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Anatomy Exam 3 > L26: Thoracic Wall > Flashcards

L26: Thoracic Wall Flashcards

(56 cards)

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1
Q

Function of thoracic wall

A
  • Protection, structure

- Attachment for musculature to allow for breathing

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2
Q

Anatomical landmarks of the thorax

A
  • Suprasternal/jugular notch
  • Sternal angle (of Louis)
  • Xiphoid process
  • Root of spine of scapula
  • Inferior angle of scapula
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3
Q

At what vertebral level is jugular notch?

A
  • T2-3 disc
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4
Q

At what vertebral level is sternal angle?

A
  • T4-5 disc
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5
Q

What is located laterally to the sternal angle?

A
  • Costal cartilage of 2nd rib
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6
Q

At what vertebral level is xiphoid process?

A
  • T9-10 disc
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7
Q

At what vertebral level is root of spine of scapula? Spinous process

A
  • T4

- T3s spinous process

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8
Q

At what vertebral level is inferior angle of scapula? Overlies what rib?

A
  • T8, T7s spinous process

- Overlies rib 7, points to 8

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9
Q

Lines of orientation for thorax

A
  • Midclavicular line
  • Axillary line
  • Scapular line: vertical line dropped through inferior angle of scapula
  • Midsternal line
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10
Q

Where is anterior axillary line? Mid-axillary line? Posterior axillary line?

A
  1. ) Anterior: vertical line dropped at lateral border of pectoralis major
  2. ) Mid: vertical line through middle of axillary fossa
  3. ) Posterior: vertical line dropped at lateral border of latissimus dorsi
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11
Q

Posterior median line

A
  • Line over spinous processes
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12
Q

Walls of the thoracic cavity: note structures that make up each wall

A
  1. ) Thoracic inlet (superior thoracic aperture): body of T1, 1st pair of ribs and cartilages, superior end of manubrium
  2. ) Thoracic outlet (inferior thoracic aperture): xiphisternal joint (xiphoid/body sternum joint), 12th ribs and costochondral junction – closed by diaphragm
  3. ) Sternal region (median anterior wall): sternum, clavicular and chondral attachments to sternum
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13
Q

Structures that pass through the superior thoracic aperture

A
  • trachea, esophagus, lung apices, common carotids, internal jugular, subclavian veins, brachiocelphalic, phrenic nerves, vagus nerves, thoracic duct, SCM, anterior and middle scalenes, sternohyoid muscle, sternothyroid muscle
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14
Q

Thoracic outlet syndrome refers to what anatomical structure/feature

A
  • thoracic inlet (superior thoracic aperture)
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15
Q

Joints of thoracic vertebrae. What type joints are these?

A
  1. ) Costovertebral joint: costal facet(s) on vertebral body and head of rib. Rib articulates with vertebra from its level and one above. 4th with T4 and 3
  2. ) Costotransverse joint: transverse costal facet (on transverse process of vertebra) and tubercle of rib. Rib articulates with vertebra on its same level.
    * Synovial plane type/sliding gliding with hyaline, synovial fluid and ligaments
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16
Q

How many ribs in body? Distinguish between the types

A
  • 12 pairs of ribs
    a. ) True ribs = directly attach to sternum via their cartilage - 1st through 7th
    b. ) False = attach indirectly to sternum via their cartilage- 8th through 12th, with 11th and 12th being specifically called floating (not attachment to sternum)
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17
Q

Anatomical landmarks of ribs

A
  • Head
  • Tubercle
  • Shaft: angle = point of greatest curvature
  • Costal groove: houses intercostal neurovascular bundle – found inferiorly
  • Joints:
    a. ) Costochondral: between rib and cartilage, no movement
    b. ) Sternocostal: between cartilage and sternum
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18
Q

What types are joints are found in the sternocostal joints?

A
  • 1st rib = primary cartilaginous joint (can ossify)

- Rest = synovial plane-type joints (ligaments with synovial fluid)

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19
Q

Facet at 3rd rib’s tubercle will articulate with what vertebra?

A
  • T3
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20
Q

Bony features of sternum. At what vertebral levels do each correspond

A
  • Manubrium: T2-5
  • Body: T5-9
  • Xiphoid process: T9-10 disc
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21
Q

Clinical relevance of costal groove

A
  • Chest tubes placed at superior angle of rib, not inferior angle where groove is
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22
Q

Joints of sternum, types?

A
  • Sternoclavicular: saddle-type joint (acts as ball and socket), synovial
  • Manubriosternal: secondary cartilaginous joint
  • Xiphisternal: primary cartilaginous joint (can ossify)
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23
Q

What types of glands are found in the breast?

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A
  • Mammary glands are modified sweat glands (~20 glands),
  • These glands empty into tree-like branched system known as lactiferous ducts.
  • Sinus / swelling (Ampulla) of duct found as duct system gets close to nipple.
24
Q

In what fascia are breast located?

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A
  • Superficial fascia
25
Anatomical location of male breast?
- 4th intercostal space
26
Anatomical location of female breast?
- Vertically from 2nd through 6th ribs - Transversely from lateral border of sternum to mid-axillary line - 2/3rds on deep fascia of pec major - 1/3rd on deep fascia of serratus anterior
27
What is the retromammary space? Function?
- space between glands and deep fascia | - allows for movement of breast
28
What ligaments support breast tissue/glands?
- Suspensory / Cooper’s ligaments: glands attach to dermis of skin, well developed superiorly
29
Vasculature of breast?
- Internal thoracic artery (clinicians call this internal mammary artery), lateral thoracic artery, pectoral branches of thoracoacromial trunk
30
Lymphatic drainage of breast?
- 75% through axillary nodes | - 25% through clavicular and parasternal (pathway between breasts) nodes
31
Pectoralis major. Attachments, innervation, vasculature
- Proximal attachment: clavicle, sternum, upper 6 costal cartilages - Distal attachment: lateral lip of intertubercular groove - Innervation: medial and lateral pectoral nerves - Vasculature: pectoral branches of thoracoacromial trunk
32
Pectoralis minor. Attachments, innervation, vasculature
- Proximal attachment: 3-5th ribs - Distal attachment: coracoid process of scapula - Innervation: medial pectoral nerve - Vasculature: pectoral branches of thoracoacromial trunk
33
Serratus anterior. Attachments, innervation, vasculature
- Proximal attachment: upper 8 or 9 ribs - Distal attachment: medial border of scapula - Innervation: long thoracic nerve (on superficial surface of muscle) - Vasculature: lateral thoracic artery (on superficial surface of muscle)
34
Action of serratus posterior superior and inferior?
- Superior: elevates ribs | - Inferior: depresses ribs
35
Levator costarum. Attachments
- 12 pairs of fan shaped muscles | - Run from transverse processes of C7-T11 to costal tubercles and costal angles
36
Name the thoracic muscles from superficial to deep
1. ) Intercostal muscles: external, internal, innermost 2. ) Subcostal muscles 3. ) Transversus thoracis
37
External intercostal muscles. Attachments, innervation, action
- Attachments: run anteroinferiorly from upper to lower rib starting at costal tubercle, runs to costochondral junction, extends to sternum as external / anterior intercostal membrane - Innervation: local intercostal nerves (ventral primary rami of spinal nerve) - Action: elevates ribs
38
Internal intercostal muscles. Attachments, innervation, action
- Attachments: run posteroinferiorly from upper to lower rib, starts at lateral border of sternum, runs to costal angle, extends to vertebrae as internal/posterior intercostal membrane - Innervation: local intercostal nerves (ventral primary rami of spinal nerve) - Action: costal/bony ribs portion=depresses ribs, chondral/cartilage portion=elevates ribs
39
Innermost intercostal muscles. Attachments, innervation, action
- Attachments: internally on posterolateral thoracic wall, third layer of intercostals - Innervation: local intercostal nerves (ventral primary rami of spinal nerve) - Action: elevates ribs
40
Subcostal muscles. Location, action
- Located in third muscular layer of intercostal space posteriorly, crosses more than one intercostal space - Elevates ribs
41
Transversus muscles. Location, action
- Located in third muscular layer of intercostal space anteriorly on lower sternum to internal surface of 2nd-6th costal cartilage - Depresses ribs
42
Which muscles act to depress ribs?
1. ) Serratus posterior inferior 2. ) Internal intercostal muscles (chondral portion) 3. ) Transversus muscles
43
Which muscles act to elevate ribs?
1. ) Serratus posterior superior 2. ) External intercostal muscles 3. ) Internal intercostal muscles (costal portion) 4. ) Innermost intercostal muscles 5. ) Subcostal muscles
44
Thoracic diaphragm attachments
- Sternal, costochondral and lumbar attachments
45
What muscles compose the third layer of intercostal space?
- Innermost intercostal muscles: posterolaterally - Subcostal muscles: posteriorly - Transversus thoracis: anteriorly
46
How many intercostal spaces are there?
- 11
47
How do the intercostal muscles attach internally to the parietal pleura?
- Via the endothoracic fascia
48
What is housed in the costal groove? Between what muscular layers is the costal groove found?
- Costal groove is found between the second and third muscular layers - Neurovascular bundle is found in this groove
49
Neurovascular bundle is found in the costal groove. In what order?
- VAN | - Vein, artery, nerve
50
Intercostal nerves distributions and contributions
- Intercostal nerves arise from thoracic spinal nerves from T1-11 - T7-12 intercostal nerves continue anterior into abdominal wall and are called thoracoabdominal nerves
51
Discuss contributions to the anterior and posterior intercostal arteries. Discuss supply to each IC space.
1. ) Anterior: - Internal thoracic artery gives off anterior intercostal arteries, terminates in 6th space into musculophrenic and superior epigastric arteries - Musculophrenic (from int thoraci) supplies 7th through 9th space - No anterior intercostals in 10th and 11th spaces 2. ) Posterior: - Superior intercostal (from costocervical trunk off subclavian) assists in supplying 1st and 2nd IC spaces - Thoracic aorta gives off posterior intercostal arteries that supply all 11 IC spaces *Anterior and posterior intercostal arteries form anastomoses with one another
52
Venous drainage of intercostal spaces
- Intercostal veins drain into azygos system of veins and internal thoracic vein
53
What supplies vasculature and innervation to the space under the 12th rib?
- Subcostal artery (from thoracic aorta) - Subcostal vein - T12 nerve
54
Principle muscles of breathing
- External intercostals - Chondral part of internal intercostals - Diaphragm
55
Accessory breathing muscles – used for elevation of ribs
- SCM | - Scalenes
56
Muscles used to depress ribs for active breathing
- internal intercostals costal part | - abdominals (rectus, obliques and transversus)

Anatomy Exam 3 (10 decks)

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