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Thorax (I)

Thoracic Wall

Functions of the Thoracic Wall (1) Protect vital thoracic and abdominal organs
Functions of the Thoracic Wall (2) Resist negative internal pressure generated by elastic recoil of lungs and inspiratory movements
Functions of the Thoracic Wall (3) Provides attachment for and support the weight of upper limbs
Functions of the Thoracic Wall (4) Provides anchoring attachment of the muscles that move the upper limbs, abdomen, neck, back and that generates respiration
RIB Curved, flat bones that form most of the thoracic cage
Classifications of the Ribs True Ribs, False Ribs and Floating Ribs
True Ribs (vertebrosternal) 1st-7th; attach directly to the sternum through individual costal cartilage (one to one)
False Ribs (vertebrosternal) 8th-10th; cartilages connected to cartilage of rib superior to them; connection to sternum is indirect (vertebra to cartilage to sternum)
Floating Ribs (vertebral, free) 11th and 12th do not connect with sternum
Components of a TYPICAL rib Head, Neck, Tubercle and Body
Head (Typical rib) Wedge-shaped with two facets that articulate with numerically corresponding vertebra and the vertebra superior to it
Neck (Typical rib) Connects head to the body
Tubercle (Typical rib) At the junction of the head a body; has a smooth articular part for articulating with the corresponding transverse process of the vertebra
Body (Typical rib) Thin, flat, curved most markedly at the costal angle
Components of an ATYPICAL rib 1st, 10th, 11th and 12th ribs
1st rib (Atypical rib) broad, short and very sharply curved; single facet on head articulates with T1 vertebra only. Concave internal surface has costal groove to protect intercostal nerve and vessels
10th-12th rib (Atypical rib) only have one facet (smooth flat area covered by cartilage)
Costal Cartilage extend ribs anteriorly and contribute to elasticity of thoracic wall
Intercostal Spaces separates ribs and costal cartilage from one another; named according to rib forming superior border
Thoracic vertebral characteristics (1) Bilateral costal facets on vertebral bodies for articulation with heads of ribs
Thoracic vertebral characteristics (2) Costal facets on transverse processes for articulation with tubercles of ribs
Thoracic vertebral characteristics (3) Long, inferiorly oriented spinous process, usually overlap vertebrae below
STERNUM Flat, elongated bone that forms the middle of anterior part of thoracic cage; directly overlies much of heart
MANUBRIUM Trapezoidal bone, most superior structure; jugular notch medial landmark, clavicular notches articulate with clavicles bilaterally; sternal angle-formed by manubriosternal joint
Body of Sternum Longer, narrower main structure of sternum
Xiphoid Process Smallest and most variable part of sternum; thin and elongated but varies in form; cartilaginous in young people. It is the midline marker for superior level of liver.
Superior Aperture Bounded posteriorly by T1, laterally by rib 1 and costal cartilage and anteriorly by superior border of manubrium; passes through trachea, esophagus, nerves and vessels
Inferior Aperture Bounded posteriorly by T12, posterolaterally by ribs 11 + 12, anterolaterally by costal cartilages of ribs 7-10 and anteriorly by xiphisternal joint; attachment for diaphragm
Costovertebral joints synovial type; head of a rib articulates with superior costal facet of corresponding vertebra, the inferior costal facet of vertebra superior to it, and adjacent IV disc;
Sternocostal joints synovial type; 1st pair of costal cartilages articulates with manubrium; 2nd 7th pairs of costal cartilages articulate with body of sternum
Three Movements of Thoracic Wall Vertical dimension, anterior-Posterior Dimension, and Transverse Dimension
Movements of Thoracic Wall: Vertical Dimension Increases as diaphragm contracts and descends during inspiration; returns to neutral due to elastic recoil of lungs during expiration
Movements of Thoracic Wall: Anterior-Posterior Dimension Increases with contraction of intercostal muscles; pump-handle movement; primarily ribs 2-6
Movements of Thoracic Wall: Transverse Dimension Increases slightly, raising lateral aspect of ribs; bucket-handle movement; primarily lower ribs
Three Muscles of Thoracic Wall External Intercostal Muscles, Internal Intercostal Muscles, and Innermost Intercostal Muscle
Muscles of Thoracic Wall: External Intercostal Muscles 11 pairs run infero-anteriorly from rib above to rib below ; most active during inspiration
Muscles of Thoracic Wall: Internal Intercostal Muscles 11 pairs; deep to and at right angles to external intercostals ; run infero-posteriorly from rib above to rib below (90 degrees), most active during expiration
Muscles of Thoracic Wall: Innermost Intercostal Muscles Essentially deeper parts of of internal intercostals but are separated from them by nerves and vessels (different from internal intercostal muscles because it has layer of fascia=arteries, veins and nerves)
BREASTS Extends transversely from lateral border of sternum to midaxillary line and vertically from 2nd thru 6th ribs primarily overlying pectoralis major muscle; glandular and supporting fibrous tissue embedded within a fatty matrix
MAMMARY GLANDS subcutaneous tissues, each lobule of gland is drained by lactiferous duct to nipple; suspensory ligaments support lobes of glands
Lymphatic Drainage Much of superior medial and both lateral quadrants drain into axillary nodes (75% drainage), medial portion and inferior medial quadrant drain into parasternal nodes
CLAVICLES Junction of thorax and neck; easily palpable throughout length; medial end articulates with manubrium, lateral end with scapula
STERNUM T3 and T4 vertebrae, anterior to the arch of aorta, jugular notch can be palpated btw sternal ends of clavicles, and has sternal angle where it articulates with sternal body at T4-T5 IV disk
STERNAL ANGLE lies at second pair of costal cartilages, main bronchi pass inferolaterallly from bifurcation of the trachea at level of the sternal angle
SUPERIOR VENA CAVA passes inferiorly deep to the manubrium
Counting Ribs and Intercostal Spaces 1st rib not palpable, begin counting 2nd rib adjacent to sternal angle, intercostal space numbered according to rib forming the superior boundary
ANTERIOR MEDIAN (MIDSTERNAL) LINE the intersection of the median plane with the anterior thoracic wall
MIDCLAVICULAR LINES pass through the midpoints of the clavicles, parallel to the anterior median line
ANTERIOR AXILLARY LINE runs vertically along the anterior axillary fold, which is formed by the border of the pectoralis major as it spans from the thorax to the humerus (arm bone)
Created by: vzapanta



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