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pt momints ver 2.0 > Org Ana: The Thoracic Wall > Flashcards

Org Ana: The Thoracic Wall Flashcards

1
Q

what comprises the exterior of the thoracic wall

A

covered by skin and muscles of the shoulder girdle

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2
Q

where is the thorax located

A

at the region between the head, neck and abdomen

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3
Q

what comprises the inner surface of the thoracic wall

A

lined by parietal pleura

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4
Q

what is the thoracic cage

A

bony framework or the thoracic region’s wall

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5
Q

describe the shape of the thorax

A

flat in front and at the back but rounded on the sides bc of the angulation of the ribs

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6
Q

what are the boundaries of the thoracic cage

A

anterior - sternum and costal cartilages
posterior - T1-T12
laterally - ribs and intercostal spaces
superiorly - w neck
inferiorly - diapraghm

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7
Q

what is the superior thoracic aperture

A

bordered by T1, rib 1 and manubrium

structures from the head and neck passes as it goes down

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8
Q

what is the inferior thoracic aperture

A

bordered by T12, rib 12 and rib 11, costal margin and xiphoid process

structures from thoracic to abdomen pass here

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9
Q

what are the functions of the thoracic wall

A

protects heart and lungs
conduit for passing structures from head to abdomen
role in breathing
supports UE
attachment of muscles

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10
Q

what are the lines of orientation in anterior view from lateral to medial

A

anterior axillary
midclavicular
midsternal

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11
Q

what are the lines of orientation in lateral view from posterior to anterior

A

posterior axillary
midaxillary
anterior axillary

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12
Q

what are the lines of orientation in posterior view from lateral to medial

A

scapular
vertebral

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13
Q

what are the spaces in anterior view from superior to inferior

A

supraclavicular
infraclavicular
precardiac
traubes

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14
Q

what are the spaces in posterior view from superior to inferior

A

suprascapular - T2
interscapular - T3
infrascapular - T7

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15
Q

describe the pleuras of the thoracic cavity from most superficial to deep

A

parietal - inner surface of chest wall
pleural cavity - space bet
visceral - lines the lungs

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16
Q

what are the 3 parts of the sternum

A

manubrium
body
xiphoid

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17
Q

what is the articulations of the manubrium

A

w/ clavicle - clavicular notch
w/ first nd upper parts of second costal cartilages - 1st costal notch
w/ body - manubriosternal joint

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18
Q

what level is the jugular notch

A

T2

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19
Q

what is the level of manubrium

A

T3-4

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20
Q

at what level is the manubriosternal joint located

A

sternal angle of louie - T4-5

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21
Q

where does the body of sternum articulate

A

2nd-7th costal cartilages - ribs 8-10 w/ rib 7
w/ manubrium - manibriosternal
w/ xiphoid - xiphisternal

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22
Q

describe the xiphoid

A

hyaline cartilage that ossifies at proximal end in adults

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23
Q

what are the articulations of the xiphoid process

A

no ribs or costal cartilage
7th costal cartilage may have along w/ body
w/ body - xiphisternal
inferior end - attachment for line alba

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24
Q

at what level can the xiphisternal joint be found

A

opposite T9

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25
Q

what is the significance of the sternal angle of louis

A

ribs are counted here - 2nd rib @ sternal angle

separates sup nd inf mediastinum

asc aorta ends, where arch is, desc aorta begins

trachea divides into bronchi

azygous vein arches over right lung into SVC

pulmonary trunk divides into pulmonary arteries

thoracic duct reaches left side here

upper limit of base of heart

cardiac plexus

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26
Q

what are the types of ribs

A

TRUE - first 7
- connected to sternum

FALSE - 8-10
- attaches to rib 7 by costal cartilages
- forms costal margin

FLOATING - 11-12
- no attachment to sternum
- costal cartilage embed to muscles at abdomen

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27
Q

what are the articulations of the head of a typical rib

A

sup - inferior costal facet of vertebra above

inf - articulates w the superior costal facet of its vertebrae

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28
Q

describe the typical rib

A

long, twisted and flat
sup border - round and smooth
inf border - sharp nd thin w costal groove
ant attaches to costal cartilage

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29
Q

describe the neck

A

separates head from tubercle

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30
Q

describe the head

A

posterior vertebral end

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31
Q

compare articular nd non articular parts of the tubercle

A

articular - articulates w numerically corresponding vertebra

non articular - attachment of ligament

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32
Q

describe the shaft

A

long, thin, flat and twisted on long axis from tubercle to sternal end

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33
Q

describe the costal groove

A

elongated depression found in the inferior internal surface of the shaft of rib; holds intercostal vessels and nerve.

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34
Q

describe the angle

A

where body sharply turns from a lateral to a more anteriorly directed orientation; slightly distal to the tubercle

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35
Q

describe the sternal end

A

flat and has a depression for the costal cartilage

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36
Q

describe the first rib

A

small, flattened from above downward; thick

attached only to T1 body; has a facet in the tubercle to articulate to the transverse process; 1 attachment only

scalene tubercle (superior surface) which separates two smooth grooves crossing the rib at the shaft

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37
Q

describe the subclavian groove of the first rib

A

Anterior groove (subclavian vein)

Posterior groove where lower trunk of brachial plexus (between clavicle and rib 1) and subclavian artery cross the rib and lie in contact with the bone

38
Q

describe the second rib

A

Flat but twice as long as first rib; thicker than usual

Articulates with the vertebral column in a way typical of most ribs

39
Q

describe the tenth rib

A

Head of rib 10 has a single facet for articulation with own vertebra; no other articulation to T9

40
Q

describe ribs 11 nd 12

A

articulates only with the bodies of their own vertebrae;
have no tubercles or necks;

both are short, little curve and are pointed anteriorly;

has sternal end w costal cartilage embed to abdomen

41
Q

what are costal cartilages

A

Hyaline cartilage connecting the upper seven ribs to the lateral edge of sternum and the 8th to 10th ribs to the cartilage immediately above

42
Q

what is the function of costal cartilages

A

helps elasticity of thoracic wall - ribs expand

n old age, it tends to lose some of its flexibility as the result of superficial calcification

attaches rib to sternum

43
Q

what are costal facets

A

demifacets - articular surface on the posterolateral aspect of the body at the junction of body and pedicle; located in superior and inferior sides;

44
Q

compare sup nd inf demifacets

A

Superior articular facet faces posterolateral and inferior articular facet faces anteromedial

45
Q

describe T1

A

a full costal facet for the head of 1 strib and inferior demifacet for the superior half of the head of the second rib

46
Q

describe T11-12

A

costal facets (located mainly on the pedicles) instead of demifacets because the heads of ribs 11 & 12 articulate only with their own individual vertebrae

47
Q

what are transverse costal facets

A

for articulation of the tubercle of the rib on the transverse processes; absent in T11 and T12

48
Q

describe the movement of the sternal joint

A

small amount of angular movement during respiration

49
Q

what is the landmarks for the sternal joint

A

opposite T4

attachment of 2nd costal cartilage

plane of separation bet sup nd inf mediastinum

50
Q

what type of joint is the sternal joint

A

cartilaginous

51
Q

what type of joint is the costovertebral

A

synovial plane

52
Q

which ribs have single synovial joints

A

1, 10, 11, 12

53
Q

which ribs have 2 synovial joints

A

2-9

54
Q

what connects the head of a rib to the IV disc

A

intra-articular lig

55
Q

what type of joint is the tubercle to transverse process

A

synovial pane

absent in 11-12 bc no tubercle

56
Q

what type of joint is the rib to costal cartilage

A

cartilaginous - no movement

57
Q

describe the joints betw costal cartilage and sternum

A

1st rib to manubrium - cartilaginous = no movement

2nd to 7th - synovial plane - lateral border of sternum

6th - 10th - synovial plane - cc articulates w one another

58
Q

what type of joint is the manubriosternal

A

cartilaginous

59
Q

what type of joint is the xiphisternal

A

cartilaginous

60
Q

explain the significance of the 1st rib and the 12th rib during respiration

A

1st rib raises ribs during inspiration

12th rib pulls ribs down during expiration

61
Q

what are the structures that pass through the thoracic outlet

A

esophagus
trachea
vessels and nerves
apices of the lungs and pleura

62
Q

what is the thoracic outlet syndrome

A

compression of brachial plexus or the subclavian vein/artery as it exits rib 1 and clavicle

63
Q

what are the vascular symptoms of thoracic outlet syndrome

A

swelling/puffy hands
cyanotic hands
heaviness of arm
pulsating lump above clavicle - weak radial pulse
tooth ache like pain at neck and shoulder - inc at night
easily fatigued arms
superficial vein distention in hand

64
Q

what are the neurologic symptoms of thoracic outlet syndrome

A

paresthesia at C8 and T1 dermatomes - inside forearm and palm
C8: closing and opening of palms
T1: add nd abd of fingers

muscle weakness nd atrophy in gripping
difficulty in fine motor tasks
cramps of inner forearm
pain
tingling and numbness

65
Q

what is the cause of thoracic outlet syndrome

A

cervical rib - extra rib at C7 = higher chance of pinch

scalene syndrome - pinch bet movement of ant and middle scalene

costoclavicular syndrome - bet clavicle and rib 1

hyperabduction syndrome -hyper abd of shoulder like backpack may pinch in betw rib 1 and clavicle

66
Q

how to test for thoracic outlet syndrome

A

allen - elbow at panatang makabayan nd head pointed away - radial pulse dissapears as head rotates = +

adsons - UE in abd, extension and ER - head towars involved side - diminished radial pulse = +

costoclavicular maneuver - exaggerated attention posture - absence of pulse = +

done if complains of pain during back pack etc

67
Q

what is an intercostal space

A

space bet ribs
where costal groove lies - intercostal nerves, arteries and vein

68
Q

what are the layers of the thoracic wall from superficial to deep

A

skin
superficial fascia
deep fascia
intercostal membrane
endothoracic fascia
extrapleural fatty layer
parietal pleura

69
Q

compare the intercostal muscles

A

external - most superficial
down nd forward

internal - intermediate
down nd back

innermost - deepest
straight arrangement
relates to endothoracic fascia nd parietal pleura

70
Q

what fixes the first rib

A

scaleni muscle

71
Q

what fixes the 12th rib

A

quadratus lumborum and oblique muscles

72
Q

relate intercostals to respiration

A

external - elevates
internal - depresses

strength prevents sucking in or blowing out of lungs during changes in psi

73
Q

what are the 3 parts of the diaphragm

A

sternal - from posterior surface of xiphoid

costal part - from deep surface of lower six ribs nd cc

vertebral - from the VC (crura) and arcuate ligaments

74
Q

compare left nd right crus

A

left - from L1-2
right - L1-3

75
Q

compare the medial and lateral arcuate ligaments

A

medial - side of L2 body to transverse process of L1

lateral - transverse process of L1 to lower border of 12th rib

76
Q

what is the central tendon

A

muscle fibers of diaphragm that converge in the center at T9

sup surface partially fused w pericardium

acts as a sphincter to prevent regurgitation of stomach contents

77
Q

compare left nd right diaphragm

A

r - reaches upper border of rib 5
l - reaches lower border of rib 5

right is higher bc liver pushes it up

78
Q

relate the levels of the diaphragm in diff positions

A

sitting/standing - lower
supine/after meal - higher

78
Q

what are the openings of the diaphragm

A

caval - T8 in the central tendon
inf vena cava and right phrenic nerve

esaphogeal - T10 in muscles from right crus
esophagus
vagus nerve
left gastric vessel
lymphatics

aortic - T12 bet crura - gap behind posterior margin

aorta
thoracic duct
azygos vein
thoracic aorta becomes abdominal aorta

78
Q

what passes at the crura

A

greater, lesser and lowest sympathetic splanchnic nerves

79
Q

what passes medial arcuate ligament

A

sympathetic trunk passes posterior

80
Q

what passes betw sternal and costal margin

A

superior epigastric vessel

81
Q

what passes at the left dome

A

left phrenic nerve

82
Q

arterial supp of diaphragm

A

pericardiophrenic and musculophreninc arteries - from internal thoracic art

superior phrenic (thoracic) and inferior phrenic (abdominal)

83
Q

venous supp of diapraghm

A

drains to brachiocephalic, azygos/abdominal veins

84
Q

where does intercostal nerves come from

A

anterior rami of spinal nerves T1-11

T12 is subcostal nerve

85
Q

describe the passage of intercostal nerves

A

first six - distributed w/in their intercostal spaces

seventh to ninth - leave anterior ends of their intercostal spaces by passing deep to cc to enter the abdominal wall

10-11 = pass directly to abdominal wall

86
Q

what does intercostal nerves carry

A

somatic motor intervention to muscles of thoracic wall

sensor innervation skin and parietal pleura

postganglionic sympathetic fibers to periphery, autonomic

anterior ramus of T1 forms part of brachial plexus

lat cutaneous branch of 2nd intercostal - sensory of upper arm

lower intercostal supplies muscle, skin nd peritoneoum of abdominal wall

87
Q

whats the arterial supp of thoracic wall

A

subclavian - sup intercostal nd internal thoracic

axillary - sup nd lateral thoracic

thoracic aorta - posterior intercostal and subcostal

ant intercostal from lat thoracic - branch to 12 arteries to the ribs

88
Q

what is the venous drainage of thoracic wall

A

right - superior intercostal azygos
left - superior thoracic brachiocephalic veins

pt momints ver 2.0 (14 decks)

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