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Thoracic wall
Short notes on thoracic wall
| Thorax is an irregularly shaped cylinder with narrow opening superiorly and larger opening inferiorly. consists of segmentally arranged vertebrae,ribs,muscles and sternum. Thoracic cavity is enclosed by thoracic wall and diaphragm. |
| It incudes left and right plueral cavity Mediastinum |
| FUNCTIONS Breathing Protection of vital delicate organs provide surface for muscle attachment. Support weight of upper limb. Conduit - allows structures to pass thru thorax completely to other regions of the body. |
| COMPONENTS OF THORACIC WALL Posteriorly- 12 TVs Laterally- 12 ribs on each side, 3 layers of flat muscles in the IC spaces. Anteriorly- by sternum |
| Articulation of ribs. Each rib articulates with body of its own vertebrae @ superior coastalfacet and to superior vertebrae @ inferior costal facets As the ribs curve posteriorly they attach to costal facet of transverse process. |
| Costal cariladges of ribs 1-7- attach to sternum ( True ribs) CC of 8to 10- attach to inferior margins of costal catiladges above them .(False ribs) CC of 9to 12- don't articulate to other ribs. (floating ribs) |
| Typical ribs (3-9th ribs) 3parts; Head- has 2 facets articulate with corresponding vertebrae articulates with superior vertebrae. Neck; connect head and tubercle Tubercle, smooth-attach2T.process, rough- costotransverse ligament to process |
| Superior T. Aperture For communication with neck and upper limb. Posterior- T1 vertebrae Laterally- R1&2 pairs and their cc Anterior- superior border of manubrium. Structures are ; trachea, esophagus, vessels and nerves. |
| Inferior T. Aperture Allows communication btwn thoracic c & abdomen. Diaphragm closes and separate abdomen and thorax. Posterior- T12 vertebrae Posterolaterally- 11&12 pair of ribs Anterolaterally - joint cc of ribs 7-10 Anterior-Xiphisternal joint |
| STERNUM Contains manubrium, body and xiphoid process Manubrium Is superior part Lies at bodies of T3,4 Has jugular notch, superiorly Clavicular notch on both sides- articulate with clavicle inferiorly is attachment of cc of 1st rib. |
| Sternal angle Formed by manubrium and body of sternum , since they lie in different planes . It is palpable lies opposite 2nd pair of costal cartiladges btwn T4and T5. |
| Body of sternum It is longer,narrower,thinner than manubrium width varies due to costal notches laterally |
| Xiphoid process Smallest part Cartilaginous in young pple and ossified in older pple(40yrsabove) Xiphisternal joint at T9 marks: superior level of liver central tendon of diaphragm inferior border of the heart |
| JOINTS OF THORACIC WALL Occur btwn: Vertebrae - Symphsis joint ant& post longitudinal ligaments 2.Ribs and vertebrae- Synovial plane joint Has costovertebral&costotransverse joints Radiate & intraarticular ligaments |
| 3.Sternocostal joints(sternum&cc) R1- primary cartilaginous joint R2-R7- Synovial plane joints Ant &post radiate ligaments 4.Sternoclavicular joint(sternum&clavicle) Saddle type of synovial joint Ant &post sternoclavicular and Costoclavicular ligam |
| 5.Costochondral joints (ribs &cc) Primary cartilaginous joint Bound by periosteum. 6.Interchondral joints (btwn cc) btwn R6-R9 Synovial plane joint Interchondral ligaments |
| 7.Manubriosternal joint Secondary cartilaginous joint (symphysis) 8.Xiphisternal joint Primary cartilaginous (synchondrosis) Fuse in eldery pple to become synotosis. |
| MUSCLES OF THORACIC WALL External ICM; replaced by External IC membrane Internal ICM; replaced by Internal IC membrane * lateral ends Innermost ICM; located at lateral parts of IC spaces. |
| Table 3.2 Muscles of the thoracic wall |
| Muscle: Superior attachment :Inferior attachment :Innervation :Function |
| External intercostal : O:Inferior margin of rib above I:Superior margin of rib below NV: Intercostal nerves;T1–T11 F:Most active during inspiration, support IC space, moves ribs superiorly |
| Internal IC O: lateral edge of costal groove of rib above I:Superior margin of rib below NV: Intercostal nerves T1-T11 F:Most active during expiration; supports intercostal space; moves ribs inferiorly |
| Innermost intercostal O: Medial edge of costal groove of rib above I: Internal aspect of superior margin of rib below NV: Intercostal nerves; F: Acts with internal intercostal muscles |
| Subcostales O: Internal surface (near angle) of lower ribs I: Internal surface of second or third rib below NV: Related intercostal nerves F: May depress ribs |
| Transversus thoracis O:Inferior margins and internal surfaces of costal cartilages of second to sixth ribs I: Inferior aspect of deep surface of body of sternum, xiphoid process, and costal cartilages of ribs IV–VII NV: Related intercostal nerves |
| F:Depresses costal cartilage. |
| ARTERIAL SUPPLY OF WALL 1.Posterior Intercostals O: Supreme intercostal arteries, Thoracic aorta C: Passes between internal and innermost IC muscles S: Intercostal muscles |
| 2. Aterior Intercostals O: Internal thoracic arteries,Musculophrenic arteries C: Between internal and innermost IC muscles S: IC muscles ,skin and parietal pleura |
| 3.Internal thoracic O: Subclavian artery C: Passes inferiorly ,lateral to sternum btwn castal cartilages and internal IC muscles to divide into superior epigastric and musculophrenic arteries S:IC spaces 1-6 & musculophrenic ic spaces 7-9 |
| 4.Subcostal O: Thoracic aorta C: Along inferior border of R12 S:Anterolateral abdominal wall muscles and overlying skin . |
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irvene
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