Thoracic wall Flashcards
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
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
three types of ribs
true (verbrosternal) ribs: 1-7
false (verbrochondral) ribs: 8-10
floating: 11-12
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
atypical ribs
1, 2, 10, 11, 12
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
2nd rib
thinner and more typical
formations for attachment of serratus anterior and posterior scalene
10th through 12th ribs
only one facet on their head
11th and 12th ribs
short and have no necks or tubercles
costal spaces
11 intercostal
1 subcostal
subcostal nerve
anterior ramus of T12
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
manubrium
trapezoidal bone
at level of bodies of T3 and T4 vertebrae
jugular notch, 2 clavicular notches
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
body of sternum
T5-T9 vertebral level
scalloping of lateral borders by costal notches
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
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
