neck

3) Tubercle where the angulation starts

4) Body

5) Outer and inner border

6) Upper and lower surfaces

7) Anterior end head

8) Groove for subclavian vessels

9) Tubercle in the inner border for the scalene muscle

10) Ridge on the upper surface for the scalene muscle

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11
Q

Which rib is rarely fractured?

A

Rib number 1 as the clavicle protects it

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12
Q

Which fascial modification is attached to the inner border of rib 1?

A

Suprapleural membrane

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13
Q

Describe the characteristics of the second rib

A
  • It is a transition between the first and 3rd typical rib

1) It has a head with 2 facets

2) Its tubercle has a facet

3) It is not twisted so there is not an upper and lower border

4) It has a tuberosity for serratus anterior

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14
Q

Which rib is most easy to fracture?

A

Rib number 2

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15
Q

What are the different structures in the second rib?

A

1) Head

2) Neck

3) Tubercle

4) Body

5) Costal end

6) Tuberosity for serratus anterior first and second digitations attachment

7) Scalene posterior muscle attachment

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16
Q

Describe the characteristics of the 10th rib

A

other than the normal what makes it atypical is that it has a single facet on the head

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17
Q

What makes rib 11 and 12 atypical?

A
  • They are short

1) They have a single large facet on the head

2) They do not have a neck nor a tubercle

3) They have a pointed anterior end

4) Rib 11 has a slight angle and a shallow costal groove

5) Rib 12 is straight and has no costal groove

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18
Q

Which ribs have no neck and tubercle?

A

ribs 11 and 12

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19
Q

What are examples of abnormal ribs?

A

Sometimes a person might have an extra rib or a missing rib

1) Cervical rib (Articulates with the transverse process fo C7)

2) Lumbar rib where a person might have and extra rib 13

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20
Q

Describe the sternum bone

A

Otherwise named as the breast bone:

  • Composed of three bony parts:

1) Manubrium

2) Body

3) Xiphoid process

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21
Q

What are the different joints found in the Ribcage anterior

A
  • Sternum:

1) Sternoclavicular joint (synovial joint “features of ball & socket”)

2) First Sterno-chondral joint” (primary cartilage joint/synchondrosis “not movable”)

3) 2-7th rib “Sterno-chondral joints” (synovial plane joint)

4) Manubrio-sternal joint (secondary cartilaginous joint)

5) Xiphisternal joint (secondary cartilaginous, initially it is a symphysis joint, at 40 it becomes a synostosis joint)

  • Costochondral joints (Primary cartilaginous)
  • Interchondral joints (synovial)
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22
Q

Which structures articulates with the manubrium?

A

1) Clavicle (synovial joint)

2) First rib via the cartilage (primary cartilage joint)

3) Part of the second rib via the cartilage (synovial joint)

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23
Q

Which structure articulates with the body of the sternum?

A

Half of rib 2 till Half of rib 7

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24
Q

Which structures articulates with the xiphoid process?

A

Half of rib 7

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25
What are the corresponding vertebral segments in regard to the jugular/clavicular notch?
The inferior border of T2
26
What is the vertebral segment that corresponds to the sternal angle?
The lower border of T4
27
What is the vertebral segment that corresponds to the Xiphoid process?
T10 calcifies after the age of 40
28
How is the body of the sternum formed?
It is formed by the fusion of four segments (sternebrae) where the transverse ridges indicate the lines of fusion, incomplete ossification will result in a foramen
29
What are the structures that correlate anatomically with the xiphisternal joint?
1) Central tendon of the diaphragm 2) Inferior border of the heart 3) Superior limit of the liver
30
What are the different costal cartilages found in the rib cage?
1) Sterno-chondral joints 2) Costal margin (inferior edges of the 7th-10th costal cartilages) - They are made of hyaline cartilage and calcified with old age reducing their elasticity
31
What are the different ways to count ribs?
1) Anteriorly: Via the sternal angle which corresponds to rib number 2 2)Posteriorly: Inferior angle of the scapula corresponds to rib 7
32
Can you collect bone marrow samples from the sternum?
Yes and it is easily accessible due to its subcutaneous position
33
What are the relations and attachments of the left first rib?
1) Subclavian vein 2) Subclavian artery 3) T1 nerve root 4) Subclavius muscle attachment 5) Scalenus medius attachment
34
When does the different segments of the sternum ossified?
1) Manubrium: 5-months intrauterine 2) 1st sternebra: 6-month intrauterine 3) 2nd sternebra: 7-month intrauterine 4) 3rd sternebra: 8-month intrauterine 5) 4th sternebra: 9-month intrauterine 6) Xiphod: 4th year
35
Which muscle attaches to the manubrium?
Sternocleidomastoid
36
Which muscle attaches to the body of the sternum?
Pectoralis major
37
Which muscle attaches to the xiphoid process?
Rectus abdominus
38
What are the features of the thoracic vertebrae?
1) Corpus 2) Superior costal facet 3) Inferior costal facet 4) Superior vertebral notch 5) Inferior vertebral notch 6) vertebral foramen 7) Superior articular facet 8) Pedicle 9) Transverse costal facet 10) Transverse process 11) Spinous process
39
What are the characteristic features of the typical thoracic vertebrae
they are from T2-T8 of the thoracic vertebrae: 1) Two articular demi facets 2) The transverse process has costal facets for the articulation with the tubercles of the ribs 3) Long, tapered spinous process that slants inferiorly
40
What are the ATypical thoracic vertebrae?
T1,T9,T10,T11 & T12
41
What are the characteristic features of T1?
1) Body: one complete facet for the head of rib 1 and a demi facet for the 2nd rib 2) Its spinous process is horizontal
42
What are the characteristic features of T9?
One superior articular demi facet for the head of rib 9
43
What are the characteristic features of T10?
One complete costal facet for the articulation with the head of the 10th rib
44
What are the characteristic features of T11?
One complete costal facet for the articular head of rib 11, and its transverse process has no costal facet
45
What are the characteristic features of T12?
1) One complete costal facet for the articular head of rib 11 2) The transverse process has no costal facet 3) Its inferior articular process is lumbar in type
46
What is the intercostal space?
It is a space between two ribs (11) - Its contents are: 1) Intercostal muscles - Between the internal intercostal muscles and the transversus thoracic muscles 2) Intercostal vessels 3) Intercostal nerves 4) Lymphatics
47
What are the different intercostal muscles?
1) External intercostal muscle 2) Internal intercostal muscle 3) Transversus thoracic muscle
48
What is the origin, insertion, and direction of the external intercostal muscle fibers?
It originates from the lower border of the rib above, and inserts into the upper border of the rib below The direction of the fibers is downwards and forwards
49
How does the external intercostal muscle extend?
From the tubercle of the rib till the costochondral junction, where it continuous afterwards as the anterior/external intercostal membrane
50
What is the nerve supply of the External intercostal muscles?
Intercostal nerves
51
What is the action of the external intercostal muscle?
Elevation of the ribs during inspiration
52
What are the origin, insertion, and direction of the fibers of the internal intercostal muscle?
1) Origin: Costal groove of the rib above 2) Insertion: Upper border of the rib below 3) The fibers run downward and backward
53
What is the extent of the internal intercostal fibers?
It runs from the lateral margin of the sternum to the angle of the rib posteriorly continuing as the posterior/internal intercostal membrane
54
What is the nerve supply of the internal intercostal muscles?
Intercostal nerve
55
What is the function of the internal intercostal muscle?
They are responsible for the forced exhalation, by depressing the ribs and decreasing the space within it
56
What are the different parts of the transversus thoracic muscle?
1) Sternocostalis 2) Intercostalis intimi/innermost intercostal 3) Subcostalis
57
What are the origin, insertion, and direction of the fibers of the sternocostalis muscle?
1) Origin: Lower 1/3 of the posterior surface of the body and xiphoid process of the sternum 2) Insertion: Costal cartilage from the second to the sixth 3) Upwards and lateral
58
What is the nerve supply of the sternocostalis muscle?
Intercostal nerves
59
What is the action of the sternocostal muscle?
Supports the sternocostal joint
60
What are the origin, insertion, and direction of the fibers of the intercostalis intimi muscle?
1) Origin: Lower border of the rib above 2) Upper border of the rib below 3) Downward and backward
61
What is the nerve supply of the intercostalis intimi muscle?
Intercostal nerve
62
What is the action of the intercostalis intimi muscle?
Depression of the ribs during forced expiration
63
What are the origin, insertion, and direction of the fibers of the Subcostalis muscle?
1) Origin: From the inner surface of the angle of the rib 2) Insertion: 2nd or 3rd ib below 3) Downwards and medially
64
What is the nerve supply of the subcostalis muscle?
Intercostal nerve
65
What is the action of the subcostalis muscle?
Depresses the lower ribs during forced expiration
66
What is the arterial supply of the thoracic cavity
Internal thoracic/mammary artery
67
Describe the course of the mammary/ internal thoracic artery
1) Originates from the first part of the subclavian artery 2) At the beginning of the upper surface of rib 1 it gives the pericardiophrenic artery (supplies the pericardium, pleura and diaphragm) 3) It then gives two anterior intercostal arteries within the first six intercostal spaces 4) in the 2nd, 3rd, and 4th intercostal space it gives the perforating artery that supplies the mammary gland 5) Just above the seventh rib it terminates into the musculophrenic artery and the superior epigastric arteries
68
What are the branches of the internal thoracic/mammary artery?
1) Pericardiophrenic artery 2) Anterior intercostal arteries 3) Perforating arteries 4) Superior epigastric artery 5) Musculophrenic artery
69
Describe the arterial supply in the intercostal spaces
Two small anterior intercostal arteries in each space that anastomoses with 1 posterior intercostal artery that originates from the superior intercostal artery "from the 2nd part of the subclavian artery" (for spaces 1 & 2), the posterior intercostal artery of the 3-11 intercostal space are branches of the descending thoracic artery - The lower right posterior intercostal artery is longer because the descending thoracic aorta is located towards the left
70
Describe the course of the internal thoracic vein
1) Begins at the third costal cartilage by the union of the venae comitantes of the internal mammary artery and the union of the superior epigastric and the musculophrenic arteries 2) It terminates in the brachiocephalic which is formed by the junction of the subclavian and jugular vein, its tributaries correspond to that of the internal thoracic artery
71
What are the intercostal veins (contribute to the internal thoracic vein)?
1) Posterior intercostal veins = (azygos "above the vertebrae" + hemiazygous vein "under the rib") 2) Anterior intercostal vein (internal thoracic vein)
72
What are the types of intercostal nerves?
There are 11 intercostal nerves: - Inside the chest wall 1) Typical 3-6 - Outside the chest wall 2) ATypical 1,2,7-11
73
Describe the typical intercostal nerve
- Arises from the posterior and anterior root forming a trunk and then dividing into a posterior and anterior rami, their branches are: 1) Ganglionic (search about it) 2) Muscular (to the intercostal muscles) 3) Collateral branch (runs along the upper border of the rib below) 4) Lateral cutaneous: (arises close to the angle of the rib and pierces the internal and external intercostal muscles supplying the skin at the side of the chest 5) Anterior cutaneous: It is the termination of the intercostal nerve supplying the skin in the front of the chest
74
Why is the first intercostal nerve considered ATypical?
Because large part of it ascends in front of the first rib forming the brachial plexus
75
Why is the second intercostal nerve considered ATypical?
As it supplies the axilla via the intercostobrachial nerve
76
Why are the last five nerves considered ATypical?
Because they complete their course in the abdomen
77
The sternal angle lies between which two dermatomes?
C4 and T2 - C5-T1 is distributed into the upper limb (hand,arm)
78
What is shingles/Herpes zoster?
It is a reactivation of the virus varicella zoster (chickenpox) due to a weakened immune system, affecting the nerve tracts causing a rash and a painful blister along the nerve pathway
79
What is a diaphragm?
A striated muscle of inspiration that closes the thoracic outlet
80
What is the origin and insertion of the diaphragm?
- ORIGIN: 1) Lower 6 ribs 2) Sternum: xiphoid 3) From the vertebrae L1-L3 4) Medial and lateral arcuate ligament - INSERTION: Central tendon
81
What is the innervation of the diaphragm?
Phrenic nerve (C3, 4 &5)
82
What are the structures that pass through the diaphragm?
- I-ATE 10X AT 12 1) Inferior vena cava (T8) 2) Esophagus (T10) 3) Aorta (T12) - Other structures
83
What is the action of the diaphragm?
1) Inspiration 2) Abdominal straining 3) Weight lifting 4) Venous pump
84
What is phrenic nerve palsy?
When the phrenic nerve is damaged it could be for half of the diaphragm and can be seen radiographically by the elevated hemidiaphragm as it is pushed upwards via the underlying abdominal viscera
85
What are the different movements of the thoracic wall and the diaphragm during breathing?
- During breathing the dimensions of the thorax change vertically, laterally, and anteroposteriorly Vertical: 1) The diaphragm significantly alters the vertical dimensions of the thorax via elevation and depression (contracts on inhalation, relaxes on exhalation) Antero-posterior diameter: 2) Because the anterior end of the ribs is inferior to the posterior ends when the ribs are elevated they move the sternum upwards and forwards decreasing the angle between the manubrium and the body of the sternum, in a pump-handle type of movement Lateral diameter 3) Bucket handle movement where the most inferior part of the rib (shaft) moves laterally

Y2S1 ANATOMY (15 decks)

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