Flashcards in The Thoracic Wall Deck (44)
What is the thorax?
The region of the body is between the neck and the diaphragm.
What are the three parts of the sternum?
The manubrium, the body, and the xiphoid process
Which rib lies at the sternal angle?
Rib 2 lies at this angle (also known as the manubriosternal joint)
What is the jugular notch?
Also known as the suprasternal notch, is a concave center at the upper border of the manubrium
What does the manubrium articulate with?
Articulates with the clavicles and the first and upper part of the 2nd rib
What level of thoracic vertebrae does the manubrium lie?
3rd and 4th thoracic vertebrae
What level of thoracic vertebrae does the xiphoid process lie at?
The 10th thoracic vertebrae
What ribs does the body of the sternum articulate with?
Articulates with ribs 2-7
Which rib lies at the xiphosternal joint lie at?
How many pairs of ribs are there? How many are true ribs and how many are false ribs? What is another name for true ribs? What is another name for the false ribs (2 names)?
Twelve pairs; 7 true ribs and 5 false ribs
True ribs are also known as vertebrosternal ribs
False ribs (8, 9 and 10 are known as vertebrochondral ribs; 11 and 12 are known as floating ribs because of no anterior attachment)
Which ribs are typical ribs?
What are the components of a typical rib?
Head, tubercle, neck, shaft/body, costal groove, angle
What is the head of a rib? What is the tubercle of a rib?
The head has two facets for articulation with the corresponding vertebral bodies and the body above; the tubercle has a facet for the transverse process of the corresponding vertebrae
What is the neck of a rib? What is the body of a rib? What is an angle of a rib?
The neck is a constriction between the head and tubercle; the body of the rib is thin and twisted and contains a costal groove along the inferior border; angle is where the shaft bends forward sharply
What is contained in the costal groove of a typical rib, from most superior to most inferior?
Intercostal nerve (VAN)
What are the atypical ribs?
Ribs 1, 2, 10, 11, and 12
What unique tubercle is present on rib 1 that allows insertion of which muscle?
Rib 1 has a scalene tubercle that allows for the insertion of the scalenus anterior muscle
What are the distinguishing features of rib 1 that make it atypical?
Shorter, smaller, wider (smaller) than the others
Head has a single facet for the first vertebral body (others have two)
Has scalene tubercle
What important structures (artery, vein, nerve) pass by the scalene tubercle either posteriorly or anteriorly?
The subclavian vein passes the first rib anterior to the scalene tubercle
The subclavian artery and the brachial plexus pass the first rib posterior to the scalene tubercle
What are the three intercostal muscles of the thoracic wall?
External intercostal muscles, internal intercostal muscles, innermost intercostal muscles
Describe the external intercostal muscles and the direction they move, their direction in relation to the thoracic wall and ribs, and what replaces the external intercostal anteriorly.
The external intercostal muscles pass downward and anteriorly from the rib above to the rib below (conform to external obliques of abdomen). They extend from rib tubercle posteriorly to the costochondral junction anteriorly. Replaced anteriorly by the external intercostal membrane.
Describe the internal intercostal muscles and the direction they move, their direction in relation to the thoracic wall and ribs, and what replaces the internal intercostal posteriorly.
The internal intercostal muscles pass downward and posteriorly from rib above to rib below (conform to the internal obliques of abdomen). They extend from sternum anteriorly to the angles of ribs posteriorly. Replaced posteriorly by the internal intercostal membrane.
What best distinguishes the innermost intercostal layer?
The innermost intercostal muscle layer is separated from the internal intercostal muscles by the neurovascular bundle
What layers in the thoracic and abdominal walls does the neurovascular bundle separate? (high yield)
The neurovascular bundle lies between the middle and deepest layers of muscle.
What are the three specific muscles of the innermost intercostal muscle layer?
Intercostalis intimi (innermost intercostal muscles), very similar to internal intercostal muscles and runs mid-axillary line
Subcostal muscles pass from the inside angle of one rib to rib two levels inferior to it (pass two intercostal spaces)
Transversus thoracis, where four or five slips of muscle fan out from inferior part of sternum to costal cartilages 2 through 6
What branch of the spinal nerve gives rise to the intercostal nerves?
They are also known as the ventral rami of the first 11 thoracic nerves (the dorsal ramus of a spinal nerve is much smaller); the 12th thoracic nerve runs below the 12th rib and is called the subcostal nerve
What space does each intercostal nerve enter?
Enters space between parietal pleura and the internal intercostal membrane then continues between the internal intercostal muscle and the innermost intercostal muscle (neurovascular plane)
What are the atypical spinal nerves?
First intercostal nerve, second intercostal nerve, the 7th-11th intercostal nerves, and the subcostal nerve (below T12)
What does the major part of the ramus of the first intercostal nerve join?
Brachial plexus (high yield)
What is the intercostobrachial nerve? What nerve does it join, and what area does it supply?
It is the lateral cutaneous branch of the second intercostal nerve, it joins the medial cutaneous nerve of the arm, supplies skin of axilla and upper medial arm
Where is pain referred along in coronary artery disease?
The intercostobrachial nerve (lateral cutaneous branch of the 2nd/3rd intercostal nerve) carries referred pan to the medial side of the arm
What makes the 7-11th intercostal nerves atypical?
They leave the intercostal spaces and continue into the abdominal wall
What plane does the 7-11th intercostal nerve travel in once reaching the abdominal wall?
They travel in the same plane between the internal oblique and the transversus abdominus muscles (i.e., in the neurovascular plane between the middle and deepest layers of muscles)
What is unique about the 12th thoracic intercostal nerve?
It lies below the 12th rib and is termed the subcostal nerve. It follows the course of the 7th - 11th itnercostal nerves.
Where do the posterior intercostal arteries arise in each of the 11 intercostal spaces?
The first two spaces originate from the subclavian -> costocervical trunk -> supreme intercostal artery -> first 2 intercostal arteries
The lower 9 spaces are direct branches from the thoracic aorta
Where do the anterior intercostal arteries arise in each of the 11 intercostal spaces (3 groups)?
Upper 6 spaces: they are branches of the internal thoracic (internal mammary arteries) and anastomose laterally with the posterior intercostal arteries
Lower (7-9th) spaces: branches off of the musculophrenic artery (which is a terminal branch of the internal thoracic artery)
Absent in the lower two intercostal spaces (10 and 11)
Which anterior intercostal arteries are supplied by branches of the internal thoracic artery (internal mammary artery)
Intercostal arteries 1-6
Does the internal thoracic artery (internal mammary artery) lie anterior or posterior to transversus thoracis muscle?
Anterior to it
Where does the internal thoracic artery divide and into which 2 terminal branches?
Divides just below the 6th costal cartilage into the superior epigastric artery and the musculophrenic artery
What are the 3 types of branches that the internal thoracic artery can give rise to?
1. The upper six anterior intercostal arteries
2. The pericardiophrenic artery (which runs with the phrenic nerve)
3. The perforating branches (which perforate wall, pass to skin with anterior cutaneous branches of intercostal nerves, and are the main blood supply of the medial part of breast; enlarged in lactating women)
What does the pericardiophrenic artery branch of the internal thoracic artery supply?
Pericardium, diaphragm, and part of the pleura
What veins do the posterior intercostal veins empty into?
The azygous and hemiazygous veins (depending on if it is from the left or the right)
What veins do the anterior intercostal veins drain into?
The internal thoracic vein or the musculophrenic vein