Thoracic Wall

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Name the three parts of the sternum.: manubrium
body
xiphoid process
Which ribs are true ribs? false ribs? floating ribs? and describe their characteristics.: 1-7 attach to sternum
8-12 have costal cartilages that don't attach to sternum
11-12 lack costal cartilage
Which ribs are typical? Describe the parts that make them typical.: 3-7
head
tubercle
shaft/body
What does the head of the rib articulate w/? the tubercle?: The head articulates w/ the body of corresponding vertebra and the vertbra immediately superior
The tubercle articulates w/ the transverse process of corresponding vertebra.
What does the inferior surface of the shaft or body house?: intercostal vein, artery & nerve
What makes the 1st rib atypical?: prominent scalene tubercle where anterior scalene muscle inserts on its superior surface
Which ribs are atypical?: 1,2,8-12
What makes the 2nd rib atypical? what attaches to it?: it has a scalene tubercle where the posterior scalene muscle attaches
What makes ribs 11 & 12 atypical? (4 things): free
lack angle
end posteriorly
help protect kidneys
What makes ribs 8-10 atypical?: costal cartilage extensions
What do ribs 8-10 create?: costal margin of the thoracic cage
Where do ribs typically break?: near their angle
Describe the cervical rib. What can it lead to?: elongation of the transverse process ossification center of the 7th vertebra
can compress brachial plexus nerves or subclavian artery
associated w/ thoracic outlet syndromes
Discuss facets/demifacets T1 T2-9 T11-12: T1-facet for rib 1
demifacet for head of rib2
T2-9 2 demis for rib heads
T11-12 1 facet for resp rib heads
The superior edge of the manubrium forms what? What attaches to it?: forms suprasternal (jugular notch)
clavicles, rib 1 and half of rib 2 attach
What articulates w/ the body of the sternum?: manubrium
ribs 2-7
xiphoid process
What are 3 sternal anomalies? Describe them: pectus excavatum-sunken chest
pectus carinaum-pigeon chest
sternal fistula-holes in sternum
Discuss ossification of the sternum.: -it ossifies w/ age
-several centers of ossification
-xiphoid process doesn't fuse until middle age
What is the synovial joint between the head of the rib and body of vertebra at a facet or demifacet?: costovertebral joint
What is a synovial joint between tubercle of the rib and transverse process of the thoracic vertebra?: costotransverse joint
Describe the characteristic of costotransverse joints at T1-7? T8-10?: fairly curved joint (1-7)
fairly flat joint (8-10)
What is a sternocostal joint?: A cartilaginous joint between 1st rib and manubrium
What is the union of rib bone w/ hyaline cartilage of the same rib?: costochondrial joint
What do external intercostal muscles do?: function to raise ribs during inspiration
What do internal intercostal muscles do?: interchondral portions anteriorly raise ribs and lateral fibers depress ribs
What do innermost intercostal muscles to?: keep intercostal space from bulging during respiration
Which muscles are on the inner surface of the thoracic wall?: transverse thoracic muscles
subcostal muscles
Where do the transverse thoracic muscles originate? insert?: on the inner surface of the sternum
insert onto inner anterior surface of ribs 2-6
What do the transverse thoracic muscles do?: depress ribs during exhaling
Where do subcostal muscles attach?: to inner surface of the lower ribs on posterior portion of thoracic wall
What do the subcostal muscles do?: elevate ribs
Which muscles are on the back/posterior/external surface of thoracic wall?: serratus posterior superior
serratus posterior inferior
levator costarum
Origination and insertion of serratus posterior superior?: originate-nuchal ligament and spinous process of C7-T3

inserts-superior posterior border of ribs 2-5
What is the function of the serratus posterior superior?: raise ribs during inspiration
Origination and insertion of serratus posterior inferior?: originate-spinous process of T11-12
insert-inferior posterior border of ribs 9-12
What is the function of serratus posterior inferior?: depress ribs during experation
Origination and insertion of levator costarum?: originate-transverse process of C7-T11

insert-upper posterior edge of the rib just inferior
What is the function of levator costarum?: elevate ribs during inspiration
What are the muscles superior to the thoracic cage (neck muscles)?: anterior scalene muscle
middle scalene muscle
posterior scalene muscle
What is the fuction of the scalene muscles?: elevate ribs during inspiration
Where does the anterior scalene muscle originate and insert?: originate-transverse process of C3-C6

insert-scalene tubercle of 1st rib
Where does the middle scalene muscle originate and insert?: originate-transverse process of C2-C7

insert-1st rib posterior to subclavian artery groove
Where does the posterior scalene muscle originate and insert?: originate-transverse process of C5-C7

insert-upper surface of 2nd rib
Which muscles are responsible for raising ribs during inhalation?: external intercostal muscles
subcostal muscles
serratus posterior superior
levator costarum
anterior scalene muscle
middle scalene muscle
posterior scalene muscle
Which muscles are responsible for depressing ribs during exhalation?: transverse thoracic muscles
serratus posterior inferior
Name the muscles of the upper extremity that attach to the thoracic cage.: pectoralis major
pectoralis minor
serratus anterior
Origination and insertion of pectoralis major.: originate-costal margin, sternum and medial clavicle

insert-crest of greater tubercle of the humerus
What is the function of pectoralis major?: flex, adduct and medially rotate the arm
Origination and insertion of pectoralis minor.: originate-outer surface of ribs 3-5

insert-caracoid process of scapula
What is the function of the pectoralis minor?: pulls scapula down and anteriorly
Origination and insertion of serratus anterior.: originate-upper, outer surface of ribs 1-8

inserts onto medial angle, vertebral boarder, and inferior angle of scapula (undersurface of scapula)
What is the function of the serratus anterior?: pulls scapula forward
Where are intercostal nerves located?: between the internal and innermost intercostal muscles, partially under the groove of the superior rib
Name the two branches of the intercostal nerves and where they branch to.: lateral cutaneous branches to the skin
anterior cutaneous branch near the sternum
Which nerve is associated w/ T12? T1-11?: subcostal nerve (12)
intercostal nerves
What is located in the intercostal space?: nerve
artery
vein
Where do intercostal arteries come from?: thoracic aorta
Where are intercostal nerve blocks generally injected?: -near the intercostal nerve and its collateral brances
-towards the top and bottom of each intercostal space
What can coarctation of the aorta lead to?: increased blood flow within the intercostal arteries
What characteristic of coarctaion (stenosis) of the aorta can be seen on AP chest films?: costal notching of the under surface of the ribs due to engorgement of the intercostal arteries
Which dermatomes are common sites of eruption of shingles?: thoracic and lumbar, some on face
What route does shingles take to get to the dorsal root ganglia?: peripheral sensory nerve
Blood within the intercostal arteries comes from what?: thoracic aorta
internal thoracic artery (internal mammary artery)
Name three blood vessels that serve the thoracic cage.: subclavian artery
supreme intercostal artery
axillary artery
Describe the veins of the thoracic wall.: 11 posterior intercostal vein
1 subcostal vein
they drain into the azygos venous system, which returns blood to the superior vena cava
Where does the nipple lie?: 4th intercostal space for males and prepuberal females
Which muscles does the breast develop on?: pectoralis major (2/3)
serratus anterior (1/3)
What attaches the breast to the skin?: suspensory ligaments
How many lobes of glandular tissue drain into corresponding lactiferous ducts?: 15-20
What allows the breast to move independent of the underlying muscle?: retromammary space-loose areolar CT behind the breast on the deep perimysium
Which arteries supply blood to the breast?: -perforating braches of the internal thoracic (internal mammary)
-anterior and posterior intercostal
-lateral thoracic branch of axillary artery
(venous drainage is through the same named veins, w/ most into axillary)
Where does lymphatic drainage of the breast go?: -75% to axillary lymph node (mainly pectoral nodes)
-medial quadrant drains to parasternal node
Explain a breast exam. What do you look for? How is it done?: -look for thickening of skin, masses, dimpling & flattening
-raise & lower arms, press arms against hips, palpation
What is polythelia? polymastia? Where do they develop?: -additional nipple
-additional breast
along embryonic mammary ridge
What is Gynecomastia? What are the causes?: -excessive development of the male mammary gland
-ductal proliferation and periductal edema, occurs at puberty and in obese males due to increased estrogen
What is the superior thoracic aperture bound by? What is its shape?: -T1 vertebra, rib 1 and superior boarder of manubrium
-kidney bean shaped
Name 2 thoracic outlet syndromes and describe their characteristics.: costoclavicular syndrome-coldness of upper arm caused by lack of blood flow due to compression of subclavian artery as it passes over 1st rib & under clavicle
Cervical rib syndrome-Compression of C8-T1 nerve roots as they pass over 1st rib
What do the pleural cavities contain?: lung and pleural membranes
What does the mediastinum contain? (5 things): heart, great vessels, trachea, esophagus, thymus
Name 2 things the thoracic diaphragm is responsible for.: -separates thorax from abdomen
-principal muscle of inspiration
What forms the thoracic diaphragm?: skeletal muscle and a central tendon
How high does the right dome of the diaphragm reach? left?: -4th intercostal space
-5th intercostal space
liver on R side pushes diaphragm up
What is the diaphragm derived from?: -septum transversum
-myoblast of 3rd, 4th, & 5th cervical myotomes (pleuroperitoneal fold)
What keeps the diaphragm alive?: C3, 4, 5
What are the 3 major openings in the diaphragm?: T8-inferior vena cava hiatus (caval hiatus)
T10-esophageal hiatus (allows vagal trunks to enter abdomen)
T12-aortic hiatus(allows thoracic duct and azygos vein to enter abdomen)
What are the peripheral attachments of the diaphragm?: medial & lateral arcuate ligament, sternal and postal part, lumbar part w/ 2 aponeurotic arches, L & R crura of the diaphragm on each side of vertebral bodies
What are the sensory parts of the diaphragm?: central phrenic nerve (C3,4,5); peripherally intercostal and subcostal nerves T5-12
What arteries supply the diaphragm?: -pericardiaophrenic artery, branches from internal thoracic artery near apex of thoracic cage=central supply
-musculophrenic artery-branches from internal thoracic artery near costal margin=anterior supply
The pericardiaophrenic artery runs w/ which nerve?: phrenic

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