Thoracic wall Flashcards by Katharine Wilchek

inferior thoracic aperture

anatomical thoracic outlet
diaphragm closes it
much larger than superior
bounded:
posteriorly by T12 vertebra
posterolaterally by 11th and 12th pairs of ribs
anterolaterally by joined costalcartilages of ribs 7-10 forming the costal margin
anteriorly by the xiphisternal joint

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superior thoracic aperture

anatomical thoracic inlet
trachea, esophagus, vessels and nerves pass
adult: 6.5 cm anteroposteriorly and 11 cm traversely
bounded:
posteriorly by T1 vertebra
laterally by first pair of ribs and costal cartilages
anteriorly by superior border of manubrium

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three types of ribs

true (verbrosternal) ribs: 1-7
false (verbrochondral) ribs: 8-10
floating: 11-12

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typical ribs

3rd to 9th
head: two facets and crest of head
neck
tubercle: articular and non articular parts
body or shaft:angle. costal groove

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atypical ribs

1, 2, 10, 11, 12

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1st rib

broad, shortest and most sharply curved of true rib
more to roof than wall of thoracic cavity
two shallow horizontal grooves crossing its superior surface for the subclavian vessels separated by scalene tubercle and ridge
articulates with T1 vertebrae

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2nd rib

thinner and more typical

formations for attachment of serratus anterior and posterior scalene

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10th through 12th ribs

only one facet on their head

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11th and 12th ribs

short and have no necks or tubercles

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costal spaces

11 intercostal

1 subcostal

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subcostal nerve

anterior ramus of T12

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characteristic features of thoracic vertebra

bilateral superior and inferior costal or demi facets on bodies (1, 10-12 have one whole costal facets)
costal facets on transverse processes exceept for inferior two or three
long inferiorly slanting spinous processes

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manubrium

trapezoidal bone
at level of bodies of T3 and T4 vertebrae
jugular notch, 2 clavicular notches

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sternal angle of Louis

between manubrium and sternum

opposite second pair of costal cartilages at the level f the IV disc between the T4 and T5 vertebrae

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body of sternum

T5-T9 vertebral level

scalloping of lateral borders by costal notches

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xiphoid process

T10 vertebral level
smallest
cartilaginous in young people but more or less ossified in people older than 40
may fuse with sternal body in elderly

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xiphisternal joint

primary cartilaginous (synchondrosis)
articulation between xiphoid process and body of sternum
often fuses and becomes synostosis in older people
T9 vertebral level
midline marker for superior level of liver, central tendon of diaphragm and inferior border of heart

intervertebral joint

symphysis (secondary cartilaginous)
adjacent vertebral bodies bound together by intervertebral disc
anterior and posterior longitudinal ligaments

costovertebral joints of head of ribs

synovial plane joint
head of rib with costal facets: superior of its number, inferior of one above
radiate and intra-articular ligaments of head of rib
1st, 10th, 11th, 12th, only with its vertebral body

costotransverse joint

synovial plane joint
articulation of tubercle of rib with transverse process of corresponding vertebra
lateral and superior costotransverse ligaments
11th and 12th do not

sternocostal joints

1st:primary cartilaginous, 1st costal cartilage with manubrium
2nd-7th: synovial plane joint, 2-7 costal cartilages with sternum
anterior and posterior radiate sternocosta ligaments

sternoclavicular

saddle type of synovial joint
sternal end of clavicle with manubrium and 1st costal cartilage
anterior and posterior sternoclavicular ligaments
costoclavicular ligament
joint divided into two compartments by articular disc

costochondral joint

primary cartilaginous
articulation of lateral end of costal cartilage with sternal end of rib
cartilage and bone, bound together by periosteum
normally no movements occur]

interchondral

synovial plane joint
articulation between costal cartilages of 6/7, 7/8 and 8/9 ribs
interchondral ligaments
articulatin between costal cartilages of 9th and 10th ribs is fibrous

manubriosternal

secondary cartilaginous joint (symphysis) articulation between manubrium and body of sternum often fuse and become synostosis in older people

flail chest

sizeable segment of anterior or lateral thoracic wall moves freely because of multiple rib fractures painful and impairs ventilation

cervical ribs

1% of people articulate with C7vertebra may compress spinal nerves C8 and T1 or the inferior trunk of the brachial plexus may also compress subclavian artery,resulting in ischemic muscle pain

sternal biopsies

sternal body often used for bone marrow needle biopsy

posterior thoracotomy

upperlimb fully abducted access as high as 4th intercostal space posterolateral aspects of 5th to 7th intercostal spaces

thoracic outlet syndrome

costoclavicular syndrome: pallor and coldness of skin of upper limb and diminished radial pulse resulting from compresion of subclavian artery

axillary process or tail of Spence

small part of breast may extend along inferolateral edge of pectoralis major toward axillary fossa

resting of breast

2/3 on pectoral fascia | 1/3 on serratus anterior fascia

retromammary space

between breast and deep pectoral fascia: loose connective tissue plane

nerves of breast

derive from anterior and lateral cutaneous branches of 4th to 6th intercostal nerves

intercostal nerves

formed by anterior rami of T1-T11 spinal nerves

subcostal nerve

anterior rami of T12

typical intercostal nerves

3rd through 6th: run interior to interior intercostal muscles collateral branches arise near angles of ribs and run along superior border of rib beow continue and give rise to latral cutaneous branches at midaxillary line turn anteriorly near the sternum and enter subcutaneous tissue as anterior cutaneous branches

atypical intercostal nerves`

1&2, 7-11 1&2 pass on internal surfaces of ribs instead of costal grooves 7-11th continue to supply abdominal skin and muscles after giving rise to lateral cutaneous branchs

posterior intercostal arteries

originate from supereme intercostal arteries (intercostal spaces 1 and 2) and thoracic aorta (remaining intercostal spaces) pass between internal and innermost intercostal muscles distributed to intercostal muscles and overlying skin, parietal pleura

anterior intercostal arteries

originate from internal thoracic arteries (intercostal spaces 1-6) and musculophrenic arteries (intercostal spaces 7-9) pass between internal and innermost intercostal muscles distributed to intercostal muscles and overlying skin, parietal pleura

internal thoracic artery

originates from subclavian artery passes inferiorly, lateral to sternum, between costal cartilages and internal intercostal muscles to divide into superior epigastric and musculophrenic arteries disribution: by way of anterior intercostals to intercostal spaces 1-6 and musculophrenic arteries to intercostal spaces 7-9

herpes zoster

shingles | dermatomally distributed skin lesion. viral disease of spinal ganglia