Anterior chest wall and thoracics Flashcards Preview

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Flashcards in Anterior chest wall and thoracics Deck (9)
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What structures cause anterolateral chest pain?

Serratus anterior
Latissimus dorsi
Obliques (internal and external)


What structures refer pain to the neck?

phrenic nerve? parietal pleural and associated dermatomes (C3/4/5)


What can cause a decrease in bone density/osteoporosis?

Decreased calcium absorption
Decreased oestrogen = decreased osteogenesis, osteo clasts destroying more than what the osteoblasts are building

Factors affecting density
Diet – is she getting enough calcium, vitamin D
Did she play spport as a youngster – increases bone strength
OA and DJD


Contents of the neuromuscular bundle (aka intercostal space)

Contain the intercostal veins, arteries and nerves (superior to inferior) sheltered in the costal groove of the rib above. From posterior, the nerves run between the parietal pleura and the internal intercostal membrane. Near the angles of the ribs they pass between innermost and internal intercostals


What is the articulation of ribs (costotransverse/ costovertebral)

- Movement of Tx cage is complex but it is generally proposed that the axis of rib motion is a line running through the centre of the CV and CT joints.
- In respiration, the movement of the upper ribs resembles that of a pump handle. That is, the anterior aspects of the ribs tend to move superiorly and inferiorly, such that the chest primarily expands in an anteroposterior dimension.
- The movement of the lower ribs resembles that of a bucket handle. That is, the lateral aspects of the ribs move superiorly and inferiorly, such that the chest primarily expands in a lateral dimension.
- The motion of the floating ribs is influenced by their lack of CT joint and anterior attachment and the action of the QL muscle. This motion is termed calliper.
- Note that all the ribs have aspects of all three types of motion. However, in the different regions, one type of movement predominates.


What structures refer pain to the T6 dermatome?

Heart and lungs and upper abdo viscera
Junctional area and therefore has more VSR than other areas


NS and attachments of the diaphragm

- Fibres converge radially on the boomerang shaped central tendon, which forms the domes of the right and left hemidiaphragms. The central tendon is fused to the fibrous pericardium
- The sternal part attaches in two muscular slips to the posterior aspect of the xiphoid process
- The costal part consists of fibres arising from the inner surfaces of the lower six ribs and their costal cartilages. This part forms the two hemidiaphragms.
- The crural or lumbar part consists of two musculotendinous crura which are attached to the anterolateral surfaces of L1 and L2 on the left and L1 to L3 on the right and the associated IVDs.
- The crura are united anterior to the T-L disc as the median arcuate ligament which passes over the aorta.
- The medial arcuate ligaments are thickenings of the thoracolumbar fascia over the psoas major muscles. Each ligament runs from the diaphragmatic crus to the TP of L1.
- The lateral arcuate ligaments are thickenings of the thoracolumbar fascia over the QL muscles. These arches run from the TP of L1 to the 12th ribs
- The major apertures in the thoracic diaphragm are:
o Vena caval foramen located in the central tendon at the level of T8/9, 2-3 cm right of centre.
o Oesophageal hiatus located in the right crus at the level of T10, 2-3cm right of centre. During inspiration the hiatus constricts to prevent reflux.
o Aortic hiatus located posterior to the diaphragm and posterior to the median arcuate ligament at the level of T12. Unaffected by diaphragmatic contraction

Supplied by the phrenic nerves


What structures can cause neck pain?



Describe the hearts nerve supply and how it relates to cardiac referred pain