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ANAT 214 > Thoracic Wall > Flashcards

Thoracic Wall Flashcards

1
Q

what is thorax aka

A

rib cage

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2
Q

what is thorax bounded by

A

thoracic vertebrae t1-12 posteriorly, sternum and ribs

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3
Q

describe thorax - gen functions

A

osteo cartilagenous (bones+cartilage) structure (chunks of cartilage linking ribs to sternum)
encloses thoracic cavity and protects content (lungs, heart, and associated structures)
frame for attachment of upper limb and its muscles (all bones=scaffold, respiration muscles)

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4
Q

describe thorax - sealed by

A

thoracic wall and floor sealed off by muscles and connective tissues with a few key passages for neurovascular structures

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5
Q

describe superior thoracic aperture

A

thoracic inlet
not sealed = open
structures for continuity = trachea, common carotid (arteries)

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6
Q

describe inferior thoracic aperture

A

thoracic outlet = floor
mostly closed off by diaphragm muscle (but still has openings for structures to get in/out)

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7
Q

name and describe boundaries of thoracic wall

A

posterior boundary = thoracic (spine - vertebral column)
lateral boundaries = ribs
anterior boundaries = sternum (breastbone)

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8
Q

describe vertebrae of posterior boundary - gen

A

t1-t12

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9
Q

describe vertebral body

A

all vertebrae have
demi facets = stacking thoracic vertebrae together to make complete articulation for costovertebral joint

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10
Q

describe transverse process of vertebrae

A

articulates with ribs
costal facet = only t1-12

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11
Q

describe spinous process of vertebrae

A

large
Attachment of muscles of back - sticks out - see in lateral view, poke at midline, sagittal plane

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12
Q

describe superior articular process of vertebrae

A

articulates with superior vertebra

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13
Q

describe inferior articular process of vertebrae

A

articulates with inferior vertebra

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14
Q

describe vertebral foramen of vertebrae

A

passage of spinal cord
each opening = spinal nerves

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15
Q

what else do thoracic vertebrae have in addition to normal processes and articular facets

A

unique - have 3 additional articular surfaces for articulations with ribs

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16
Q

what distinguishes types of ribs

A

Depends on how articulates with sternum

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17
Q

describe true ribs

A

1-7
direct insertion onto sternum via costal cartilage (links directly to sternum)

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18
Q

describe false ribs

A

8-10
indirect insertion onto sternum via costal margin
10->9->8->7->sternum
converge on costal cartilage of 7 then meets sternum
cartilagenous ridge

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19
Q

describe floating ribs

A

11-12
no insertion on sternum

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20
Q

describe anatomy of typical rib - head

A

connects to vertebrae

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21
Q

describe anatomy of typical rib - neck

A

after head

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22
Q

describe anatomy of typical rib - costal angle

A

changes direction
starts c shape
more visible in some ribs than others

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23
Q

describe anatomy of typical rib - body

A

big
after costal angle

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24
Q

describe anatomy of typical rib - tubercle

A

bump
posterior
articulates with transverse process

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25
Q

describe anatomy of typical rib - articular facets

A

2 articular facets on head
slot into demi facets on vertebrae

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26
Q

describe anatomy of typical rib - c shape

A

connects posterior (vertebral) and anterior (sternum wall)

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27
Q

what does rib 5 articulate with

A

articulates with t5 and t4
same rib and one above it

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28
Q

describe entirely the 3 articulations of typical rib

A

1- posterior - rib head with bodies of 2 thoracic vertebrae (head with vertebral bodies = same level and superior)
2 - posterior - rib tubercle with thoracic transverse process of same level
3 - anterior - costal cartilage with sternum (ribs 1-7), no bone on bone, always have costal cartilage

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29
Q

describe posterior joints - gen

A

rib articulations with thoracic vertebrae
costovertebral joint
costotransverse joint

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30
Q

describe costovertebral joint - posterior joints

A

head of rib articulates with 2 demi facets = superior demi facet on vertebral body of same number vertebrae AND inferior demi facet of vetebral body above
joint type = complex synovial (3 bones), plane/gliding synovial movements

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31
Q

describe costotransverse joint - posterior joints

A

tubercle of rib articulates with costal facet on transverse process of same number vertebrae - between rib and transverse process
joint type = synovial plane/gliding

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32
Q

what are atypical ribs

A

lack one or more articulations

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33
Q

describe ribs 1,10-12 - atypical

A

lack costovertebral articulation with superior vertebral body (only articulate with own level)
no demi facet, joint surface shifts = now only on vertebral body

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34
Q

describe ribs 11-12 - atypical

A

no neck tubercle so no costotransverse joints

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35
Q

describe sternum and parts - 6

A

jugular notch
manubrium = top
manubriosternal joint = sternal angle, fused in adults
body of sternum = main part
xiphisternal joint - fused in adults
xiphoid process = little sharp point, sticks out, can feel it, palpable landmark

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36
Q

describe sternum - facets for true ribs

A

7 joints on either side

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37
Q

at which level is jugular notch of sternum- also rib

A

level of t2
rib 1

38
Q

at which level is manubriosternal joint of sternum - also rib

A

t4/5
rib 2

39
Q

at which level is xiphisternal joint of sternum - also rib

A

t9
rib 7

40
Q

describe rib tilt

A

ribs tilted inferiorly from post to ant
so ribs at level of sternum do not coincide with thoracic vertebral levels
drop down as move forwards

41
Q

describe anterior joints - 4

A

rib articulations with sternum
costochondral
sternocostal
1st sternocostal
interchondral

42
Q

describe costochondral joint - anterior joints

A

ribs 1-10 only
ribs and costal cartilage
no movement under physiological conditions
synchondrosis - do not move, fused

43
Q

describe sternocostal joint - anterior joints

A

ribs 2-7 only
costal cartilage and sternum
limited movement (synovial plane/gliding type, some movement, respiration)

44
Q

describe 1st sternocostal joint - anterior joints

A

costal cartilage with sternum (manubrium) at rib 1
no movement synchondrosis - fused

45
Q

describe interchondral joint - anterior joints

A

between costal cartilage
ribs 7-10
another pair present between ribs 6-7 (variable tho) - cartilage bridge, sometimes not present
unique type of synovial joint - plane/gliding, limited

46
Q

name movements of thoracic wall - respiration

A

pump handle movement
Bucket handle movement

47
Q

describe pump handle movement - respiration - generally

A

sagittal plane
volume of thoracic cavity - changes in an anterior to posterior diameter
as lifts ribs on either side in sagittal plane

48
Q

describe pump handle movement - respiration - joints

A

at costotransverse (posteriorly) and costovertebral (anteriorly) joints (between 2)
ribs 2-7 (those with sternocostal joints)

49
Q

describe pump handle movement - respiration - movement visibility

A

Smaller movement superiorly
larger movement inferiorly
increasingly visible as get to lower ribs

50
Q

describe pump handle movement - respiration - what is pump handle

A

rib - not sternum
ribs move around axis of rotation

51
Q

describe bucket handle movement - respiration - generally

A

volume of thoracic cavity changes in mediolateral diameter - side to side,

52
Q

describe bucket handle movement - respiration - joints

A

at costotransverse and costovertebral joints (between), ribs 6-12 and sternocostal joint of 7&7, (recall - 8-10 have no sternocostal joints)

53
Q

describe bucket handle movement - respiration - direction

A

mediolateral direction (lift bucket handle)

54
Q

describe bucket handle movement - respiration - movement visibility

A

smaller superiorly and larger movements inferiorly (since less mobility)

55
Q

what do intercostal muscles do

A

move vertebrae between ribs

56
Q

describe external intercostals - direction

A

sup –>inf, down and medial
from ribs to costal cartilages anteriorly (membrane)

57
Q

describe external intercostals - fiber orientation

A

from attachment on sueprior rib - obliquely towards anterior and inferior (hands in jacket pockets)

58
Q

describe external intercostals - function

A

elevates ribs and sternum during forceful inspiration
bring out - in bucket handle motion

59
Q

describe external intercostals - external intercostal membrane

A

attachment to costal cartilage on medial aspect = covered by membrane

60
Q

describe internal intercostals - direction

A

deep to external intercostal membrane
from sternum anteriorly to costal angle posteriorly

61
Q

describe internal intercostals - fiber orientation

A

perpendicular to external intercostals

62
Q

describe internal intercostals - function

A

depresses ribs and sternum during forceful expiration (exercise and coughing)

63
Q

when are intercostal muscles used

A

Accessory muscles of respiration - used during forceful movements of thoracic wall and are mostly relaxed during normal respiration

64
Q

describe emg of intercostal muscles

A

electromyography
muscle activation of external intercostals at different inspiration intensities
= more activity during forceful resp

65
Q

name and describe accessory muscles of thoracic wall

A

deepest muscles
inside surface of thoracic wall
innermost intercostal muscles
transversus thoracis

66
Q

describe innermost intercostal muscles - fiber orientation

A

from superior rib = postero inferior (like internal intercostals)

67
Q

describe innermost intercostal muscles - function

A

like internal intercostals - same orientation
depresses ribs and sternum during forceful expiration

68
Q

describe transversus thoracis muscles -direction

A

from sternum body an xiphoid process to costal cartilage of ribs 2-6

69
Q

describe transversus thoracis muscles - function

A

depresses ribs, forceful expiration
pulls ribs down, sternum will not move towards rubs - opposite
so back towards sternum = bucket handle motion

70
Q

what are main muscles of respiration

A

Diaphragm

71
Q

describe diaphragm - generally

A

Separates thorax from abdomen (floor thoracic=roof abdomen)
dome shaped muscle, thin
seals off inferior thoracic aperture

72
Q

describe diaphragm - peripheral attachments

A

along circumference of inferior thoracic aperture (outlet)
stretches all around periphery, runs along costal margin, xiphoid process
ribs 6-12, l1-l3 vertebrae

73
Q

describe diaphragm - innervation

A

phrenic nerves (anterior rami of c3-5) to each hald
hiatuses for Inferior vena cava, esophagus and aorta (3 holes, not fully sealed off)
c3,4,5 keep diaphragm alive

74
Q

describe diaphragm - function

A

when fibers contract - resting respiration = depresses to increases thoracic cavity volume along superior inferior axis (dome becomes smaller and tighter, moves towards abdominal cavity)

75
Q

describe diaphragm - clinical correlate

A

damage to one phrenic nerve (2 phrenic - one on either side) can cause unilateral (hemis) paralysis of diaphragm
Can be seen on X Ray by paradoxical Rise of paralyzed side during inspiration, as abdominal viscera are pushed into it from depression of functional side (active side pushes abdominal viscera–>so the other side Rises: uneven movement of diaphragm & viscera (how diagnosed)

76
Q

describe vascular supply to thorax - gen

A

blood supply to intercostals and thoracic wall comes from intercostal arteries

77
Q

describe vascular supply to thorax - anterior intercostal arteries

A

arise from internal thoracic arteries (ica), 1st branches of subclavian arteries
running on posterior aspect of the anterior thoracic wall on either side of sternum
left and right internal thoracic artery (branch of subclavian) –> ant arteries

78
Q

describe vascular supply to thorax - posterior intercostal arteries

A

arise directly from thoracic aorta or subclavian arteries (superior 2)
Branches - moves out laterally –> post arteries

79
Q

describe vascular supply to thorax - meet

A

anterior and posterior intercostal arteries in an intercostal space from an anastomosis
along thoracic cavity, runs parallel to ribs
post meets ant
Alternative pathways if something blocking one of 2 pathways (ant or post)

80
Q

describe vascular supply to thorax - blood supply to thoracic side of diaphragm

A

2 branches of internal thoracic arteries =
musculophrenic = splits and artery runs into gutter formed where diaphragm attaches
pericardiophrenic = 1st branch, runs with phrenic nerve, also provides blood to pericardium
(and from lower intercostal arteries)

81
Q

describe somatic innervation of thoracic wall - gen

A

somatic innervation = spinal nerves t1-12
runs as intercostal nerves but t12 = subcostal since last rib = no rib under

82
Q

describe somatic innervation of thoracic wall - runs where

A

in costal groove of same numbered rib
with that levels intercostal artery and vein
runs from back to front

83
Q

describe somatic innervation of thoracic wall - branches of spinal nerves

A

intercostal nerve (motor/sensory)
lateral cutaneous nerve (sensory)
anterior cutaneous nerve (sensory)
*cutaneous = to skin, meet so all has sensory coverage from same spinal level

84
Q

describe thoracic dermatomes - gen

A

in thorax spinal nerves create regular bands of skin receiving sensory innervation - from cutaneous branches of intercostal nerves at each level

85
Q

what is dermatome t4 innervated by

A

t4 nerve

86
Q

describe thoracic dermatomes - dermatome level and approx skin areas

A

t4=nipple
t6=xiphoid process
t10=umbilicus

87
Q

describe thoracic dermatomes - clinical correlate

A

Rashes can spread along thoracic nerve Roots
Ex: Reactivation & Spread of Chicken pox virus (V. zoster
causes Shingles = painful Rash in bands along one or
more dermatomes (likely T5/Th in pic)
along intercostal nerves-irritates infects nerves supply
(band as Rash)

88
Q

what runs in costal groove - describe

A

intercostal nerve and a and v run as bundle in costal groove of rib at same thoracic level
bundle runs between innermost and internal intercostal muscles at that level

89
Q

describe VAN

A

V = ant/post intercostal vein
A = ant/post intercostal artery
N = intercostal nerve
van = order, sup, mid, inf

90
Q

describe clinical correlate - relevance of bundle

A

must be careful when insert chest tube or make nerve block
chest tube (e. g. to drain pleural cavity) = want to insert close to superior border of Rib below (if get close to inferior border = bad = risk damaging bundle running in costal groove)
if want nerve block = be closest to inf border of level you want to anesthetize

91
Q

describe lateral walls of thorax - sealed

A

lateral walls sealed off by muscles of respiration

92
Q

describe diaphragm - central attachments

A

to itself via a central tendon (fibers to top of dome, converges on itself)

ANAT 214 (34 decks)

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