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41 Cards in this Set
- Front
- Back
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thoracic outlet syndrome (TOS)
-issue -symptoms -risk factors -Tx |
-compression of neurovascular structures b/c of narrowed thoracic outlet (sup thorac aperture)
-Sx: neck & shoulder pain, numbness & weakness in arm & hand, diminished radial pulse -risk: trauma, postural distortions, heavy lifting/throwing, congenital anomalies (cervical rib), working in static positions -Tx: PT, surgery -Costoclavicular syndrome = subtype of TOS |
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costal groove
-location -structures that are there |
-inferior interior margin of rib
-intercostal nerves, arteries & veins |
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intercostal neurovasculature
-location |
-costal groove of superior rib, btwn inner & innermost costal muscles
*small collateral branches of major intercostal nerves & vessels are superior to inferior rib below |
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external intercostal muscles
-direction -action |
-"hands in pocket" (angled inferoanteromedially)
-mostly INspiration; elevate ribs -innervated by intercostals T1-11 |
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internal intercostal muscles
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-"down & out" posterolaterally
-mostly EXpiration; depress ribs -innervated by intercostals T1-11 |
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innermost intercostal muscles
-direction/location -action -innervation |
-lateral thoracic wall, VERTICAL
-EXpiration with internal intercostals -innerv by intercostals T1-11 |
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internal intercostal membrane
external intercostal membrane -locations |
-internal = interior paravertebral
-external = external parasternal (over costalchondral portion of ribs) |
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subcostal muscles
-location -action -innervation |
-internal surface of posterior ribs
-depress ribs (exhalation?) -intercostal nerves |
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transversus thoracis
-location -action -innervation |
-extend from lower sternum & xiphoid to costal cartilages 2-6 (fans out on interior surface of thorax)
-depress costal cartilages -intercostal nerves |
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levatores costarum
-location -action -innervation |
-segmental muscles of back
-elevate ribs -dorsal rami innervation |
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intercostal nerves
-origin -types of nerve fibers (fcns) -# pairs |
-ventral ramus of spinal nerve
-ALL FOUR: somatic motor (intercostal muscles); general sensory (skin); visceral motor (symp to sweat glands, errector pili musc, blood vess); visceral sensory (feedback from sg, ep, bv) -n=11 pairs; T1 to brachial plexus; T2 = intercostobrachial nerve; T3-6 = typical; T7-11 = abd wall; T12 = subcostal n |
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Intercostal nerve block
-what -why -where |
-anesth intercostal nerve after rib Fx for pain relief
-prefer injection at posterior thoracic cage -needle: contact lower border of rib then direct slightly caudad |
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Needle Decompression
-what -why -where |
-needle placed into pleural cavity to remove air in tension pneumothorax
*need to avoid neurovasc'ture -insert needle just superior to a rib (above collat branches but below intercostals) -prefer: 2nd, 3rd or 5th intercostal space @ midclavicular line |
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intercostal arteries
-location -fcn -origin |
-btwn ribs in intercostal spaces
-supply thoracic wall -anterior intercostal arts: upper 6 from internal thoracic, lower 5 from musculophrenic art -posterior intercostal arts: upper 2 from superior thoracic art, lower 9 from thoracic aorta |
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internal thoracic artery
-location -fcn -origin |
-runs along internal surface of thorax parasternal
-origin: subclavian art -branches: anterior intercostal arts (1-6), superior epigastric art, musculophrenic artery (lateral to epigas) |
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Hemiazygous vein
-location -collects blood from... |
-L side, formed by L asc lumbar & L subcostal v; lower end connects to L renal v
-collects from L posterior intercostal T9-11 veins (sometimes accessory hemiazygous) -drains to azygous vein |
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Accessory hemiazygous vein
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-L side
-collects from L posterior intercostals T5-8 -drains to either azygous, hemiazygous, or both |
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Azygous vein
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-R side of body, formed by R ascending lumbar & R subcostal veins-- connects to IVC; also arches over root of R lung to empty into SVC
-receives blood from R superior intercostal (2-4) & remaining posterior intercostals on R side of body. |
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brachiocephalic vein
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-collects blood from: L super intercostal (union of L poster intercostal v 2-4)
*1st super intercostal --> brachioceph or vertebral vein |
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Subcostal vein
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-below rib 12
-unites w/ asc lumbar vein to form hemiazygous vein |
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thoracic splanchnic nerves (greater, lesser, least)
-location/path -fcn -type of nerve |
-posterior mediastinum pierce diaphr, synapse in pervert abd ganglia
-innerv abd & pelvic viscera -sympathetic |
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mediastinum sections
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-superior: above trach bifurc (T4)
-inferior: below trach bifurc (T4) --anterior: --middle: --posterior: |
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Superior mediastinum structures
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SVC, brachiocephalic veins, aortic arch, thoracic duct, trachea, esoph, thymus, vagus, L recurrent laryngeal, phrenic n.
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Anterior mediastinum structures
(inferior) |
remnants of thymus, lymph nodes, fat
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Middle mediastinum structures
(inferior) |
heart, pericardium, phrenic nerves, roots of gr vessels, arch of azygous vein, main bronchi
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Posterior mediastinum structures
(inferior) |
esophagus, thoracic aorta, azygous & hemiazygous veins, thoracic duct, vagus nerves, symp trunks, splanchnic nerves
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Sternal angle
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btwn manubrium & sternum
-T4 -same level as tracheal bifurc (& divis btwn sup & inf mediastinum) |
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Carina
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last tracheal cartilage
-separates openings of R & L primary bronchi *R prim bronchus is shorter & wider than L (easier to aspirate obj here) |
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Muscles of inspiration
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-diaphragm
-external intercostals -sternocleidomastoid -levator costarum -serratus (anterior, posterior sup) -scalenes -pectorals |
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Muscles of expiration
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-internal & innermost intercostals
-anterior abdominals -serratus posterior inferior -passive expiration = passive, due to elastic recoil of lungs |
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Moderator band (septomarginal trabecula)
-location -fcn |
-bridges IV septum & base of anterior papillary muscle of R ventricle
-contains R limb (Purkinje fibers) of AV bundle |
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SA node (pace maker)
-location -fcn |
-in myocardium at upper end of crista terminalis
-initiates heartbeat -pulse from SA node--> AV node in interatrial septum --> AV bundle (of His) along membranous part of IV septum --> terminal Perkinje fibers branch R & L |
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superior intercostal vein
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-union of 2nd, 3rd & 4th intercostal veins
-drains into azygous v on R, brachioceph on L |
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Thoracic duct
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-begins in abdomen
-drains all parts of body except R head/neck/upperlimb/thorax -passes thru aortic opening of diaphr, asc btwn aorta & azygous vein -goes into jcn of L internal jugular & subclav veins |
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R lymphatic duct
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drain what thoracic doesn't:
R head, neck, upper limb, thorax |
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Greater splanchnic nerve
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-origin: T5-9 symp ganglia
-ends in celiac ganglion -pregang symp visceral motor & visc sens -visc mot: cell bodies = lateral horn of spinal cords -visc sens: cell bodies in DRG |
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Lesser splanchnic nerve
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-T10-11 symp gang
-end in aorticorenal gang -same as gr spln |
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Least splanchnic nerve
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-T12 symp gang
-ends in renal plexus -same as gr & ls spln |
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White rami communicantes
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-contain:
pregang symp visc motor (cell bod in lat horn) visc sens (cell bod in DRG) -connected to spinal nerves T1-L2 ONLY |
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Gray rami communicantes
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contain postgang symp visc motor (cell bodes in symp chain gang)
-supply bv, sweat glands, arrector pili musc |
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placement for thoracentesis
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btwn ribs 7-9, at or posterior to midaxillary line
(below fluid level) |
