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GAR AL01
AL01 - Anatomy of the anterior chest wall & breast
| Question | Answer |
|---|---|
| Jugular notch | Notch located on the superior surface of the manubrium; easy to palpate |
| Manubrium | "handle"; located above sternum body |
| Sternal angle | between manubrium and body; important landmark, easy to palpate |
| Angle of Louis | sternal angle |
| 2nd rib attachment site | sternal angle/angle of Louis |
| Is the sternum flat? | No. The body of the sternum is in a different plane than the maubrium |
| Xiphoid process | Most inferior part of the sternum |
| When does the xiphoid process ossify? | Ages 20-40 |
| Sternum contains the articulating surface for | Ribs 1-7 and the clavicle |
| Costal margin | Upside down V from ribs 7-10 |
| Ribs attach to the sternum via | cartilage at the costochondral joint |
| How many ribs | 12 |
| Intercostal space | space between ribs |
| Rib 12 intercostal space | doesn't exist; called the subcostal space |
| Mid-sternal line | line that goes from the jugular notch down the sternum (black) |
| Mid-clavicular lines | lines that go from middle of clavicle down through nipple |
| Subcostal line | runs along border of costal margin |
| Anterior axillary line | line down from lateral border of pectoralis major |
| Mid-axillary line | line down from apex of axilla (most commonly referenced) |
| Posterior axillary line | line down from scapula or latissmus dorsi muscle |
| Vertebra - how many? | 7 Cervical, 12 Thoracic, 5 lumbar, 5 sacral, and 4 coccyx: 33 total |
| Vertebral body | Large round anterior-most portion |
| Pedicle | between transverse process and vertebral body |
| Lamina | flat areas the form the posterior wall of the vertebral foramen |
| Transverse process | projections on either side of vertebra where the lamina and pedicle meet, between the superior and inferior articular processes |
| Spinous process | spiny process that sticks out posteriorly at the junction of the lamina (easy to palpate) |
| Vertebral foramen | space formed by lamina and pedicle, the spinal cord runs through |
| Articulating process | two each (superior and inferior), where laminae and pedicles meet |
| Articulating facet | area where rib attaches |
| Intervertebral notch | above and below pedicles (in articulated vertebrae, notches form foramen that the spinal nerves pass through) |
| Intervertebral disc | between adjacent vertebrae in the spine, a cartilaginous joint that allows movement and holds the vertebrae together |
| True ribs | 1-7; attach via costal cartilage directly to the sternum |
| False ribs | 8-10; attach to the costal cartilage of rib 7 |
| Floating ribs | 11-12, do not attach anteriorly |
| Posteriorly a rib is attached a few intercostal spaces _____ the anterior attachment | above |
| Anteriorly a rib is attached a few intercostal spaces _____ the posterior attachment | below |
| Head | attaches to vertebra: wide section containing 2 articulating facets |
| Neck | thinner area between head and tubercle |
| Tubercle | bump that includes an articulating facet which connects with transverse process of vertebra |
| Angle | where rib bends anteriorly and inferiorly (curves down about 2 intercostal spaces from back to front) |
| Costal groove | depression on bottom inside of rib where intercostal neurovascular bundle is located |
| Coastal demifacets | Superior and inferior notches on the lateral posterior surface of the vertebral body where the head of the rib articulates |
| Describe attachment of typical ribs to vertebrae | Rib 5 articulates to T5 on T5's superior demifacet and T4's inferior demifacet. The tubercle articulates with the transverse process of T5 |
| Langer lines | the natural orientation of collagen fibers in the dermis and epidermis |
| Clinical application of Langer Lines | surgeons may choose to cut parallel to Langer lines for better healing and less scarring |
| Lateral cutaneous nerves | lateral branches of intercostal nerves which travel to skin surface and help to form dermatomes |
| Pectoralis major attaches to | clavicle, sternum, ribs and humerus |
| Cephalic vein located between what two muscles? | deltoid and pectoralis major |
| clavipectoral/deltopectoral groove/triangle | bordered by i. pectoralis major ii. deltoid and iii. Clavicle |
| deltopectoral groove contains | cephalic vein |
| Pectoralis major innervation | lateral pectoral nerve and medial pectoral nerve |
| Describe lateral pectoral nerve innervation of pectoralis major | lateral pectoral nerve pierces clavipectoral fascia and innervates upper part of muscle |
| Describe medial pectoral nerve innervation of pectoralis major | goes through pectoralis minor before innervating pectoralis major |
| Clavipectoral fascia position | deep to pectoralis major |
| Describe lateral pectoral nerve course and neurovascular bundle | pierces the clavipectoral fascia and runs below the clavicle and above the pectoralis minor with the thoracoacromial artery and thoracoacromial vein |
| The thoracoacromial artery branches off | axillary artery |
| thoracoacromial vein drains into | axillary vein |
| Pectoralis minor position | imbedded in clavipectoral fascia |
| Pectoralis minor attaches at | coracoid process and to the upper ribs (2-5) |
| Pectoralis minor action | Raises the ribs (secondary respiratory) and droops the shoulder |
| Pectoralis minor innervation | medial pectoral nerve – pierces pectoralis minor to innervate lower part of pectoralis major as well |
| Breast located in what fascia? | Superficial fascia |
| Axillary tail | breast extension into the axilla (armpit) |
| Male nipple location | 4th intercostal space |
| Female nipple location | varies; lower than male nipples |
| Areola | circular pigmented area around nipple |
| Nipple | elevated area in middle of areola that contains 15 |
| Areolar glands | small bumps around the nipple in the areola that keep the nipple supple and moist |
| Mammallary crease | area where the breast attaches to the anterior chest wall (around the 6th rib), does not move with aging even if the breasts themselves become more pendulous |
| Glands of Montgomery | Areolar glands |
| Retromamallary space | space between the deep fascia of the pectoralis major and the breast upon which the breast is relatively mobile |
| Suspensory ligaments | holds breast in contour and attaches to the dermis of the skin and breast tissue but doesn’t attach to the deep fascia |
| Ligaments of Cooper | Suspensory ligaments |
| Internal anatomy of breast | 15-20 secretory units arranged radially with lactiferous sinuses toward the nipple |
| Milk line | Mammals can develop breast tissue on a line from the chest to the groin (e.g. cats and cows) |
| Polymastia | extra breasts – commonly alng axilla |
| Polythelia | extra nipples (most common) |
| Gynecomastia | male breasts (feminization) |
| Blood supply to the breast | Lateral thoracic artery - left lateral side of breast; internal thoracic (mammary) artery - medial side of breast |
| Lateral thoracic artery | comes off axillary artery laterally and supplies lateral side of breast |
| Axillary artery | subclavian artery after it runs past the first rib |
| Internal thoracic (or mammary) artery | comes off subclavian artery medially and supplies medial side of breast (located inside chest plate) |
| Best exam: Lump | tumor (or abscess or cyst) |
| Best exam: Dimpling | invasion of suspensory ligaments (or injury) |
| Best exam: Inverted (retracted) nipple | inversion of lactiferous ducts (occurs naturally in 10% of women) |
| Best exam: Peu d’orange (rough, hard, yellow skin resembling an orange peel) | blockage of subcutaneous lymphatics; sweat glands become more prominent |
| Best exam: Warmth | vascular signs (secondary to tumor recruiting blood vessels) |
| Best exam: Less mobile | invasion of underlying deep fascia of pectoral muscles |
| Breast Lymphatics (2 major drainages) | Axillary lymph drainage (more important), Parasternal lymph drainage |
| Which breast lymph drainage is more important? Why? | Axillary lymph drainage because breast cancer has a tendency to metastasize here |
| Parasternal lymph drainage runs | with the internal thoracic artery and vein |
| Where do the breast lymphatic drainages drain? | into the clavicular nodes |
| Where do the clavicular lymphatic nodes drain? | into the large veins of the neck |
| Pectoralis minor location | deep to pectoralis major and clavipectoral fascia |
| Pectoralis major origin | Sternal 1/2 of clavicle, sternum to 7th rib, aponeurosis of external oblique muscle |
| Pectoralis major insertion | Crest of greater tubercle of humerus: Lateral lip of bicipital grove. |
| Pectoralis major action | Clavicular (upper) fibers = flexion of humerus; Sternocostal (middle and lower) fibers = extension of humerus returning from flexion; Adduction, medial rotation |
| Pectoralis minor origin | Ribs 3-5 |
| Pectoralis minor insertion | Coracoid process of scapula |
| Pectoralis minor action | Tilts scapula forward, depresses and abducts scapula, Pulls shoulder forward when rhomboids are weak |
| Innermost intercostal muscles give rise to | transversus thoracis muscles |
| transversus thoracis muscles function | hold down the internal thoracic artery |
| Nerves that supply the intercostal muscles run between | innermost intercostals and the internal intercostals |
Created by:
paul411
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