Thoracic wall Flashcards
Which are true ribs
1-7
Which are false ribs
8-10
which are floating ribs
11+12
What are typical ribs and what do they have
3-9
- Head of rib which has two facets separated by crest of the head
- Neck of rib
- Tubercle of rib
- Body of rib
What does the tubercle of the rib have
Smooth articular facet that connects with corresponding transverse process of vertebra (via synovial joint)
Rough non articular facet to the process via the costotransverse ligament
What does the costotransverse ligament connect
Non articular part of rib to the spinous process
What is the scalene tubercle
Separates the grooves on the 1st rib which is for the subclavian vessels
What mm attach to the second rib
Serratus anterior and posterior scalene muscles
which ribs have no necks or ribs
11+12
What are joints between costal cartilages called
Interchondral joints
What are joints between ribs and costal cartilages called
Costochondral
What is a thoracotomy
Creating an opening through the thoracic wall to enter the pleural cavity
What is involved in an anterior thoracotomy
H shaped cuts through the perichondrium of one or more costal cartilages and then shelling out segments of the costal cartilage to gain access to thoracic cavity
Where are important sites for a posterior thoracotomy
postolateral aspects of the 5th to 7th intercostal spaces
How is a posterior thoracotomy performed
Patient lying on side and the upper limb is fully abducted, placing the forearm beside the patient’s head (allows higher access by moving scapula)
What are sternal biopsies used to obtain
Specimens of bone marrow for transplantation and for detection of metastatic cancer
What is median sternotomy
Sternum split in middle and retracted (e.g. for coronary artery bypass grafting)
What is lateral thoracotomy used for
Provides wide access to the pulmonary cavity (and is done through intercostal spaces)
What is is minimally invasive thoracic surgery fir
Allows access to the thorax through small intercostal incisions for many intrathoracic procedures
What are the symptoms of costoclavicular syndrome
Pallor and coldness of skin of upper limb and diminished radial pulse as a result of compression of subclavian artery between clavicle and 1st rib
What is a rib dislocation the dissociation of
Dislocation of costal cartilage from sternum
What is a rib separation?
Dislocation of costochondral junction between the rib and its costal cartilage
What usually happens in the separation of the 3rd-10th ribs and what is the result of this
Tearing of the perichondrium and periosteum (rib may move superiorly, overriding the rib above and causing pain)
What muscles act as accessory muscles of respiration
Pec muscles
Inferior part of serratus anterior
Scalene muscles
What is the origin of the internal thoracic artery
Subclavian artery
What is the course of the internal thoracic artery
Passes inferiorly, lateral to sternum, between the costal cartilages and internal intercostal muscles to divide into the epigastric and muscolpphrenic arteries
What does the internal thoracic artery divide into
Musculophrenic
Epigastric
What does the internal thoracic artery supply
Anterior intercostals to ics1-6
Musculophrenic arteries ics 7-9
Where does the lateral thoracic artery originate from
Axillary artery
What is the course of the lateral thoracic artery
Inferiomedially along the inferior border of pectorals minor to the anterior surface of the serratus anterior
What does the lateral thoracic artery supply
Lateral structures of the breast and thorax
Where does the acromiothoracic artery originate from
Axillary artery
What does the acromiothoracic artery supply
Pec minor + major
Anterior part of deltoid
What are the origins of the posterior intercostal arteries
Supreme intercostal arteries (ics 1+2) Thoracic aorta (remaining ics)
What are the courses of the anterior and posterior intercostal arteries
Between internal and innermost intercostal muscles
What are the origins of the anterior intercostals
internal thoracic arteries (ics1-6) and Musculophrenic arteries (ics 7-9)
How many intercostal veins are there on each side of the thoracic wall
11 posterior intercostals
1 subcostal vein
Where do most posterior intercostal veins end in
Azygos/hemiazygos venous system (which goes to superior vena cava)
What does the medial pectoral nerve innervate
Pec minor and sternocostal portions of the pec major
What does the lateral pectoral nerve innervate
Pec major
What do the intercostal nerves supply
Thoracic wall, pleura and peritoneum
What is the root value for the intercostal nerves
T1-11
Origin of the internal thoracic artery
Subclavian artery
Origin of the internal thoracic vein
Arises from superior epigastric and terminates as brachiocephalic vein
What is the arterial supply of the breast
- Medial mammary branches of anterior intercostals from internal thoracic arteries
- Lateral thoracic from axillary arteries
- Thoraco-acromial from axillary arteries
- Posterior intercostals from thoracic aorta
Where does all lymph from breast go into
Sub-areolar plexus
Where does all the breast lymph from the sub-areolar plexus drain into
Axillary (75%) [drain into infra/supra clavicular nodes then into subclavian lymph trunk]
Parasternal (opposite breast)
Abdominal
Where do the parasternal lymph nodes drain into
Bronchomediastinal trunks
What are the different axillary lymph nodes
Pectoral Humeral Subscapular Central Apical
What is the pec major innervated by (and root values)
C6-8 Lateral and medial pectoral nerves
Innervation of the pectoralis minor and root value
Medial pectoral nerve (C8-T1)
Innervation of the serratus anterior and root value
C5-7
Where are anterior intercostal arteries from
Internal thoracic aorta
Where does the anterior intercostal vein drain into
Internal thoracic vein
