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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
Costal Cartilage Attachments
- Directly: ribs 1-7 - Indirectly: ribs 8-10 - Forms costal margin
26
Intercostal Spaces
- Numbered based on the superior rib - Filled by intercostal muscles and membranes - 11 of them
27
Intercostal Spaces
- Each contains 2 sets of intercostal vessels and nerves | - Space changes dimensions with respiration
28
Subcostal Space
- Below rib 12
29
Thoracic Vertebrae (12)
- Bilateral costal facets on postero-lateral vertebral bodies - Superior and inferior costal facets for rib head articulation - Demifacets or full facets
30
Costal Facets on TP
- Articulation with rib tubercle | - T11 and 12 do not have costal face
31
Sternum
- Protects underlying viscera | - Rib attachment
32
Parts of the Sternum
- Manubrium - Body - Xiphoid process
33
Manubrium of Sternum
- Spans vertebral level T3-4) - Jugular notch (vertebral level T2) - Clavicular notches - Synchondroses of 1st rib
34
Body of Sternum
- Spans vertebral level T5-9) - Costal notches for ribs 3-7 - Transverse ridges (lines of fusion) - Represents the fuses of 4 separate sternebrae
35
Xiphoid Process of Sternum
- Vertebral level T10 | - Appearance varies
36
Manubrialsterno Joint (Sternal Angle)
- Part of the sternum | - Located T4/5
37
Xiphisternal Joint
- Located T9 in supine position - Level of central tendon of diaphragm - Inferior limit of heart, superior limit of liver
38
Costovertebral Joint
- Rib head and vertebral body | - Synovial joint
39
Costotransverse Joint
- Rib tubercle and TP | - Synovial joint
40
Costochondral
- Rib with costal cartilage | - Primary cartilaginous
41
Interchondral
- Between cartilages ribs 6-9 | - Synovial joint
42
Sternocostal Joint
- Between costal cartilages and sternum - Strengthened by radiate ** ligaments - 1st is primary cartilaginous, synchondrosis - 2-7 are synovial
43
Manubriosternal Joint
- Secondary cartilaginous (fibrocartilage)
44
Xiphisternal Joint
- Primary cartilaginous
45
Sternoclavicular Joint
- Upper extremity
46
Costovertebral and Costotransverse Joints
- Also considered joints of the vertebral column
47
Joints of the Thoracic Wall
- Costovertebral - Costotransverse - Costochondral - Interchondral - Sternocostal - Manubriosternal - Xiphisternal - Sternoclavicular
48
Costovertebral Joints
- Articulates with costal facets on vertebral bodies | - Synovial joints, gliding
49
Head of Ribs 2-9
- 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
Head of Ribs 1, 10-12
- Articulate with only its corresponding vertebral body
51
Costotransverse Joint
- 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
Rib Fracture
- 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
Flail Chest
- Life-threatening condition | - Fracture of 3 or more adjacent ribs at 2 locations
54
Flail Chest
- 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
Intercostal Muscles
- Span the intercostal space, attached to the ribs | - Superior border of rib below, inferior border of rib above
56
External Intercostal Muscles
- 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
Internal Intercostal Muscles
- 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
Innermost Intercostals
- 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
Transversus Thoracis Muscles
- Originates from the inner surface of sternum - Inserts onto the costal cartilages (ribs) of 2-6 - Function: depress ribs
60
Subcostal Muscles
- Internal aspect of posterior thoracic wall - Span multiple ribs - Function: similar to internal intercostals
61
Inspiration
- Increase volume --> decrease pressure, air flows in
62
Expiration
- Decrease volume --> increase pressure, air flow out
63
Inspiration
- 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
Additional Muscles Recruited when Needed for More Inspiration
- External intercostals - SCM - Scalenes - Anterior axio-appendicular muscles
65
Expiration
- Muscle relaxation and natural elasticity of tissue decreases volume of thoracic cavity
66
Forced Expiration
- Recruitment of additional muscles - Abdominals - Internal intercostals
67
Layers of the Thoracic Wall
- 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
Thoracic Spinal Nerve Branches
- Posterior ramus | - Anterior ramus (intercostal nerve)
69
Posterior Ramus
- Innervates skin over back
70
Anterior Ramus (Intercostal Nerve)
- Branches have segmental distribution - Anterior and lateral cutaneous branches - Branches to intercostal muscles - Connection with rami communicantes
71
Lateral Cutaneous Branch of the 2nd and/or 3rd Thoracic Spinal Nerve
- Give rise to the intercostobrachial nerve
72
Intercostobrachial Nerve
- Supplies axilla, communicates with branches of brachial plexus - 7th – 11th intercostal nerves also supply the abdominal wall
73
C4/5 Dermatome
- Dermatome to clavicles
74
T4 Dermatome
- Dermatome to nipples
75
T10 Dermatome
- Dermatome to umbilicus
76
Posterior Intercostal Arteries
- 1 and 2 (1st and 2nd intercostal space) - Arises from superior intercostal artery (costocervical trunk) - 3 – 11 arise from thoracic aorta
77
Subcostal Artery
- A branch off thoracic aorta
78
Anterior Intercostal Arteries
- 1 - 6 arise from internal thoracic artery - 7 - 9 arise from musculophrenic artery - Space 10 and 11 lack these arteries
79
Superior and Lateral Thoracic Arteries
- Branch off axillary artery
80
Internal Thoracic Arteries (Internal Mammary)
- Branches of the subclavian arteries | - Descends lateral to sternum on interior aspect of thoracic wall
81
Branches of Internal Thoracic Arteries
- Pericardiophrenic - Anterior intercostal arteries (1st 6 spaces) - Superior epigastric and musculophrenic (terminal branches)
82
Musculophrenic Artery
- Gives off anterior intercostal arteries to spaces 7-9
83
Intercostal Neurovascular Bundle
- Found between the internal and innermost intercostal muscles - In the costal groove - Intercostal Nerves - Posterior/Anterior intercostal arteries and veins
84
Intercostal Neurovascular Bundle
- 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
Below the 12th Rib
- Subcostal nerve and vessels
86
Venous Drainage of Thoracic Wall
- 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
11 Posterior Intercostal Veins and Subcostal Vein
- Drain into the azygos venous system
88
Anterior Intercostal Veins
- Drain into internal thoracic and musculophrenic veins

Gross Anatomy (50 decks)

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