Thorax, Abdomen, Upper Limb Flashcards
1
Q
thoracic cage/skeleton of thoracic wall
A
- thoracic wall = ribs + sternum component
- functions:
- protect organs ⇢ heart, lungs, spleen, liver, kidneys
- role in breathing
- expanded by respiratory muscles – creates a vacuum ⇢ draws air into lung
- rhythmic movement
- compressed to expel air
- attachment points
- anchoring attachments for upper limb
2
Q
sternum
A
- sternum = chest
- most anterior
- directly overlies mediastinal viscera
- 3 parts (joined by symphyses usually):
- manubrium - superior
- body
- xiphoid process - inferior
- symphyses will turn into synostosis/bony joint in older individuals
3
Q
sternum – notches/sternal angle
A
- jugular (suprasternal) notch
- palpable superior border of manubrium
- clavicular notches
- articulate with clavicles
- sternoclavicular joints ⇢ synovial – allows movement of clavicles
- articulate with clavicles
- sternal angle
- between manubrium & body
- 2nd rib attaches
4
Q
ribs – true/false/floating
A
- 12 pairs of ribs
-
true ribs: attach directly to sternum via (their own) costal cartilage
- costal cartilage ⇢ hyaline cartilage strip - remnant of ossification process – ribs turned into bone but cartilage strip stayed (helps w elasticity)
- 1st - 7th ribs
-
false ribs: indirect connection to sternum – not their own costal cartilage
- cartilage connects to the superior cartilage
- 8th - 10th (sometimes)
-
floating ribs: rudimentary cartilages do not connect to sternum
- 10 (sometimes), 11th, & 12th
5
Q
ribs – intercostal spaces/costal margin
A
-
intercostal spaces: separates ribs and costal cartilages
- named according to rib forming superior border
- ex: 4th intercostal space is between ribs 4 & 5
- filled in during life with muscles
- named according to rib forming superior border
-
costal margin (arch)
- cartilaginous
- formed by shared cartilages of false ribs
6
Q
ribs – head/tubercle
A
-
head of rib
- articulate with vertebral bodies
-
tubercle of rib
- articulate with thoracic transverse processes
7
Q
1st rib
A
- broadest, shortest, most sharply curved
- attachment for anterior scalene muscle ⇢ deep muscle in neck
- forms prominent bump/tubercle on this rib
- much of this rib lies above the level of the clavicle
- most superior rib
- root of neck region
- deep – not palpable
8
Q
axio-appendicular muscles
A
- extend from thoracic cage to bones of upper limb or pectoral girdle
9
Q
intercostal muscles
A
- keep thoracic cage stiff during respiration ⇢ keep it from collapsing
-
external intercostal muscles:
- 11 pairs
- action: most active during inspiration
-
internal intercostal muscles:
- 11 pairs
- action: most active during expiration – specifically forceful
- innermost intercostal muscles
10
Q
diaphragm
A
- sepates thoracic and abdominal cavities
- action: chief muscles of inspiration
- contracts ⇢ flattens diaphragm – allows thoracic cage size to increase and expand
- innervation: phrenic n.
- “C3, 4, & 5, keep the diaphragm alive” ⇢ damage to these spinal nerves could have implications in terms of phrenic nerve
11
Q
diaphragm openings
A
- 3 openings:
-
caval opening:
- inferior vena cava (IVC) ⇢ deoxygenated blood from lower limb/abdominal region traverse through to get to right atrium of heart
-
esophageal hiatus:
- esophagus ⇢ traverse to get into abdominal cavity & get to stomach
- vagus nerves (CN X) ⇢ parasympathetics with GI tracts
-
aortic hiatus:
- descending aorta ⇢ descend to supply blood to portions inferior to diaphragm
- thoracic duct – lymphatics
-
caval opening:
12
Q
muscles of abdomen
A
no bones anteriorly
13
Q
muscles of anterolateral abdominal wall
A
- external oblique muscle: superficial
- internal oblique muscle: intermediate
- transverse abdominis muscle: deep
- action:
- supports & compresses abdominal viscera
- protection – keep everything in place
- supports & compresses abdominal viscera
14
Q
rectus sheath
A
- aponeurosis (wide tendon) of anterolateral abdominal muscles
- encloses rectus abdominis muscle
- linea alba
- fibers
- = white line
- midline raphe – seam
15
Q
rectus (“straight”) abdominis muscle
A
actions:
- flexes waist – like in doing sit ups
- compresses abdominal viscera ⇢ protecting deeper structures
- tendinous intersections
- 3-4 pairs
- if hypertrophied – six-pack appearance
- long ⇢ from costal margin region/xiphoid process down to pubic symphysis
17
Q
clavicle
A
- “collarbone”
- pectoral girdle = what’s linking axial skeleton to the arm
- directly connected to thorax
sternal (medial) end: articulates with manubrium
- sternoclavicular joint
acromial (lateral) end: articulates with acromion
- acromioclavicular joint
18
Q
clinical connection: fracture of clavicle
A
- one of the most frequently fractured
- common in children (greenstick fracture)
- often caused by indirect force transmitted from a fall with an outstretched hand ⇢ force moves up
- weakest part:
- junction of middle and lateral 3rds
- fracture ⇢ try to immobilize
- make sure any fractured ends don’t project too far posteriorly
- important neurovasculature (subclavian vein/artery, nerves of brachial plexus)
- make sure any fractured ends don’t project too far posteriorly
19
Q
scapula – coracoid process
A
- scapula = shoulder blade
- sitting on back of ribs (~ ribs 2-7)
- not full articulation with ribs – attachments with muscles ⇢ not true joints
-
coracoid process = like a crow’s beak
- superior to glenoid cavity & projects anterolaterally
- attachment site for pectoralis minor & short head of biceps brachii muscles
- ligaments of AC joints
20
Q
scapula – spine/acromion
A
-
spine of scapula
- posterior surface
- palpable
-
acromion (process)
- lateral continuation of spine
- ‘point of shoulder’
- articulates with lateral end of clavicle – acromioclavicular joint
21
Q
scapula – glenoid fossa
A
-
glenoid fossa
- socket – ball & socket shoulder joint
- glenohumeral joint
- relatively shallow ⇢ bulbous head of humerus doesn’t fit well
- fit of bones ⇢ so much mobility associated with shoulder joint ⇢ also why decreased stability
- socket – ball & socket shoulder joint
22
Q
humerus: proximal
A
- head
- smooth – covered by articular cartilage
- ‘ball’ – ball and socket joint (shoulder)
- glenohumeral joint
- more mobility, less stability
- anatomical neck
- just distal to humeral head
- surgical neck
- constriction just distal to tubercles
- common site of fracture – weaker area of bone
- axillary n. endangered
- innervate deltoid muscle ⇢ abduction of shoulder joint
- axillary n. endangered
23
Q
humerus: proximal p2
A
- greater tubercle
- lateral margin of proximal humerus
- 3 of 4 rotator cuff muscles attach
- lesser tubercle
- anterior projection
- 1 of 4 rotator cuff muscles attach
- intertubercular sulcus
- between the tubercles
- long head of biceps tendon
- latissimus dorsi (floor)
- movement of shoulder joint
24
Q
humerus: distal
A
- medial epicondyle
- epicondyle = articulations w certain joints
- same side as head
- more prominent
- flexors located on forearm attach here – proximal attachment (flexion)
- ulnar nerve
- lateral epicondyle
- extensors located on forearm attach here (extension)
25
Q
humerus: distal (capitulum/trochlea)
A
- capitulum
- = little head
- articulation of head of radius
- trochlea
- = pulley
- articulation with trochlear notch of ulna
- forming humero-ulnar joint (elbow)
26
Q
humerus: distal – olecranon fossa
A
- posterior
- accommodates olecranon during full extension of elbow joint
- fits into fossa during extension
- will move away from it during flexion
27
Q
ulna
A
- longer, medial, stabilizing of the 2 forearm bones
- radius will rotate around ulna during pronation/supination
-
olecranon process
- posterior
- ‘point of elbow’
- triceps brachii muscle – distal attachment
-
coronoid process
- anterior projection
- brachialis muscle – flexion of elbow
-
trochlear notch
- moving around trochlea
-
radial notch
- divot
- head of radius – articulation of ulna + radius
28
Q
radius
A
- lateral & shorter
- larger more distally ⇢ articulate with proximal row of carpal bones to form wrist joint
-
head
- articulate with:
- capitulum of humerus (top of head)
- radial notch of ulna (side of head)
- articulate with:
-
radial tuberosity
- medial projection distal to head
- biceps brachii muscle – distally attach
29
Q
clinical connections: colles fracture
A
- complete transverse fracture of distal 2 cm of radius
- results from forced extension of hand
- FOOSH (Falling On an Out-Stretched Hand)
- typically, >50 years (osteoporosis) ⇢ higher incidence
30
Q
wrist (carpus)
A
- two rows, each has 4 bones
-
proximal (L to M)
- scaphoid, lunate, triquetrum, pisiform
- pisiform doesn’t articulate with radius, rest do
- pisiform: sesamoid bone – form within tendon (flexor carpi ulnaris tendon) ⇢ develop after birth with movement over time
- scaphoid, lunate, triquetrum, pisiform
-
distal (L to M)
- trapezium, trapezoid, capitate, hamate
- articulates with metacarpals
-
proximal (L to M)
31
Q
clinical connections: scaphoid fracture
A
- most frequently fractured carpal bone
- often results from a fall on the palm
- hand abducted
- often misdiagnosed early ⇢ doesn’t show up on radiograph right after injury – with time (bc of poor blood supply) it’ll become more prominent
32
Q
carpal tunnel
A
- anterior concave space formed by carpal bones
- roof: transverse carpal ligament (flexor retinaculum)
- what passes through the tunnel?
- tendons (long) & tendon sheaths of flexor muscles
- median nerve ⇢ one of the terminal branches of brachial plexus
33
Q
carpal tunnel syndrome
A
- reduction of size of carpal tunnel or increasing of size of structure within the tunnel
- often swelling of tendon or tendon sheaths
- median nerve compression can cause:
- paresthesia (tingling)
- hypoesthesia/anesthesia
- progressive loss of coordination and strength of thumb
- median n. – provides motor innervations ⇢ movement of thumb
34
Q
metacarpals (5)
A
- numbered 1-5 (lateral/thumb to medial)
-
carpometacarpal joints
- articulation with distal row of carpal bones
-
metacarpophalangeal joints
- articulation with proximal phalanges
35
Q
phalanges
A
- proximal (5)
- middle (4)
- distal (5)
- pollex = thumb
- proximal interphalangeal joint (PIP)
- distal interphalangeal joint (DIP)
