Thoracic Wall Flashcards by Aaron Shoskes

Suprasternal (Jugular Notch)

T2-T3 at level of intervertebral disc

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Sternal Angle (Angle of Louis)

T4-T5. Manubriosternal joint. Costal cartilage of 2nd rib. Slop below jugular notch. Tob ribs is covered by clavicle; sternal angle slopes up to 2nd rib

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Xiphoid process

T9-T10. Starts off cartilaginous, ossifies @ approximately 40 years of age. Sits approximately in front of heart. CPR @ approximately xiphoid process

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Root of spine of scapula

On medial border of spine @ T4/spine of T3

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Inferior angle of scapula

Points to T8, lies over T7

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Midclavicular Line

Verticle line extending from midpoint of clavicle

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Anterior axillary line

Verticle line dropped at lateral border of pectoralise major

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Mid-axillary line

Vertical line dropped through middle of axillary fossa

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Posterior axillary line

Vertical line dropped at lateral border of Latissimus Dorsi

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Scapular line

Vertical line dropped from inferior angle of scapula

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Midsternal line

Vertical line dropped from middle of sternum

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Thoracic Inlet

Body of T1, 1st pair of ribs and cartilages, and superior end of manubrium. AKA Superior thoracic aperture. COUNTERINTUITIVE NOTE: Thoracic outlet syndrome deals with a problem (impingement of nerves and vessels) with the thoracic INLET, not the thoracic outlet.

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Thoraic Outlet

Round opening whose edges are the lowest ribs. Closed by the diaphragm. Bounded by ribs 11-12, T12, xiphoid process. COUNTERINTUITIVE NOTE: Thoracic outlet syndrome deals with a problem (impingement of nerves and vessels) with the thoracic INLET, not the thoracic outlet.

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Sternal Region

Median anterior wall. Sternum (manubrium, body, xiphoid process) & clavicular/chondral attachments to sternum make up the sternal region

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Costovertebral Joint

Point of articulation between head of rib and the vertebral body at and above its level. EX: Rib 4 articulates with SUPERIOR COSTAL FACET of T4 and INFERIOR COSTAL FACET of T3.

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Costotransverse joint

Point of articulation between rib and transverse process of vertebra at SAME level alone.

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True ribs

Rib pairs 1-7. True because they attach to spine and sternum

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False ribs

Rib pairs 8-12. “False” because they attach to spine, but not sternum. 8-10 anchor to the costal cartilages of the rib above them. 11-12 have no anchor in the front.

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Floating ribs

Rib pairs 11 and 12. Floating because they lack any anchor at all in the front.

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Head of rib

End closest to the vertebra with which it articulates

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Tubercle of rib

Eminence of rib on its back surface at the junction between neck and body of the rib.

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Shaft of rib

Rib consists of head, neck, and shaft. The angle of the rib is the point on the shaft of greatest curvature

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Costal Groove

groove between the ridge of the internal surface of the rib and the inferior border. Houses intercostal neurovascular bundle (nerves and bloodvessels)

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Costochondral joint

Joint between bone and cartilage at manubrium. No movement. Cartilage –> sternum

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Sternocostal joint (1st Rib)

1st rib is a primary cartilaginous joint (point of attachment to axial skeleton).

Sternocostal Joint

synovial plane type joints

Manubrium

Runs T2-T5

Body of sternum

T5-T9

Joints of sternum

Sternoclavicular, manubriosternal, and xiphisternal

Sternoclavicular Joint

Synovial, saddle-type joint

Manubriosternal Joint

Secondary cartilagenous joint

Xiphisternal Joint

Primary cartilagenous Joint

Breast

Located in the superficial fascia. Modified sweat gland. Males: 4th intercostal, females: 2nd-6th ribs.

Areola

Darkened area around nipple so baby can locate it for feeding.

Nipple

Location where lactiferous ducts empty

Lactiferous ducts

Milk is secreted into ducts and flows into ampulas (sinuses). Milk is pulled from sinus to nipple, resulting in more milk being pulled to the sinus.

Anatomical location of breast

Male: 4th intercostal. Female 2-6th ribs vertically. Medial 2/3rds over pectoralis major, lateral 1/3rd over seratus anterior.

Pectoralis major

Proximal attachment: Clavicle, sternum, upper 6 costal cartilages. Distal attachment: Lateral lip of intertubercular groove [also an attachment for Lat. Dorsi]. Innervated by medial and lateral pectoral nerves on deep surface. Blood supply by pectoral branches of thoracoacromial trunk

Pectoralis minor

Proximal attachment: ribs 3-5. Distal attachment: coracoid process of scapula. Innervated by medial pectoral nerve. Blood supply: pectoral branches of thoracoacromial trunk.

Serratus anterior

Proximal attachment: upper 8-9 ribs. Distal attachment: medial order of scapula. Innervated by long thoracic nerve. Blood supply: lateral thoracic artery on superficial surface

Retromammary space

Allows breasts to move. Between glands and deep fascia.

Suspensory ligaments

Cooper's ligaments. Attach gland to dermis of skin. Well developed superiorly. Tumor growing in this region can pull on ligaments leading to dimpling of the skin as the skin is pulled in

Vasculature of the breast

Internal thoracic artery, lateral thoracic artery, and pectoral branches of thoracoacromial trunk

Internal thoracic artery

Medial aspect of breast, lateral to sternum. AKA internal mammary artery (IMA)

Lateral thoracic artery

Found at lateral angle of thoracic cavity

Pectoral branches of thoracoacromial trunk

Go to pecs, supply glands

Lymphatic drainage of breasts

75% via axillary nodes in axilla's apex, 25% through clavicular and parasternal nodes. Parasternal nodes responsible for potential of breast cancer to spread from one breast to another.

Serratus posterior superior

Elevate 2-5 ribs, aiding respiration

Serratus posterior inferior

Depress lower ribs, aiding expiration

Levator costarum

Attach transverse processes C7-T11 to costal tubercle and costal angle. 12 pairs of fan shaped muscles. Aid in respiration

Intercostal muscles

Innervated by local intercostal nerves (ventral primary rami of spinal nerve)

External intercostal muscle

ELEVATION. Fibers run anteroinferiorly from upper rib to lower rib. Muscle starts at the costal tubercle and runs to chostochondral junction. Extends to sternum as an external intercostal membrane (aka anterior intercostal membrane)

External (anterior) intercostal membrane

Membrane that replaces the external intercostal muscles anteriorly from costochondral junctions to the sternum.

Internal intercostal muscle

Costal (bony rib) portion depresses. Chondral (costal cartilage) portion elevates. Fibers run posteroinferiorly from upper rib to lower rib. Muscles start at lateral border of sternum and run to the costal angle. Extend to the vertebrae as internal (posterior) intercostal membrane at the angles of the ribs.

Innermost intercostal muscle

Deepest layer. Elevate. Located in third muscular layer of intercostal space. Found internally on posterolateral thoracic wall.

Subcostal muscle

Located internally on posterior thoracic wall. Muscles cross more than one intercostal space. Elevate. Located in third muscular layer of intercostal space posteriorly

Transversus thoracis

Depress ribs. Lower sternum to internal surface of 2-6th costal cartilage. Located in third muscular layer of intercostal space anteriorly.

Thoracic diaphragm.

Sternal, costochondral, and lumbar attachments. Responsible for 80% of quiet breathing.

Endothoracic Fascia

Serves to attach muscles of intercostal space to parietal pleura

Parietal Pleura

Fused to innermost surface of chest wall via endothoracic fascia

Neurovascular bundle

Housed in costal groove between 2nd and 3rd muscular layers. Contains intercostal nerves, intercostal arteries, intercostal veins, and subcostal nerve

Intercostal Nerves

Spinal nerves. Thoracic nerves T11-T11. Thoracoabdominal nerves T7-11

Intercostal arteries

Anastomose within the intercostal space. Anterior and posterior

Intercostal arteries on anterior side

Internal thoracic artery. Terminates in 6th intercostal space. 1st Branch of subclavian

Musculophrenic artery

Branch of internal thoracic artery. Supplies 7-9th intercostal spaces

Superior epigastric artery

Branch of internal thoracic artery. Supplies anterior part of abdominal wall and some of diaphragm.

Posterior intercostal arteries

Superior intercostal and thoracic aorta

Superior intercostal artery

Branch of costocervical trunk. Assists in supplying 1st and 2nd spaces

Thoracic aorta

Suplies all 11 IC spaces. First 2 IC spaces reinforce blood supply of superior intercostal artery from costocervical trunk and superior thoracic artery from 1st part of axillary artery

Intercostal veins

Azygos system of veins (drains everything in region) and internal thoracic vein (drains thoracic cavity)

Subcostal Nerve, artery and vein

Located under 12th rib. T12 nerve.

Thoracic Wall Flashcards

(71 cards)