Thoracic Wall Flashcards
1
Q
what forms lateral walls of thoracic cage
A
12 pairs of ribs
2
Q
anteriorly the ribs articulate with what
A
midline sternum
3
Q
are the scapula and clavicle part of the thoracic cage
A
no
4
Q
posteriorly ribs articulate with what
A
12 thoracic vertebrae
5
Q
what are the boundaries of the superior thoracic aperture (inlet)
A
body of T1 posteriorly
1st pair of ribs and costal cartilages (laterally)
superior border of manubrium (anteriorly)
6
Q
what are the boundaries of the inferior thoracic aperture (outlet)
A
body of T12 posteriorly
ribs 11 and 12 and costal cartilages of ribs 7-10 (costal margin) laterally and anteriorly
xiphysternal joint anterior midline
7
Q
transverse process of vertebrae allows what
A
allows muscle attachment and articulation with ribs
8
Q
the head of the 7th rib will sit above/below T7
A
above - head of the 7th rib will sit between T6 and T7
9
Q
what are the parts of the vertebrae called that articulate with the heads of the ribs
A
superior and inferior demifacets
10
Q
what part of the rib articulates with the transverse process
A
tubercle
11
Q
the tubercle of rib 7 will articulate with the transverse process of
A
T7
12
Q
what are the true ribs
A
1-7
13
Q
what are the false ribs
A
8-10
14
Q
what are the floating ribs
A
11 and 12
15
Q
how do true ribs connect with sternum
A
directly via own cartilage
16
Q
how do false ribs connect with sternum
A
indirectly via cartilage of ribs above - costal cartilage fuses with costal cartilage of rib above
17
Q
how do floating ribs connect with the sternum
A
no connection - end on musculature of posterior abdominal wall
18
Q
what are the 2 classifications of ribs based on their bony features
A
typical - 3rd - 9th
atypical 1st 2nd and 10-12
19
Q
describe the head of a typical rib
A
wedge shaped with 2 articular facets separated by a crest
20
Q
the head of a typical rib articulates with what
A
articular facets articulate with own vertebra and vertebra above
crest articulates with IVD
21
Q
typical rib : the tubercle articulates with what
A
transverse process of own vertebrae
22
Q
typical rib : what are the non-articular parts of the tubercle for
A
costotransverse ligament
23
Q
typical rib : what attaches the head and body at the tubercle
A
neck
24
Q
what is the most curved part of a typical rib
A
costal angle
25
where is the costal groove of a typical rib
on the internal surface of inferior border of body
26
what does the costal groove protect
intercostal vessels and nerves
27
what is different about the head of the first rib
only has 1 facet on head
28
why does rib 1 only have one facet on its head
articulates with T1 only as C7 doesn't have costal facets
29
the 1st rib has grooves on superior surface for what
subclavian vessels
30
what separates the subclavian grooves on the first rib
scalene tubercle for attachment of anterior scalene muscle
31
what else makes rib 1 atypical
highly curved
32
rib 2 has a tuberosity for the attachment of what
serratus anterior
33
rib 2 has a rough area where
upper surface
34
describe the heads of ribs 10-12
single facet on head as they only articulate with single vertebra
35
describe ribs 11 and 12
short with no neck or tubercle
36
what are the 3 parts of the sternum
manubrium
body
xiphoid process
37
what are the 2 joints of the sternum
```
sternal angle (manubriosternal joint)
xiphisternal joint
```
38
how many notches does the sternum have on lateral border
7 for articulation of costal cartilages of ribs
39
where does the 1st rib articulate with the sternum
with manubrium adjacent to clavicular notch
40
where does the 2nd rib articulate with the sternum
with sternal angle
41
where does the 7th rib articulate with the sternum
at xiphisternal joint
42
the joints between adjacent vertebrae are intervertebral joints and they are
secondary cartilaginous joints
43
what kind of joints are between articular facets of vertebrae
synovial plane joints
44
the synovial plane joints between articular facets in vertebra are called
zygopophysial joints
45
can rotational movement occur between vertebrae of the thoracic region of vertebral column
yes - due to the orientation of articular facets
46
what are sternocostal joints
joints between sternum and costal cartilages of ribs
47
the sternocostal joint between rib 1 and manubrium is what kind of joint
primary cartilaginous joint (synchondrosis)
48
the sternocostal joints between ribs 2-7 and body of sternum are what kind of joints
synovial plane joints
49
what are interchondral joints
joints between adjacent costal cartilages
50
interchondral joints are what kind of joints
synovial plane
- between 6-7-8-9
fibrous
- between 9 and 10
51
costovertebral joints are what kind of joints
synovial plane joints
52
describe the axis of movement of the costovertebral joints
movement will occur at joints formed by the head and tubercle at the same time so rib will move around an axis that runs through both of these joints
- elevation and depression of rib
53
what are the participants in the costovertebral joint of head of rib
body of vertebra superior to rib
IVD
head of rib - 2 facets and crest
body of vertebra of same number as rib
54
what are the participants in the costotransverse joint
transverse process of vertebra of same number as rib
| tubercle of rib
55
upper ribs (1-6) have an axis which is angled more _____
laterally
56
lower ribs (7-12) have an axis that is angled more ____
posteriorly
57
upper ribs (1-6) have their greatest degree of movement at the _____ aspect
anterior
58
upper ribs (1-6) have a movement called
pump handle
59
lower ribs (7-12) have their greatest degree of motion at the _____ aspect
lateral
60
lower ribs (7-12) have a movement called
bucket handle
61
how is the rib cage expanded in the AP dimension
sternum and upper ribs move anteriorly and superiorly
62
how is the rib cage expanded laterally
lower ribs flare out laterally
63
how is the rib cage expanded vertically
diaphragm descends as it contracts and flattens
64
what is the primary muscle of inspiration at rest
diaphragm
65
what are the groups of muscles of the thoracic wall
respiratory - true muscles of thoracic wall
accessory respiratory
superficial - assoc. with upper limb or abdominal wall
66
what are the true muscles of the thoracic wall
intercostal muscles
| subcostal and transversus thoracis
67
what are the secondary muscles of respiration
```
scalene muscles of the neck
serratus posterior (superior and inferior) of back
```
68
what are the superficial muscles assoc. with the upper limb and anterior abdominal wall
pectoral muscles
serratus anterior
external oblique
rectus abdominis
69
nerve supply of pec major
medial (C8,T1) and lateral (C5-7) pectoral nerves
70
nerve supply of pec minor
medial pectoral nerve (C8,T1)
71
nerve supply of serratus anterior
long thoracic nerve (C5-7)
72
nerve supply of external oblique
anterior rami T7-T12
73
nerve supply of rectus abdominis
anterior rami T7 - T12
74
nerve supply of serratus posterior superior
2nd - 5th intercostal nerves
75
nerve supply of serratus posterior inferior
anterior rami T9-12
76
nerve supply of anterior scalene
anterior rami C3-7
77
nerve supply of middle scalene
anterior rami C4-7
78
nerve supply of posterior scalene
anterior rami C5-7
79
where do scalene muscles attach proximally
transverse process of cervical vertebrae
80
where do anterior and middle scalene attach distally
first rib
81
where does posterior scalene attach distally
second rib
82
what is the function of the scalene muscles
primarily involved in neck movement but when neck is fixed can act as accessory respiratory muscles by raising 1st and 2nd ribs
83
serratus posterior superior extends downwards from what to what
spinous process of C7-T3
| to upper borders of ribs 2-4
84
serratus posterior inferior extends upwards from what to what
spinous process of T11-L2 towards the lower borders of ribs 8-12
85
what is the main function of serratus posterior superior and inferior
proprioception but may assist in raising/lowering ribs respectively
86
what are the 3 layers of intercostal muscles
external
internal
innermost
87
fibres of external intercostal muscles run in what directoin
anteriorly and inferiorly from lower border of upper rib to upper border of lower rib
- inferomedial, hands in pockets
88
fibres of external intercostal muscles run from where to where
tubercles of ribs to costochondral junction
89
what are the external intercostals replaced with anteriorly
external intercostal membrane that extends between costal cartilages to lateral border of sternum
90
where are the external intercostals most obvious
posteriorly and laterally
91
what is the function of the external intercostal muscles
raise ribs in inspiration
92
what way do fibres of the internal intercostal muscles run
posteroinferiorly (down and back) - 90 degree angle to external intercostal
93
from where to where do fibres of internal intercostal muscles run
sternum to angle of ribs
94
what are internal intercostal muscles replaced with posteriorly
internal intercostal membrane
95
what is the function of the internal intercostal muscles
interosseous part - depresses ribs on expiration
| interchondral part - raises ribs on inspiration
96
the fibres of the innermost intercostal muscles run in the same direction as what
internal intercostal muscle fibres
97
is the innermost intercostal muscle layer continuous
no, very thin often incomplete
98
what are the deepest muscles of the thoracic wall
subcostal and transversus thoracis
99
the internal thoracic vessels that run on either side of the sternum lie _____ to the transversus thoracis muscle
superficial
100
where are the subcostal muscles found
near angle of ribs
101
fibres of subcostal span ____ ribs and may blend with fibres of ____
span 1-2 ribs
| may blend with innermost intercostal
102
where is the neurovascular plane of the intercostal space
between internal and innermost layers
103
describe the neurovascular bundle in the ICS from superior to inferior
VAN
vein
artery
nerve
104
the vein artery and nerve run where
costal groove
105
describe the nerve bundle of the ICS
intercostal nerve that will supply musculature of the ICS
| - also give lateral and anterior branches that pierce through the muscle layers into skin to supply sensory innervation
106
describe the arterial supply of the ICS
most via posterior intercostal arteries, most of which will come directly from aorta
PIA will also give a cutaneous branch to pass through muscle walls and out to supply skin
107
anterior part of each ICS is supplied by what
anterior ICA - will branch out to supply skin
108
anterior ICA usually branch directly from
internal thoracic artery
109
the internal thoracic artery is a branch of what
subclavian artery
110
PICA supplying spaces 3-11 and subcostal (inferior to rib 12) originate as posterolateral branches of
thoracic aorta
111
PICA supplying 1st and 2nd ICS arise from
supreme intercostal artery
112
the supreme intercostal artery is a branch of
costocervical trunk from subclavian artery
113
AICAs for 1-6 come directly from
internal thoracic artery
114
internal thoracic artery runs
either side of sternum the bifurcates to form superior epigastric artery and musculophrenic artery
115
AICAs supplying ICS 7-9 come from
musculophrenic artery
116
the anterior intercostal veins drain to the
internal thoracic vein
117
the internal thoracic vein runs with the
internal thoracic artery
118
on the right, the 1st PICV drains to the
right brachiocephalic vein
119
on the right the 2-11 PICVs + subcostal drain to the
azygous vein
120
on the left, the 1-4 PICVs drain to the
left brachiocephalic vein
121
on the left, the 5-8 PICVs drain to the
accessory hemiazygous vein
122
on the left the 9-11 PICVs + subcostal drain to
hemiazygous vein
123
nipple dermatome
T4
124
belly button dermatome
T10
125
glandular tissue in the breast is organised into
lobules
126
lobules of the mammary gland will open at the nipple via
lactiferous ducts
127
how is support for the glandular tissue provided
fibrous tissue which is organised into a number of thick fibrous glands - suspensory ligaments
128
what is the function of the suspensory ligaments
support the breasts and anchor breasts at dermis of skin
129
what is the arterial supply of the breast
lateral and medial mammary branches
130
lateral mammary branches come from
lateral thoracic artery from axillary artery
131
medial mammary branches come from
internal thoracic artery
132
venous drainage of the breast goes to
medial and lateral mammary veins
133
what is the name of lymphatic plexus in the breast
subareolar lymphatic plexus
134
>75% of lymph of breast goes where
axillary nodes
135
remainder of lymph from breast goes where
parasternal nodes and some may go to abdominal nodes
