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Gross Anatomy > Thoracic Wall > Flashcards

Thoracic Wall Flashcards

1
Q

Thoracic Wall

A
  • Rigid but flexible

- Constantly in motion

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2
Q

Boundaries Forming the Thoracic Wall

A
  • Skin
  • Subcutaneous tissue
  • Thoracic cage
  • Ribs and costal cartilage
  • Sternum
  • Thoracic vertebrae and IVD
  • Muscle (intercostals, pecs)
  • Fascia
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3
Q

Thoracic Wall Function

A
  • Protect thoracic and abdominal organs
  • Respiration
  • Muscle attachment
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4
Q

Thoracic Cavity

A
  • Space enclosed by the thoracic cage, intercostal muscles and diaphragm
  • Superior thoracic aperture
  • Inferior thoracic aperture
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5
Q

Superior Thoracic Aperture

A
  • Slopes antero-inferiorly

- Communication with neck and upper limb

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6
Q

Boundaries of Superior Thoracic Aperture

A
  • Posterior: T1 body
  • Lateral: rib 1 and cartilage
  • Anterior: superior manubrium
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7
Q

Inferior Thoracic Aperture

A
  • Posterior is more inferior than anterior
  • Larger and enclosed by diaphragm
  • Passageway to/from abdominal cavity pass
  • Posterior or through diaphgram
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8
Q

Boundaries of Inferior Thoracic Aperture

A
  • Body of T12 vertebra
  • Rib 12 and distal end of rib 11
  • Costal cartilage of ribs 7 – 10
  • Xiphoid process
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9
Q

Infrasternal Angle (Subcostal Angle)

A
  • Formed by costal margin and xiphisternal joint
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10
Q

Ribs

A
  • Flat bones

- Active hematopoietic tissue (Red bone marrow)

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11
Q

True Ribs

A
  • Vertebrosternal ribs (1-7)
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12
Q

False Ribs

A
  • Vertebrochondral ribs (8-10)
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13
Q

False, Floating Ribs

A
  • Free ribs (11, 12)
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14
Q

Typical Ribs

A
  • Ribs 3-9
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15
Q

Atypical Ribs

A
  • Ribs 1, 2, 10-12
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16
Q

Typical Ribs

A
  • Head
  • Neck
  • Tubercle
  • Body
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17
Q

Head of Typical Ribs

A
  • 2 facets for articulating with 2 adjacent vertebrae and disc between
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18
Q

Tubercle of Typical Ribs

A
  • Articular part that articulates with the TP of the corresponding vertebra, non-articular part
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19
Q

Body of Typical Ribs

A
  • Costal angle and costal groove
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20
Q

1st Rib

A
  • Morphology
  • Single facet on the head (articulates with one vertebral body)
  • Grooves for subclavian vessels
  • Scalene tubercle
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21
Q

2nd Rib

A
  • Noticeable tuberosity for serratus anterior
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22
Q

Ribs 10-12

A
  • Single facet on the head (articulates with one vertebral body)
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23
Q

Ribs 11-12

A
  • Single facet on the head (articulates with one vertebral body)
  • Short and lack a neck and tubercle (no TP articulation
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24
Q

Costal Cartilages

A
  • Provide flexibility

- Attach ribs to sternum

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25
Q

Costal Cartilage Attachments

A
  • Directly: ribs 1-7
  • Indirectly: ribs 8-10
  • Forms costal margin
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26
Q

Intercostal Spaces

A
  • Numbered based on the superior rib
  • Filled by intercostal muscles and membranes
  • 11 of them
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27
Q

Intercostal Spaces

A
  • Each contains 2 sets of intercostal vessels and nerves

- Space changes dimensions with respiration

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28
Q

Subcostal Space

A
  • Below rib 12
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29
Q

Thoracic Vertebrae (12)

A
  • Bilateral costal facets on postero-lateral vertebral bodies
  • Superior and inferior costal facets for rib head articulation
  • Demifacets or full facets
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30
Q

Costal Facets on TP

A
  • Articulation with rib tubercle

- T11 and 12 do not have costal face

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31
Q

Sternum

A
  • Protects underlying viscera

- Rib attachment

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32
Q

Parts of the Sternum

A
  • Manubrium
  • Body
  • Xiphoid process
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33
Q

Manubrium of Sternum

A
  • Spans vertebral level T3-4)
  • Jugular notch (vertebral level T2)
  • Clavicular notches
  • Synchondroses of 1st rib
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34
Q

Body of Sternum

A
  • Spans vertebral level T5-9)
  • Costal notches for ribs 3-7
  • Transverse ridges (lines of fusion)
  • Represents the fuses of 4 separate sternebrae
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35
Q

Xiphoid Process of Sternum

A
  • Vertebral level T10

- Appearance varies

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36
Q

Manubrialsterno Joint (Sternal Angle)

A
  • Part of the sternum

- Located T4/5

37
Q

Xiphisternal Joint

A
  • Located T9 in supine position
  • Level of central tendon of diaphragm
  • Inferior limit of heart, superior limit of liver
38
Q

Costovertebral Joint

A
  • Rib head and vertebral body

- Synovial joint

39
Q

Costotransverse Joint

A
  • Rib tubercle and TP

- Synovial joint

40
Q

Costochondral

A
  • Rib with costal cartilage

- Primary cartilaginous

41
Q

Interchondral

A
  • Between cartilages ribs 6-9

- Synovial joint

42
Q

Sternocostal Joint

A
  • Between costal cartilages and sternum
  • Strengthened by radiate ** ligaments
  • 1st is primary cartilaginous, synchondrosis
  • 2-7 are synovial
43
Q

Manubriosternal Joint

A
  • Secondary cartilaginous (fibrocartilage)
44
Q

Xiphisternal Joint

A
  • Primary cartilaginous
45
Q

Sternoclavicular Joint

A
  • Upper extremity
46
Q

Costovertebral and Costotransverse Joints

A
  • Also considered joints of the vertebral column
47
Q

Joints of the Thoracic Wall

A
  • Costovertebral
  • Costotransverse
  • Costochondral
  • Interchondral
  • Sternocostal
  • Manubriosternal
  • Xiphisternal
  • Sternoclavicular
48
Q

Costovertebral Joints

A
  • Articulates with costal facets on vertebral bodies

- Synovial joints, gliding

49
Q

Head of Ribs 2-9

A
  • Articulate with superior aspect of corresponding vertebra
    the inferior aspect of the one above
  • Intervening IVD
  • 2 joint cavities separated by intra-articular ligament
    supported by radiate ligaments
50
Q

Head of Ribs 1, 10-12

A
  • Articulate with only its corresponding vertebral body
51
Q

Costotransverse Joint

A
  • Synovial joint, gliding joints
  • Between rib tubercle and TPs of corresponding vertebra
  • Supported by ** ligaments
  • Shape of articulating surfaces of TPs differs between superior and inferior ribs
  • Ribs 11 and 12 do not articulate with TP therefore they do not have a tubercle
52
Q

Rib Fracture

A
  • Usually as a result of blunt trauma to thorax
  • 4-9 most commonly injured
  • Can result in injury to underlying organs
  • Pulmonary laceration, hemothorax, pneumothorax
53
Q

Flail Chest

A
  • Life-threatening condition

- Fracture of 3 or more adjacent ribs at 2 locations

54
Q

Flail Chest

A
  • Creates a free segment
  • Paradoxical movement of the free segment with respiration
  • Indicative of more serious underlying injuries (pulmonary contusion, cardiac tamponade)
  • Leading to respiratory compromise causing hypoxia
55
Q

Intercostal Muscles

A
  • Span the intercostal space, attached to the ribs

- Superior border of rib below, inferior border of rib above

56
Q

External Intercostal Muscles

A
  • Most superficial
  • Located from rib tubercle to costochondral junction
  • ** membrane spans the gap to the sternum
  • Anteromedial muscle fiber direction
  • Elevate rib during inspiration
57
Q

Internal Intercostal Muscles

A
  • Deep to external intercostals
  • Muscle fibers run postero-inferior (90⁰ angle to the externals)
  • Located from rib angle to sternum
  • ** membrane spans the gap to about rib neck
  • Depress the ribs during forced expiration
  • Interchondral part (anteriorly) elevates the ribs
58
Q

Innermost Intercostals

A
  • Deep to internal intercostals, attached to inner part of rib
  • Only found in the lateral part of the intercostal space
  • Function similar to internal intercostals
59
Q

Transversus Thoracis Muscles

A
  • Originates from the inner surface of sternum
  • Inserts onto the costal cartilages (ribs) of 2-6
  • Function: depress ribs
60
Q

Subcostal Muscles

A
  • Internal aspect of posterior thoracic wall
  • Span multiple ribs
  • Function: similar to internal intercostals
61
Q

Inspiration

A
  • Increase volume –> decrease pressure, air flows in
62
Q

Expiration

A
  • Decrease volume –> increase pressure, air flow out
63
Q

Inspiration

A
  • Muscle contraction increases volume of thoracic cavity
  • Diaphragm contraction increases vertical dimensions
  • Pump handle movement increases AP diameter
  • Bucket handle movement increases transverse diameter
64
Q

Additional Muscles Recruited when Needed for More Inspiration

A
  • External intercostals
  • SCM
  • Scalenes
  • Anterior axio-appendicular muscles
65
Q

Expiration

A
  • Muscle relaxation and natural elasticity of tissue decreases volume of thoracic cavity
66
Q

Forced Expiration

A
  • Recruitment of additional muscles
  • Abdominals
  • Internal intercostals
67
Q

Layers of the Thoracic Wall

A
  • Skin
  • Superficial fascia
  • Deep fascia
  • Serratus anterior or some other muscle (depends on the - - Region of the thoracic wall)
  • External intercostal
  • Internal intercostal
  • Innermost intercostal
  • Endothoracic fascia
  • Parietal pleura
68
Q

Thoracic Spinal Nerve Branches

A
  • Posterior ramus

- Anterior ramus (intercostal nerve)

69
Q

Posterior Ramus

A
  • Innervates skin over back
70
Q

Anterior Ramus (Intercostal Nerve)

A
  • Branches have segmental distribution
  • Anterior and lateral cutaneous branches
  • Branches to intercostal muscles
  • Connection with rami communicantes
71
Q

Lateral Cutaneous Branch of the 2nd and/or 3rd Thoracic Spinal Nerve

A
  • Give rise to the intercostobrachial nerve
72
Q

Intercostobrachial Nerve

A
  • Supplies axilla, communicates with branches of brachial plexus
  • 7th – 11th intercostal nerves also supply the abdominal wall
73
Q

C4/5 Dermatome

A
  • Dermatome to clavicles
74
Q

T4 Dermatome

A
  • Dermatome to nipples
75
Q

T10 Dermatome

A
  • Dermatome to umbilicus
76
Q

Posterior Intercostal Arteries

A
  • 1 and 2 (1st and 2nd intercostal space)
  • Arises from superior intercostal artery (costocervical trunk)
  • 3 – 11 arise from thoracic aorta
77
Q

Subcostal Artery

A
  • A branch off thoracic aorta
78
Q

Anterior Intercostal Arteries

A
  • 1 - 6 arise from internal thoracic artery
  • 7 - 9 arise from musculophrenic artery
  • Space 10 and 11 lack these arteries
79
Q

Superior and Lateral Thoracic Arteries

A
  • Branch off axillary artery
80
Q

Internal Thoracic Arteries (Internal Mammary)

A
  • Branches of the subclavian arteries

- Descends lateral to sternum on interior aspect of thoracic wall

81
Q

Branches of Internal Thoracic Arteries

A
  • Pericardiophrenic
  • Anterior intercostal arteries (1st 6 spaces)
  • Superior epigastric and musculophrenic (terminal branches)
82
Q

Musculophrenic Artery

A
  • Gives off anterior intercostal arteries to spaces 7-9
83
Q

Intercostal Neurovascular Bundle

A
  • Found between the internal and innermost intercostal muscles
  • In the costal groove
  • Intercostal Nerves
  • Posterior/Anterior intercostal arteries and veins
84
Q

Intercostal Neurovascular Bundle

A
  • Collateral branches run on the super aspect of the inferior rib
  • VAN: Vein (closest to the rib), Artery, Nerve
  • Below rib 12 are the subcostal nerve and vessels
85
Q

Below the 12th Rib

A
  • Subcostal nerve and vessels
86
Q

Venous Drainage of Thoracic Wall

A
  • 11 posterior intercostal veins and the subcostal vein drain into the azygos venous system
  • Anterior intercostal veins drain into internal thoracic and musculophrenic veins
87
Q

11 Posterior Intercostal Veins and Subcostal Vein

A
  • Drain into the azygos venous system
88
Q

Anterior Intercostal Veins

A
  • Drain into internal thoracic and musculophrenic veins

Gross Anatomy (50 decks)

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