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Y2S1 CARDIO. > Thoracic Wall > Flashcards

Thoracic Wall Flashcards

1
Q

What are the roles of the Thorax

A
  • rigidity and elasticity
  • respiration
  • movement , provides attachment for muscles
  • haematopoiesis
  • connections with the neck upper limbs and abdomen
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2
Q

what makes up the thoracic cage

A 
sternum
12 pairs of ribs 
their costal cartilages
12 thoracic vertebrae 
intervertebrae
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3
Q

what makes up the thoracic wall

A 
thoracic cage 
skin
subcutaneous tissue
thoracic muscles + fascia 
3 layers of muscles extending between ribs 
mammary glands/breast tissue
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4
Q

features of thoracic vertebrae

A

inferior and superior articular processes are vertical

articular facets face slightly medially to allow some rotation but no flexion

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5
Q

what are true ribs

A

1-7 and attach directly to the sternum through costal cartilage

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6
Q

false ribs

A

8-10 attach sternum indirectly through costal cartilage of 7th rib

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7
Q

floating ribs

A

11-12 and do not articulate with the sternum

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8
Q

structure of typical ribs 2-10

A 
neck
head
tubercle
body
costal angle
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9
Q

structure of atypical ribs - rib 1

A
  • scalene tubercle attachment for anterior scalene muscle
    groove for subclavian vein
  • groove for subclavian artery and inferior trunk (c8 and t1) fo brachial plexus
    No costal groove
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10
Q

atypical rib - floating ribs structure

A
  • no attachment to sternum
  • heads articulate only with corresponding vertebra
    do not articulate with the transverse processes
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11
Q

three parts of the sternum

A

manubrium
body
xiphoid process

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12
Q

why is the sternal angle an important land mark

A

the second cc is at this le vet so can be used to count the ribs

this is at the level of the intervertebral disc between the T4 AND T5 vertebrae

the proximal and distal boundaries of the aortic arch are at this level

the bifurcation of the trachea

superior limit of the pulmonary trunk

azygous vein opening SVC

Ligamentium arteriosum

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13
Q

site of bone marrow aspiration

A

sternum

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14
Q

COSTOVERTEBRAL JOINT

A

each rib (exculding 1, 11, 12) articulates with the superior costal facet on its corresponding vertebrae and the inferior costal facet of the vertebrae above

this is a SYNOVIAL joint and is supported by a capsule with ligaments

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15
Q

facets of T1

A

1 and a half costal facets on its body

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16
Q

facets of T2 - T9

A

2 half costal facets

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17
Q

facets of T10

A

1 half costal facet

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18
Q

facets of T11 + T12

A

1 Oval costal facet each

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19
Q

costotransverse joint

A

the joint between the tubercle of the rib (except 11 and 12) and the transverse process of its corresponding vertebrae

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20
Q

costotransverse joints 1-7 structure

A

curved facets allowing rotary movement

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21
Q

costotransverse joints 8,9,10

A

flat facets allowing a gliding movement

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22
Q

COSTOCHONDRAL / COSTOSTERNAL JOINTS

A

All ribs articulate anteriorly with a costal cartilage (CC) via a primary cartilaginous joint

CC ribs 1-7 articulate directly with the sternum via synovial joints to allow movement (not rib 1)\

CC ribs 8-10 articulate with costal cartilage above and indirectly with the sternum

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23
Q

what is thoracic inlet bound by

A

T1 vertebrae, 1st rib and CC + manubrium

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24
Q

structure of thoracic inlet

A

slopes anteriorly inferiorly, the apex of the lung extends 2-3 cm above the anterior part of the 1st rib and clavicle

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25
Q

Structures that pass between the thorax and the neck

A
  • Vessels that supply and drain the head and neck
  • Trachea
  • Oesophagus
  • Vagus + recurrent laryngeal nerves
  • Phrenic nerves
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26
Q

Structures that pass between the thorax and the upper limb lie on the first rib

A
  • Subclavian vein
  • Subclavian artery
  • (Inferior trunk of the brachial plexus)
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27
Q

what is the thoracic outlet bound by

A

T12 vertebra, 11th and 12th ribs, CC of ribs 7-10 and xiphoid process
closed incompletely by the diaphragm

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28
Q

THORACIC OUTLET SYNDROME

A

Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic intlet) are compressed

29
Q

what composes the breast

A

mammary glands, skin and connective tissues

15-25 lobes and ducts surrounded by fat and well developed connective tissue

30
Q

what are Montgomery tubercles

A

they are visible portions of areolar glands on the skin surface within the areola

31
Q

what are Montgomery glands

A

sebaceous glands in the breast

32
Q

where is the base of the breast located

A

In adult females, base of it is located between the levels of 2nd – 6th (7th) ribs

33
Q

where is the breast found anatomically

A

between the superficial and deep layers of superficial fascia

they sit on pec. major, serratus anterior and external oblique miscues

34
Q

where is the deer pectorlis fascia

A

between the superficial fascia and the muscle

35
Q

coopers ligaments

A

connective tissue condenses to form ligaments which support the breast and connect the deep fascia to the dermis of the skin

36
Q

The retromammary space

A

a layer of loose connective tissue between the deep layer of superficial fascia and the deep fascia, provides a good degree of movement over underlying structures

37
Q

what are the two main arteries that supply the breast and their branches

A

internal thoracic artery - mammary branches and
anterior intercostal arteries

axillary artery - lateral thoracic artery and the thoracic-acromial artery

38
Q

where do the veins in the breast drain

A

they follow the arteries and drain mainly to the axillary and internal thoracic veins

39
Q

where do the areola and lateral quadrants drain to

A

axillary lymph nodes

40
Q

where does the medial quadrant drain to

A

parasternal lymph nodes and often the opposite breast

41
Q

where do the inferior breast quadrants drain to

A

the inferior phrenic lymph nodes

42
Q

how many intercostal spaces are there

A

11 pairs each filled with three layers of muscles and membranes

43
Q

external intercostal muscles - structure and what is their role

A

extend from the inferior edge of the rib above to the superior edge of the rib below

however anteriorly they are replaced by the intercostal membrane

they raise the ribs during inspiration, as there origin (superior attachment) is more proximal to the vertebral column

44
Q

internal intercostal muscles

A

extends from the lateral edge of the costal groove of the rib above, to the superior edge of the rib below

posteriorly the muscle fibres are replaced by internal intercostal membrane

prevent undraping during inspiration and aids in the elastic recoil by moving the ribs inferiorly in expiration

45
Q

innermost intercostal muscles

A

act with intercostal muscles and their deep surface is covered with endothoracic fascia

46
Q

transverse thoracis

A

lies posterior to the sternum

runs from the internal aspect of the ribs and costal cartilages 3-6, to the sternum, xiphisternum and costal margin

47
Q

subcostalis

A

lies on the posterior wall

runs from the lower internal surface near the angle down to the inner surface of 2 to 3 ribs below

48
Q

intervertebral foramen

A

run between the pedicle, articular processes, vertebral body and IV disc

49
Q

what puts the spinal intercostal nerve at risk

A

compression by arthritis, fracture or disc prolapse

50
Q

intercostal nerves

A

Intercostal nerves, together with the intercostal vein and artery (the order is VAN) lie in the costal groove at the inferior edge of the rib, between the internal and innermost intercostal muscles

51
Q

intercostal nerves journey

A
  • gives of lateral cutaneous branch
  • travels in the costal groove
  • becomes superficial parasternally, named after anterior cutaneous branch
52
Q

nerve supply to the thoracic wall

A
  • Supraclavicular nerves (C3-4) descend over the clavicle as far as the 2nd costal cartilage
53
Q

T1 nerve

A

has no cutaneous distribution over the anterior thoracic wall
- Joins the brachial plexus, supplying the medial arm and forearm

54
Q

T2 nerve

A

gives a large lateral cutaneous branch (THE INTERCOSTOBRANCHIAL NERVE) that supplies the thorax wall in axilla and upper, medial part of upper limb (at risk in breast surgery)

55
Q

T7-12

A

Supply the skin and muscles of the abdominal wall as well

56
Q

Ventral rami of T2 – T11

A

provide motor fibres to intercostal muscles, abdominal
muscles
– sensory supply to the skin and parietal pleura

57
Q

The ventral ramus of T1 joins the Brachial Plexus (inferior

trunk) to supply

A

– the small muscles of the hand

– the skin of the medial aspect of the arm and forearm – muscles of the 1st intercostal space

58
Q

arterial supply of the thoracic wall

A 
Subclavian artery
✓ vertebral artery
✓ thyrocervical trunk
✓ costocervical trunk
✓ Internal thoracic artery
Thoracic aorta 
✓ Anterior intercostal arteries
59
Q

✓ Internal thoracic artery

A

– Lies along the margins of the sternum

– Terminates as the superior epigastric and musculophrenic arteries

60
Q

Thoracic aorta (between T4/5 - T12)

A

✓ Parietal branches:
– 3rd - 11th posterior intercostal arteries
– Subcostal artery (inferior to 12th rib, supply posterior abdominal wall)
– Superior phrenic artery (diaphragm)

61
Q

✓ Anterior intercostal arteries

A

– 2 per space in spaces 1-6
– 7th -10th Anterior intercostal arteries are branches of the musculophrenic artery
– 11th intercostal space and subcostal area have no anterior supply

62
Q

Other supplies to arterial

A

✓ 1st-2nd posterior intercostal arteries (from supreme intercostal branch of costocervical trunk)
✓ 3rd-11th posterior intercostal arteries (from Thoracic aorta)
– 2 per space
✓ Anterior and posterior intercostals anastomose.
– This anastomosis may form a collateral circulation in Coarctation of the Aorta

63
Q

venous drainage of the thoracic wall

A

✓ Anterior intercostal veins drain to the internal thoracic vein →brachiocephalic vein
✓ Posterior intercostal veins drain either to the brachiocephalic vein or to the superior vena cava via azygos system

64
Q

AZYGOS SYSTEM

A

✓ Drains the posterior wall of the thorax and part of the posterior abdominal wall
✓ Begins from lumbar and subcostal veins and/or direct branch of the inferior vena cava
✓ Passes behind the diaphragm, with the aorta and thoracic duct
✓ Ascends in the posterior mediastinum, passes posterior to the right lung hilum, arches and opens into the superior vena cava
− Connects superior and inferior vena cava

65
Q

HEMIAZYGOS

A

✓ =Inferior hemiazygos vein
✓ Has connections with the left renal vein
✓ Passes through or behind the left crus of the diaphragm
✓ Crosses to the right at approximately T9 and joins the azygos

66
Q

ACCESSORY HEMIAZYGOS

A 
✓ =Superior hemiazygos
✓ Descends from 4th intercostal space, crosses to the right at approximately T8
✓ Can open into
• Azygos
• Hemiazygos 
• Both
67
Q

anterior lymph drainage of the thoracic wall

A

→parasternal nodes
– alongside internal thoracic (mammary) artery
→bronchomediastinal trunks

68
Q

posterior lymph drainage of the thoracic wall

A

→intercostal nodes

→thoracic duct (inferiorly) or bronchomediastinal trunks (superiorly)

69
Q

rib fractures

A

✓ most frequently occur between ribs 3 and 10.

✓ Little can be done to assist the healing of broken ribs other than binding them tightly to limit movement.

✓ Can cause hemothorax, pneumothorax with or without pulmonary injury, splenic injury

Y2S1 CARDIO. (47 decks)

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