Thorax Flashcards
What does the rib (thoracic) cage consist of?
thoracic vertebrae, ribs, costal cartilage, sternum, and the intercostal space
Ribs are classified as what type of bones?
flat bones
What are the three types of ribs?
What are their rib numbers?
True Ribs
- Ribs 1-7
- attach directly to sternum via costal cartilage
False Indirectly Attached Ribs
- Ribs 8-10
- Attach indirectly via costal cartilage to cartilage of the rib above (Rib 7)
False Floating Ribs
- 11-12
- Do not connect to sternum, instead, connect to posterior abdominal wall
Our true ribs (except 7) are also known as our _____ _________ and act to ______ the rib cage.
- pump handle
- lift
Ribs 7-12 are considered our ______ ________.
bucket handle
Function of the pump handle?
Function of the bucket handle?
- Lifts sternum, extend anterior to posterior to increase thoracic cavity
- Expand laterally
-End game is inhalation (3L)
Difference between head ribs 2-9 and ribs 1,10,11, and 12?
- Ribs 2-9 have superior and inferior articular facets to allow for 2 articulations with vertebral body above and below
- Ribs 1, and 10-12 only have 1 facet
What is the crest of the rib?
The projection between the articular facets
The rib consists of:
- Head
- Neck
- Tubercle
- articular facet for transverse process of vertebrae below
- body
- angle: curved medially
- costal groove: intercostal blood vessels, nerve and muscles
- cup: for the costal cartilage to form costochondral joint except for false ribs 11 and 12
THORACIC VERTEBRAE REVIEW
THORACIC VERTEBRAE REVIEW
Body of the thoracic vertebrae
T_-T_ have __________ _________ on the superor and inferior surfaces (4 total) to articulate with 2 pairs of ribs (one above and one below) which bridge the articular disk.
T1, and T10-T12 have paired ____ ________ to articulate with a single pair of ribs (no interaction with disk)
- T2-T9
- bilateral demifacet
-whole facets
What makes up the vertebral arch?
- Paired pedicles
- Paired laminae
What are the seven processes of the thoracic vertebrae?
- ) Unpaired spinous process- slope inferior to cover gap between adjacent vertebrae
- ) Paired superior articular processes- face posterior in coronal plane with a slight medial tilt so the pair form an arch of rotation
- ) Paired inferior articular processes- face anterior in coronal plane with a slight medial tilt so the pair form an arch of rotation
- —-The plane of the articular processes allows thoracic vertebrae to rotate and ab/adduct, but not flex/extend - ) Paired transverse processes- articular
What are the three parts of the sternum?
Manubrium
Body
Xiphoid
What are the three parts of the manubrium?
-Jugular notch
-Clavicular notch- sternoclavicular joints (synovial saddle with disk between
Point of articulation with rib 1- amphi or syn
The body has costal notches of ribs -.
2-7
The xiphoid has costal notch of rib _
What is different about the xiphoid?
7
It is the last bone to ossify
What are the 2 joints of the rib called?
- Costovertebral
- Sternocostal
The costovertebral joint has how many articulations?
3 articulations of ribs 2-9
- 2 articulations are the superior and inferior demifacets of the vertebrae to form a condyloid joint with a vertebral disk between them
- last is the costotransverse joint (1 per rib)
The joints of the head attach ________ to _______.
ribs to vertebral bodies
Although the joint types appear to be condyloid they are actually ________.
Planar (gliding)
What are the ligaments of the head of the ribs?
- Intra-articular ligaments- from crest of head to intervertebral disc (limits rotation)
- Radiate ligament- anterior capsule thickening
Head only moves slightly in rotation, but slight movement of head can mean appreciable movement at _________
sternal end of rib
The costotransverse joint has how many articulations per rib?
Where does this articulation occur?
1
-Occurs at the transverse process of vertebrae with the rib above
What is the joint type of the costotransverse joint?
- Planar
a. )ribs 1-6 slightly convex (rib) with slightly concave (transverse process)- this allows rotation= pump handle
b. )ribs 7-10 are flat planar - allow gliding=bucket handle
- this allows rotation= pump handle
Ribs 1-6 have a _____ on ______. When action occurs elevation increases _________ volume ________ to ________.
- Convex on Concave
- Thoracic volume anterior to posterior
Ribs 7-10 act on ________ ____ ____ increasing volume _________.
- Lateral body wall
- laterally
What are the ligaments of the costotransverse joints?
Lateral costotransverse ligament:
- goes from vert. transverse process to adjacent rib
- prevents lateral seperation
Superior costotransverse ligament:
- goes from vert. transverse process to rib below
- prevents inferior seperation
What are the movements of the costotransverse joints called?
Pump handle and bucket handle
- T1-6 rotate at costotransverse joint to elevate/depress sternum.
- T7-10 glide at costotransverse to elevate/depress the lateral rib cage
Sternocostal joint articulations
- Rib 1 directly attaches to the sternum in a _______.
- Ribs 2-10 are attached to sternum by ______________ either directly (Ribs -) or indirectly (Ribs -)
-synchondrosis
- costal cartilage
- Ribs 2-7
- Ribs 8-10
What ligament is known as the bone fuzz?
Radiate costosternal ligament
What are the borders of the superior rib (thoracic) aperture?
What are the border of the inferior rib (thoracic) aperture?
Superior
- posterior- T1 body
- lateral- rib 1
- anterior- manubrium
Inferior
- posterior- T12 body
- lateral posterior- 11 and 12 ribs
- lateral anterior- costal cartilage ribs 7-10
- anterior- xiphosternal joint
What is the inferior aperture covered by?
Respiratory diaphragm
What are the contents of the superior rib (thoracic) aperture?
What are the contents of the inferior rib (thoracic) aperture?
Superior
- Esophagus
- Trachea
- Nerves: Vagus, sympathetic trunks, cervical plexus
- Blood vessels: carotid, subclavian, vertebral, jugular
Inferior
- Esophagus
- Nerves: Vagus, sympathetic chain
- blood vessels: IVC, descending aorta
- internal thoracic arteries which are renamed to superior epigastric once they pass the diaphragm
The thoracic cavity is thin walled and articulated for _______ and ______
flexibility- not much ROM at each individual articulation but enough to give when impacted
-breathing- ribs tilt up and down
The thoracic cavity is divided into what 3 subdivisions?
- R pleural cavity
- L pleural cavity
- mediastinum
- pericardial cavity
- esophagus
- trachea
- great vessels
- nerves
What are all the muscles of the thoracic cavity?
-Serratus posterior superior
-Serratus posterior inferior
-Levator costarum
-External intercostals
-Internal intercostals
-Innermost intercostals
-Subcostal
Transversus thoracis
Serratus Posterior Superior Origin? Insertion? Innervation? Action?
Origin- spinous process C7-T3
Insertion- Ribs 2-5
Innervation- intercostal n. / ventral rami
Action- proprioception for respiration control
Serratus Posterior Inferior Origin? Insertion? Innervation? Action?
Origin- T11-L2
Insertion- Ribs 9-12
Innervation- intercostal n. / ventral rami
Action- proprioception for respiratory control
Levator costarum Origin? Insertion? Innervation? Action?
Origin- C7-T11 transverse process
Insertion- rib below
Innervation- dorsal rami
Action- elevate rib for inspiration
External Intercostals Origin? Insertion? Innervation? Action?
Origin- superior rib
Insertion- inferior rib
Innervation- intercostal n. / ventral rami
Action- elevate ribs for inspiration
Internal Intercostals Origin? Insertion? Innervation? Action?
Origin- inferior rib
Insertion- superior rib
Innervation- intercostal n. / ventral rami
Action- depress ribs for expiration
Innermost Intercostals Origin? Insertion? Innervation? Action?
Origin- inferior rib
Insertion- superior rib
Innervation- intercostal n.
Action- depress ribs for expiration
What muscles stick out at the sternum?
Internal intercostals
Subcostal Origin? Insertion? Innervation? Action?
Origin- inferior rib
Insertion- superior rib 2 or 3 above
Innervation- intercostal n.
Action- depress rib for expiration
Transversus Thoracis Origin? Insertion? Innervation? Action?
Origin- sternum
Insertion- costal cartilage
Innervation- intercostal n.
Action- proprioception for respiratory control
External intercostals are hand in _____ pockets
Internal intercostals are hands in ____ pockets
front
back
Nerves involved with the muscles of the thoracic cavity.
a. ) ventral rami T1-11 = intercostal nerves = sup and inf collateral branches = lateral and anterior cutaneous
b. ) ventral rami T12 = subcostal nerve
c. ) dermatomes = peripheral nerve sensory area correlate with spinal cord level
d. ) T1 superior collateral contributes to brachial plexus
e. ) sympathetic chain ganglia
- connected to the ventral rami by rami communicantes
- located on either side of vertebral bodies forming thoracic vertebral column
What is important about the dermatomes?
There is a frameshift from anterior to posterior.
- Umbilicus = T10 anteriorly, L3 posteriorly
- Nipple = T5 anteriorly, T8 posteriorly
Blood and lymph vessels of the thoracic wall?
a. ) anterior and anterior/lateral wall: right and left subclavian arteries → internal thoracic artery → anterior intercostal arteries (ant and lat intercostal spaces of ribs 1-10)
b. ) posterior and posterior/lateral wall: descending thoracic aorta → paired posterior intercostal arteries (post and post/lat intercostal spaces of ribs 4-11)
c. ) veins follow arteries and are named for the arteries they follow
- anterior intercostal veins → internal thoracic veins→ brachiocephalic veins
- posterior intercostal veins → hemi/azygous system → SVC
d. ) lymph vessels
- lymph flow
- right lymphatic duct- drains right side of head, arms, and thorax
- thoracic duct- drains left side of head, arms and thorax. Also drains entire abdomen, pelvis, legs
What is the intercostal space borders?
Superior and Inferior rib
What are the contents of the intercostal space?
Muscles: -external intercostals -internal intercostals -innermost intercostals -subcostals (cross 2 intervertebral spaces) Blood Vessels: -intercostal artery -intercostal vein Nerves: -intercostal nerves / ventral rami (mixed motor/sensory)
Arranged superior to inferior:
Vein→Artery→Nerve
The mammary glands are _______ in females and __________ males
Developed
Underdeveloped
Mammary glands structure:
- ) glandular tissue- 15-20 lobules of modified sweat glands
- ) lactiferous ducts/sinus- connect glandular tissue to skin surface at nipple
- ) nipple- concentration of lactiferous duct openings w/ smooth muscle
- ) areola- pigmented skin around nipple contains sebaceous (oil) glands
- ) fat- determine size of breast
- ) retro-mammary space- allows movement
- ) pectoralis fascia- base of support
- ) suspensory (Cooper’s) ligaments- connect breast structures to pectoralis fascia
Mammary glands blood flow:
Arteries
a.) anterior intercostal → medial mammary branches
b.) axillary a. → lateral thoracic and thoracoacromial → lateral breast
c.) posterior intercostals → deep structures
Veins
-axillary, axygous, and internal thoracic veins
Mammary glands lymph:
a. ) lymph drains from periphery to the center of the breast
b. ) from the center of the breast lymph drains to:
- axillary nodes
- parasternal nodes
- abdominal nodes
c. ) from the nodes lymph is returned to venous system
- right side = right lymphatic duct into brachiocephalic vein
- left side = thoracic duct into left subclavian vein
What is lymph obstruction related to?
Edema
