Week 1 - Thoracic Wall Flashcards
Thorax is the part between …
neck and abdomen
Abdomen is the part between
thorax and pelvis
Pelvis is the part ….. to abdomen
inferoposterior
What is the physical separation between the thorax and the abdomen?
Answer: the diaphragm
What is the seperation between the abdomen and pelvis?
Answer: technically, there is no real separation between the abdomen and pelvis, we have a mixture of pelvic organs and abdominal open within the pelvic region. There is no diaphragmatic version.
what is the Thoracic Cavity ?
It is an upside-down cone shaped cavity; it is narrow at the top and much broader down the bottom.
what is thoracic cavity made up of?
It’s made up of the thoracic cage (wall) with ribs, costal cartilages, sternum and thoracic vertebrae.
what makes up the floor of the thoracic cage?
The diaphragm makes up the floor of the thoracic cage as seen by the dotted red line in the diagram
What organs are within the thoracic cage?
Within the thoracic cage we have all the organs that relate to respiration and the cardiovascular systems.
What are some other structures that pass through the thoracic cage that are no part of these cardiovascular or respiratory systems?
Nerves, Esophagus
is thoracic cage a closed/open cavity?
Although the thoracic cage is a closed cavity. It also is a transitioning space for some other structures.
what does thoracic wall include?
It includes the thoracic cage, muscles, fascia, 12 thoracic vertebras.
what does a dissected specimen of the thoracic cage look like?
This is what a dissected specimen looks like once we have removed the skin, some of the muscle and then we are able to see the wall itself.
the thoracic wall is everything …..
anterior and everything posterior
what can be seen in a dissected thoracic cage specimen?
We can see the muscles in between the ribs itself and we can see some muscles on top of those as well that cover the anterior chest or the anterior thoracic wall.
There is lots of fissure (a natural cleft between body parts or in the substance of an organ/a break or slit in tissue usually at the junction of skin and mucous membrane)
what does the skeleton of thoracic wall include?
The skeleton of thoracic wall includes 12 pairs of ribs and costal cartilages, 12 thoracic vertebrae and intervertebral discs (IVD) which connecr to the 12 pairs of ribs and sternum.
Label this thoracic segment pic
why doesnt a thoracic segment have to be cut exactly horizontally?
If we removed a thoracic segment, it doesn’t have to be cut exactly horizontally, because when we look at the rib cage, they all tend to incline downwards anteriorly.
what is the connection between all the components in a thoracic segment?
If we had to look at the connections between all these different components, we see that anteriorly we have the sternum, on either side laterally we have the costal cartilages connecting to the sternum and more lateral than we have the ribs on either side, eventually those robs then articulate with the vertebra and in this case specifically a thoracic vertebra where you can see the body, the head of the rib articulating with the body on the top and you can see the cubicle articulating with the transverse process and there’s our spinous process. There are quite a few connections between the ribs and the vertebra, between the costal cartilage and the rib out here and between the costal cartilage and the sternum.
what are the 3 parts of the Sternum superior to inferior
It is shaped a lil bit like a sword, where we have 3 parts; the broader superior part called the manubrium, which is the handle of the sword, the longest middle bit being the blade called the body and the inferior bit being really sharp, the tip, called the xiphoid process.
what does sternum mean in latin?
chest
what is sternum commonly called?
it is commonly called the breastbone
is the sternum strong?
no, it is so superficial, you should be able to break it by yourself
what does the manubrium mean in latin?
handle or hilt of sword
what shape is the manubrium?
It is trapezoid shaped and the widest and thickest part of the sternum.
label this diagram of the sternum
What type of bone is the sternum?
flatbone
what is the jugular notch?
The superior part of the sternum has a bit if a dip in it called the jugular notch or suprasternal notch.
where is the jugular notch found anterior to?
the jugular notch is found anterior to the inferior body of the T2 vertebra and the 1st and 2nd thoracic spinous process (its infront of those)
what is another name for the jugular notch?
suprasternal notch
what is the clavicular notch?
as we go laterally in the maunrium we find this. This is where the clavicle bone will articulate with the sternum through the sternoclavicular joint.
what is the sternoclavicular joint?
The sternoclavicular (SC) joint is the link between the clavicle (collarbone) and the sternum (breastbone). T
what is the articular facet?
the vertebral articular facets are where two vertebrae articulate. Each vertebra has two sets of facet joints. The superior articular facet faces upward and works like a hinge with the inferior articular facet (below). Like other joints in the body, each facet joint is surrounded by a capsule of connective tissue and produces synovial fluid to nourish and lubricate the joint. joins two vertebraes together.
what is the sternal angle?
then eventually all of the maubrium is really flattened out and where the manubrium meets the body of the sternum, you have what you call the sternal angle.
approx how long is the sternal angle?
sternal angle, which is about 2-3 cm long
the 1st rib is a synchrondrosis what does this mean?
he 1st rib is a synchondrosis, we don’t want too much movement around it because there’s quite a few structures, passing from the thoracic region into the neck, and if we don’t have stability around there were going to have lots of movement around in that region which we don’t want.
how is the second rib clinical?
in a clinical situation, is the sternal angle because you get the second rib articulating at the sternal angle. The reason this is clinical, is that the second rib is then a way for the dr to count the number of ribs, especially if you have a fractured rib, they can work out which one is fractured.
label the lateral view of entire sternum
the body of the sternum characteristics
Very simple, flattened. Long, narrow and thin
what is the length of the sternum?
the T2-T9 vertebra and it is approx 20cm long.
do ribs attach directly to sternum?
The first seven pairs are attached directly to the sternum by costal cartilages and are called true ribs. The 8th, 9th, and 10th pairs—false ribs—do not join the sternum directly but are connected to the 7th rib by cartilage.
what are sternabrae?
The sternum is made up of different parts, in the manubrium image you can see spiky wavy shapes on the sides (which is more visible on children), this is how we develop we call them sternabrae (4), they have primary 1 degree cartilaginous joints, in between each of the sternabrae, which will eventually disappear
what are transverse lines in adults?
Primary cartilaginous joints you see between epiphysis and the diathesis , they are transverse lines in adults
label development of the sternum in 8 prenatal mnths
label development of the sternum at 3yrs, 4 mnths
label development of the sternum at 8yrs, 7mnths
You can see the manubrium is really …. aspect compared to the sternabrae
large
the …. will eventually join up, to then become a full bone.
sternabrae
In a young individual, 8 prenatal mnths, you can see the …….
ossification canters, in this case you have a cartilaginous model before you go to an ossified model.
label anterior view of sternum
label lateral view of sternum
label another lateral view of sternum
the sternal angle, is at the level at which the ….. will attach.
second rib so t4-5 vertebrae
The body of sternum and xiphoid process is between
T8 and T9
we only have the .. … attaching directly to the sternum vertebra attaching directly to the sternum.
7 vertebra
what is the xiphoid process a good landmark for?
They use this as a good landmark for CPR and resuscitation
xiphoid process meaning in latin
In latin it means sword shaped
xiphoid process characteristics
It is the most inferior, smallest part of sternum and is variable (can have different shapes)
what are the different shapes of a xiphoid process
different shapes; a normal one which is just a straight one, a bifid one, a curves one, one deflected to one side, one with a foramen (hole) in between
which vertebra is xiphoid process generally found
Xiphoid is generally found at the T10 level vertebra
do young kids have a xiphoid process?
In young individuals its not completely formed/ossified, only in adults. Which is why you don’t do CPR around there on kids you can actually break that off from the main part because it is not complete, it ossifies in adults.
important landmarks/points to find xiphoid process
Important landmarks include; infrasternal angle which is basically the point where you have the superior limit of the liver. It is also where you have the midpoint of the costal margin
ribs meaning in latin
costae, as we talk alot about costal cartilages, costal facets everything costal pertains to the ribs.
how many pairs of ribs are there
12
what are the 3 different types of classifications of the ribs,
There are 3 different types of classifications of the ribs, true, false and floating.
what are true ribs?
The first classification is called vertebro-costal or true ribs (1-7), they are shown in the picture as orange, each one of them directly attaches to the sternum
technical name for true ribs?
vertebrocostal ribs
what are false ribs?
The second classification is called vertebro-chondral or false ribs (8-10), they are shown in the picture as blue, each of them don’t directly attach to the sternum but via cartilages
technical name for false ribs?
vertebro-chondral ribs
what are floating ribs?
The third classification is called vertebral or floating ribs (11-12), they are shown in the picture in the greyish green colour, they are different they are not normal ribs and they do not attach to the sternum.
technical name for floating ribs
vertebral ribs
what is a second classification ribs can have?
Each of these ribs whether they are true, they’re false or floating can have a second classification and the 2nd classification is whether it’s a typical or atypical rib.
majority of which ribs are atypical or typical?
All of the floating ribs are actually atypical, and most of the ribs in the middle are typical
label this Typical ribs diagram
what ribs are typical ribs?
Typical ribs are the 3rd to 9th ribs
what are the features of typical ribs?
- The Head which has 2 facets; superior articular facet for vertebral body and inferior articular facet for vertebral body.
-The neck which comes after the head - The tubercle which includes the articular facet for transverse process of vertebra.
-Every typical rib will have a large shaft (curve) which is also known as the body this includes the costal angle and the costal groove and sternal end of the shaft
-When we look at the shaft towards the end inferiorly, we have a little groove, this little groove creates this very sharp order of the rib, and that’s how we know that is the inferior section of the rib.
What do we find in the costal groove?
The vein, the artery and the nerve that supplies the thoracic wall (the band)
what are the atypical ribs?
it is rib 1 and 2 - These are the easiest ribs to find and Ribs 10, 11 and 12.
label this diagram of rib 1 and rib 2
approx length of small rib
rib 1 which is the smallest of them all its about 5cm.
1st rib characteristics
Shortest, broadest & most curved and has a Single facet for attachment to– T1 vertebra
why is the scalene tubercle and scalene muscle important for 1st ribs?
Scalene tubercle which includes the anterior scalene muscle, which is important as it forms the landmark for 2 grooves on either side. The scalene tubercle seperates the grooves for subclavian vessels. Posteriorly we have the subclavian artery.
what runs through scalene tubercle grooves and what is the scalene tubercle?
The scalene tubercle is a small projection that runs along the medial border of the first rib between two grooves, which travel anteriorly for the subclavian artery and posteriorly for the subclavian vein
2nd rib size
Twice the length of 1st rib approx 10cm
what type of rib is the 2nd rib
It is a transition rib, which has the same features as atypical rib, the difference however is that it’s not as smooth as the other ribs simply because it has a large tubercle or an area on the shaft, which allows for the serratus anterior muscle to attach to it.
what and where is tuberosity of serratus anterior?
The tuberosity attaching to serratus anterior is near the middle of the external surface of the body of second rib. It is a rough eminence for the origin of the lower part of the first and the whole of the second digitation of the Serratus anterior; behind and above this is attached the Scalenus posterior muscle
what are other atypical ribs
10-12th ribs. These are the other atypical ribs they are small and very hard to identify
label this diagram of the superior view is atypical 11th and 12th ribs
characteristics of 10-12th rib
they only have one facet on head and no neck, the shaft starts immediately. Sternal end is not as broad as they don’t attach to the sternum
characteristics of 11-12th ribs
Short
No neck
No tubercle
where are costal cartilages located?
- On the image the costal cartilages are the blue bits
- Anterior part of rib
what material are costal cartilages and what does it mean?
They are cartilaginous so they allow for some movement, basically allows for the chest to move a little bit, especially when we are breathing. Provides flexible attachment to sternum
which costal cartilages attach to sternum?
First 7 attach directly & independently to sternum
which costal cartilages attach to rib number 7?
8th, 9th & 10th attaching to rib number 7, above costal cartilage
what is the costal margin formed by?
The costal margin is the medial margin formed by the cartilages of the seventh to tenth ribs. It attaches to the body and xiphoid process of the sternum. The thoracic diaphragm attaches to the costal margin.
what forms the cartilaginous caps?
Formed by the costal cartilages of ribs 11 and 12 anterior ends. These cartilages connect the ribs to the sternum, providing flexibility and support to the lower rib cage.
what are Intercostal spaces?
Intercostal spaces are the spaces that are found between these ribs, within each of these spaces, as previously seen in the costal queue, we’re gonna have the nerve, artery and vein.
what is subcostal space
The space below rib 12 is called the subcostal space.
how many intercostal spaces are there?
There are only 11 intercostal spaces (as we count the space in between the ribs etc like drawing 3 straight lines and counting the space in between them = 2 spaces)
what do intercostal spaces include?
Basically, intercostal spaces include; muscles, membranes, blood vessels and nerves
label this intercostal space diagram
what are apertures?
Apertures are basically openings;
how many apertures do you have and name them?
you have one at the top and one at the bottom known as Superior thoracic aperture & inferior thoracic aperture.
what does the thoracic cage contain?
The thoracic cage does contain the organs of respiration and cardiovascular, however they are also transitioning areas to allow for structures to pass through it to go either from the inferior end to the superior end or vice versa.
what is the thoracic cage a passageway for?
Passageway allowing communication between Neck & upper limb and Thorax & abdomen
superior thoracic aperture distinct characteristic
Superior thoracic aperture is a lot more structured in terms of being a lot more horizontal.
what are the superior thoracic aperture boundaries?
We start off with the Posterior boundary, being the body of T1.
We then go Laterally to the 1st rib, the 1st costal cartilage
And then we go over the margin off the Anterior: manubrium, all the way bacm to the same point.
This is a narrow region, but lots of structures pass through it
what are the contents of the superior thoracic aperture
Contents:
- Trachea, comes from the pharynx region
-Oesophagus, comes from the pharynx region
-Lots of Nerves (cranial nerves and nerves that supply the aspects like the diaphragm )
-Arteries, veins and other Vessels – head, neck & UL
-A lot of these structures that will go up and supply the head and neck and some structures that would drain the head and neck towards the heart
Inferior thoracic aperture distinct characteristic
It is a lot less structured, anterially is it much more superior, posteriolly a lot more inferior
what is the inferior thoracic aperture made up of?
It is made up of the vertebra at the back, the costal margin on either side ans the bodies of the ribs.
label this posterior view of vertebral column with the parts of the vertebra/spine
label this Typical vertebra
label this superior view of thoracic vertebra
how much vertebrae does the sacrum have?
Has Five fused sacral vertebrae
The black dotted line represents the fusion line
The region at the top (circular type of pool shape, is pointing into the pelvis, is seen specifically with the gyno because they want to know how much space there in there when the baby passes through during labour.
This is an anterior view. Caved towards the posterior part
what is the canal in the sacrum?
Posteriorly you can see the canal (the hole like opening at the top of the sacrum) this is where all the nerves from the spinal cord will eventually pass through because the spinal cord ends at the level of L1 and L2, it is all the nerves that actually lie in it. You will find that all the spinous processes now seem to have connected to each other and so have these bumps to form crests.
what is the Coccyx ?
Very insignificant bone but also very important
what generally are the joints of the vertebral column?
- There’s lots of joints in the vertebral column
- These vertebra don’t work singularly, they work as a column, to keep them as a column we do need to have ligaments in place, however we still want to allow for that small little range of movement between each of those vertebra.
- When we are looking at the joints, we’re going to be looking at all the articulations with the body. All the articulation with the spinous processes or the vertebral arches themselves.
what do the joints of the vertebral column include?
- Vertebral bodies
- Vertebral arches
- Craniovertebral joints; these are the ones where the vertebrae articulate with the skull. We do that in head and neck anatomy
-Atlanto-axial - Atlanto-occipital
-Costovertebral joints
-Sacroiliac joints
what is Herniation of IV discs
Degeneration/weakening of the anulus fibrosus and there’s escaping of the gelatinous mass in a certain direction, most commonly that mass will move towards the vertebral foramen, which will put pressure on the spinal cord, the reason that happens is because that most of the other parts of this vertical column is actually covered by ligaments and so therefore it can’t really escape.
When you do Hyperflexion of vertebral column a herniation will happen
As its Compression anteriorly
Nucleus pulposus squeezed posteriorly
This is commonly called a “Slipped-disc”, which basically means as we get older the discs arent holding its shape as much as it should be
its Compression of spinal cord
what is anterior longitudinal ligament?
Anterior longitudinal ligament is another ligament that holds the vertebral body . This is a anterior to posterior view, in this image you can see this T9 in top half of the image, we have cut out some of the bodies of T9, 10 and T11, you can see some of the vertebral bodes of T12 there and you can see on the anterior part of the body, we have this ligament that runs longitudinally called the anterior longitudinal ligament, it covers the entire body, including the intervertebral discs.
what is Posterior longitudinal ligament?
Posterior longitudinal ligament: With the posterior part of the vertebrae, you have a much thinner longitudinal ligament
It is shown in the second image above, circled. straw/tube type structure
what are Zygoapophysial joints?
The joints between each of the vertebral arches are these Zygoapophysial joints
These joints are really interesting, one of the main jobs of chiropractors and the physiotherapists, as there’s lots of issues around these joints as they work similarly they need to eventually work as a column
They can also be called Facet joints but the technical name is preferred
They are Plane synovial joints so they move a joint
what is Ligamentum flavum ?
Also called the Yellow ligament
Goes from Lamina to lamina
The blue joints circled in red in the second image is the ligamentum flavum
We should be able to see this structure both arterially and posteriorly depending on the space that we find in the vertebrae.
All of these vertebrae/ligaments are holding the contents of the vertical column in its place but also holding the vertebraes together to allow them to work as a single unit.
what are the 3 types of Abnormal curvature ?
Sometimes we have too much curvature in certain regions or a change in the curvature.
Comonly found in the elderly is kyphosis – exaggerated thoracic curvature. Due to the beinding of the body, the less use of this region, your going to get lots of being in this region
Another abnormal curvature is scoliosis, instead of being exaggerated in any direction it’s going to be going up laterally. Some of these curvatures are associated with congenital diseases/aspects as well.
Lordosis is the exaggeration curvature of the lumbar curvature only
what are Costovertebral joints?
-joints of the head of ribs
-Articulates w the Head of rib with corresponding vertebra via superior costal facet, Inferior costal facet of vertebra above, Intervertebral disc
-It is a Synovial plane joint, most of the joints around the vertebral column are synovial, except for intervertebral discs.
what are Costotransverse joints?
Found between transverse process of same vertebra to tubercle of rib
Synovial plane joints
what are the Movements of thoracic wall ?
- Bucket handle which is Transverse and Superior-inferior movement.
- Water pump etc when u breathe in deeply where the sternum lifts upwards towards the head, its pulling the ribs as it moves upwards, which is called the bucket handle , it is Anterior-posterior, Superior-inferior movement.
-Calliper is a Transverse movement Technically it is part of the bucket handle, if you move both vertebra on either side it increases transverse diameter.
label this typical vertebrae structure
what is the vertebral column made up of?
What are the muscles of the anterior Axioappendicular muscles?
The anterior axioappendicular muscles are the:
Pectoralis major.
Pectoralis minor.
Subclavius.
Serratus anterior.
scalene muscles (neck)
what is the Pectoralis Major and its location
The pectoralis major is the superior most and largest muscle of the anterior chest wall. It is a thick, fan-shaped muscle that lies underneath the breast tissue and forms the anterior wall of the axilla.
What is the pectoralis minor
Pectoralis minor is a small muscle in the anterior chest wall that attaches from the ribs to the coracoid process of the scapula, and assists with stabilisation of the shoulder complex, protraction of the shoulders, and plays a small role in elevating the ribs for inspiration.
difference between pec major and minor muscles
what is Serratus anterior muscle?
The serratus anterior is a fan-shaped muscle that originates on the superolateral surfaces of the first to eighth ribs or the first to ninth ribs at the lateral wall of the thorax and inserts along the superior angle, medial border, and inferior angle of the scapula.1 Feb 2024
what are the scalene muscles?
The scalene muscles are three paired muscles (anterior, middle and posterior), located in the lateral aspect of the neck. Collectively, they form part of the floor of the posterior triangle of the neck. The scalenes act as accessory muscles of respiration and perform flexion at the neck.
what are the Posterior (Superficial) Axio-appendicular muscles
- Trapezius
– Latissimus dorsi
what are the Posterior (Deeper) Axio-appendicular muscles?
– Rhomboid major
– Rhomboid minor
what are the True muscles of thoracic wall
- Serratus posterior superior
- Serratus posterior inferior
- Levator costarum
- Intercostal muscles
- Subcostal muscles
- Transversus thoracis
what is Serratus posterior superior
The serratus posterior superior muscle is a thin, quadrilateral muscle. It is situated at the upper back part of the thorax, deep to the rhomboid muscles.
Where does the serratus posterior superior originates from?
Originates from the lower part of the nuchal ligament, and the cervical and thoracic spines (usually C7 – T3).
Where does serratus posterior superior inferially attach from?
It inserts on the upper borders of ribs 2–5
serratus Posterior superior muscle anatomical image
The difference between serratus posterior and inferior ?
What is the Serratus posterior inferior?
The serratus posterior inferior is a muscle within the intermediate compartment of the back. It lies deep to the latissimus dorsi muscle in the lower back.
Where does serratus posterior inferior superiorlly attach from?
the spinous processes of T11 to L2 vertebrae, and the intervening supraspinous ligament.
what is the Levator Costarum
The levatores costarum (or levator costae) muscles are paired muscles of the posterior thorax. They number twelve on each side.
What is the Superior attachment of levator costarum?
Transverse processes of
C7-11 vertebraes
What is the inferior attachment of levator costarum?
Subjacent ribs between
tubercles & sternal angle
What are Intercostal muscles
- Muscles found in the intercostal spaces, within the ribcage
- consists of Three layers from external to internal and innermost layer they combine to fill the space between the ribs.
what are the external intercostal muscles and where does it attach?
The external intercostals are small muscles located in between each rib they attach superiorally to the inferior border of rib and inferiorally to the superior border of rib below. (attaches to the bottom of 1 rib and the top of another).
what innervates the external intercostals?
the Intercostal nerves
what are the External intercostal
membrane?
The external intercostal membrane is the sternal (anterior) continuation of the external intercostal muscles in the intercostal space. It ends on the sternum. (The external intercostal membrane continues in the direction of the sternum, specifically its front or anterior aspect.)
What is the Internal intercostal muscles and where do they attach?
The internal intercostals are small muscles located in between each rib they attach superiorally to the inferior border of ribs and inferiorally to the superior border of the rib below.
what are internal intercostal membranes?
The internal intercostal membrane is the thin fibrous tissue that arises from the posterior end of the internal intercostal muscles.
What are Innermost intercostal
The innermost intercostal muscles are muscles of respiration. They are the deepest intercostal muscles located in the intercostal spaces.
What is the superior and inferior attachment of the innermost intercostal muscle?
superior: the Inferior border of the rib
inferior: superior border of ribs below
what are Subcostal muscles?
Subcostal muscles are the thin muscles found on the inner surface of the posterior thoracic wall bridging two or three intercostal spaces. Together with the intercostal, serratus posterior, levatores costarum, and transversus thoracis muscles they comprise the intrinsic musculature of the chest wall.
what is the superior attachment of subcostal muscles
Internal surface of lower
ribs near their angles
what is the inferior attachment of subcostal muscles?
Superior borders of 2nd
or 3rd ribs below
what are Transversus thoracis muscle?
a thin, triangular, muscular layer, with transversely oriented fibers, on the inner surface of the anterior thoracic wall that is always in concern during harvesting of the internal thoracic artery. It lies on the inside of the sternum and the sternal costal cartilages.
what is the superior attachment of the transversus thoracis muscle?
Posterior surface of sternum & xiphoid
process
what is the inferior attachment of the transversus thoracis muscle?
Internal surface of costal
cartilages 2-6
what does Diaphragm mean on latin
through wall
which part of the diaphragm is muscular?
The muscular part refers to the outer rim or periphery of the diaphragm where the muscle fibers are concentrate. so the peripheral/away from center part.
what is the central tendon,IVC and aponeurotic part on diaphragm
- aponeurotic part: refers to the portion of the diaphragm that is made up of aponeurosis, which is a sheet of fibrous tissue. The aponeurotic part of the diaphragm is located around the periphery of the central tendon.
- image is cut in half horizontally
What are the 3 parts that make up the muscular bit of the diaphragm?
sternal part, costal part and lumbar part.
What is the sternal part of the muscular diaphragm?
The sternal part originates as 2 muscular slips from the back of the xiphoid process.
What is the Costal part of the muscular diaphragm?
- Wide muscular strips attach to
internal surface of inferior 6
costal cartilages & ribs - Forms left & right domes
What is the lumbar part of the muscular diaphragm?
- Arises from two aponeurotic
arches
– Medial & lateral arcuate ligament. They are located on the posterior aspect of the diaphragm, where the diaphragm attaches to the vertebral column. The medial arcuate ligament is closer to the midline of the body, while the lateral arcuate ligament is more laterally positioned. - Lumbar part consists of:
– Right crus & left crus (cruca; plural). These are muscular bands that arise from the vertebral column (specifically, the lumbar vertebrae) and ascend to merge with the central tendon of the diaphragm. The right and left crura provide stability and support to the diaphragm, anchoring it to the spine.
What is the diaphragm innervated by?
- Motor supply
– Right & left phrenic nerves (C3,4,5) - Sensory supply
– Phrenic nerve
– Lower Intercostal nerve.
– Subcostal nerve
What are the 3 diaphragmatic apertures?
caval opening, oesophageal opening, and aortic hiatus.
what muscles are in the Superficial layer of the intrinsic back muscles, and their actions?
There are two muscles in this group – splenius capitis and splenius cervicis. They are both associated with movements of the head and neck.
where does the splenius capitis muscle start and end?
starts: posterior mastoid process (just under ball of skull)
ends: spinous processes C7 to T3
so it covers the neck.
where does the splenius cervicis start and end.
start: transverse processes C1 to C3
end: spinous processes T3 to T6
Intermediate layer muscle/s of instrinsic back muscles
Erector spinae which includes the 3 parts ilicostalis, longissimus and spinalis which allows us to stand. Use the acronym “i like standing”
what muscles are in the deep layer of the instrinsic back muscles
Transversospinales, interspinales, intertransversarii, and levator costarum.
What are the transversospinales muscles and what do they include?
Transversospinales muscle group is a deep group of back muscles that lies deep to the Erector Spinae. It lies between the spinous and transverse process. It consists of 3 major subgroups: semispinalis, multifidus and rotatores.
What are the interspinales and where are they found ?
Interspinales muscles (Musculi interspinales) Interspinales muscles are short, paired muscles that belong to the deepest layer of the intrinsic muscles of the back. They extend between adjacent spinous processes of the vertebral column. They are found between the spinous process of vertebrae.
What are the intertransversarii muscles and where are they found?
The intertransversarii muscles function to flex the spine laterally by approximating adjacent transverse processes. They also help to stabilize adjacent vertebrae during large spinal movements. The thoracic intertransversarii muscles are small and are usually only present in the lower thoracic region. They’re found between vertebra above and below the transverse process.
What is levator costarum?
The levatores costarum (or levator costae) muscles are paired muscles of the posterior thorax. They number twelve on each side and attach to the transverse processes of C7 to T11 vertebrae and the ribs below, helping to elevate the ribs during respiration.
Diagrams of deep layer of intrinsic back muscles
What is surface anatomy of thoracic wall and why is it clinically important?
Surface anatomy of the thoracic wall refers to the study of the external features, landmarks, and structures present on the surface of the chest area. These include bones, muscles, ribs, sternum, and other superficial structures visible or palpable on the chest. Surface anatomy of the thoracic wall is essential for clinical examination, diagnostic imaging, surgical procedures, medical education, and effective communication in the healthcare field.
etc CPR, x-rays, surgery
What is the manubrium anterior to?
- bodies of T3 and 4 vertebrae
-the sternal angle: T4-5 IVD and 2nd costal cartilage
What is the body of sternum and xiphisternal joint anterior to
T5-T9 and joint is anterior to Inferior border of T9 vertebra.
costal margin diagram
what does the Anterior Imaginary lines consist of?
- Anterior median line
– Midsternal line
– Intersection of median
plane with anterior
thoracic wall - Midclavicular line
– Passes through midpoint
of clavicle
Medial and lateral(from left to right): midclavicular line, anterior median line and midclavicular line.
label these lines
Medial and lateral(from left to right): midclavicular line, anterior median line and midclavicular line.
what do axillary lines consist of?
right to left
* Anterior axillary line
(AAL)
– Runs along anterior
axillary fold
* Mid-axillary line
– From apex (armpit)
– Parallel to AAL
* Posterior axillary line
– Posterior axillary fold
what do posterior lines consist of?
- Posterior median line
– Midvertebral line
– Tips of spinous
processes - Scapular lines x 2
– Intersect inferior angles
of scapula
what are Intercostal space and what do they consist of?
An intercostal space os the anatomical space between 2 ribs. There are 11 of them.
It consists of a Costal groove which includes From superior to
inferior Vein, Artery and Nerve. And also intercostal muscles and fascia.
difference between cervical, thoracic and lumbar vertebrae
label this vertebrae and state which type it is?
This is a typical thoracic vertebrae.
label this vertebrae and state which type it is?
This is a typical cervical vertebrae.
label this vertebrae and state which type it is?
This is a typical lumbar vertebrae.
