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52 Cards in this Set
- Front
- Back
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3 functions of the thoracic wall
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protects the viscera
Framework for respiration Attachment & support of upper limbs G20/4 |
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2 kinds of costo vertebral joints
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1. of head of rib with vertabrae
2.Costotransverse joint: tubercle of rib with vertabrae synovial joints to allow small rotations of ribs during respiration G20/7 |
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3 kinds of ribs
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1-7 vertebro-costal ribs "true" ribs
8-10 vertebrochondral ribs "false" ribs 11-12 vertebral ribs "floating" ribs G20/8 |
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6 bony features of a rib listed posterior to lateral
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1. head
2. Neck 3. tubercle 4. Angle 5. Shaft 6. Costal groove G20/9 |
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Flail chest
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Fracture of adjacent ribs in 2 or more places
makes free moving section movement in and out with respiration and mediastinal shift impairs both inspiration & expiration G20/10 |
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supernumerary ribs
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"extra ribs"
e.g. a cervical rib G20/13 |
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manubrial land marks
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manubrium is at T3-T4 vertebral level
jugular notch is at T2 vertebral level G20/13 |
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land marks of the sternal angle
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the manubrium & body come together at
- T4/T5 IV disk level - 2nd costal cartilage G20/13 |
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xyphoid process landmarks
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Xyphoid process is T10 Vertebral level
Xiphisternal junction is at -T9 - 7th costal cartilage G20/13 |
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vertebral range of the body of the sternum
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T5-T9
G20/13 |
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Costal cartilages
where are they? & what are they made of? |
They bridge the gap between the ribs & the sternum
they are made of hyaline cartilage G20/15 |
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Where are Costochondral joints?
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between costal cartiladges & anterior end of ribs
*flexible but no movement G20/15 |
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Where are Sterno Costal joints and what kind of joint are they?
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-between the sternum and costal cartilages
-all but the first one are synovial joints -first one is a synchondrosis which acts to maintain thoracic cavity shape while the rest move for inspiration. G20/15 |
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Where is the costal margin?
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Between ribs 7-10
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what is the pyramid that houses the xyphoid process?
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infrasternal angle
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What are the boundaries of the inferior thoracic aperture
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T12
Ribs 11 & 12 Costal cartilages 10-7 Xiphisternal junction -Closed by the diaphragm |
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Structures that pass through diaphrgam to abdomen
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I Ate
Inferior Vena Cava at rib 8 10 Eggs Esophagus at rib 10 At noon Aorta at rib 12 |
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boundaries of superior thoracic aperture and what passes through it
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Body of T1, 1st ribs, & manubrium
Trachea Esophagus Nerves Great vessels |
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What is thoracic outlet syndrome
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tight thoracic outlet puts pressure on:
- subclavian artery -brachial plexus can also be caused by a cervical rib |
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explain pump & bucket handle models for how the thoracic cavity can expand & contract
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Pump handle is seen in the ribs from a sagital view and increases the anterior to posterior area of thoracic cavity
Bucket handle can be seen in the ribs from an anterior view and it expands the side to side area of the cavity |
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Serratus Posterior Superior
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Origin: nuchal ligament & sp C7-T3
Insertion: ribs 2-5 innervation: 2-5 intercostal nerves Action: proprioception & elevates ribs to aid in inspiration |
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Serratus posterior inferior
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origin: T11-L2
Insertion: ribs 9-12 Innervation: intercostal nerves 9-12 Action: proprioception & depress/lower ribs to aid in expiration |
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levator costorum
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Origin: TP of vertabrae
Insertion: surface of rib inferior to vertabrae of origin Action: elevates the ribs aids in respiration |
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Intercostal muscles
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between ribs
Innervation: intercostal nerves (anterior rami) action: elevation & depression of ribs |
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Intercostal muscles of forced inspiration
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external intercostal muscles
-have non muscular membrane anteriorly |
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Intercostal muscles of forced expiration
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Internal intercostal muscles
-have non muscular membrane posteriorly innermost intercostal muscle |
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subcostal muscles
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rib to rib skipping 2-3 ribs
depresses ribs |
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Transversus thoracis
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Origin: costal cartilages of bottom ribs, xyphoid process, body of sternum
Insertion: Costal cartilages of ribs 2-6 Actions: depress ribs |
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Diaphragm shape
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dome shaped with R side higher than L
C shaped central tendon |
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Diaphragm innervation
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Motor & central sensory:
-phrenic nerve (C3-5) Peripheral sensory: lower intercostal nerves |
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Diaphragm posterior attachments
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Right crus forms esophageal hiatus (rib 10)
Right & left Crura together form aortic hiatus(rib 12) via the Median arcuate ligament which connects left crus to right crus |
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Internal thoracic artery
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Source: Subclavian artery
Branches: Anterior intercostal branches |
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Posterior Intercostal arteries
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Branch off the thoracic aorta
1st & 2nd Posterior Intercostal arteries branch of the subclavian artery |
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Thoracic aorta
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Source: descending aorta
Branches: posterior intercostal arteries |
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1st & 2nd superior intercostal arteries
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source Subclavian artery
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Coarctation of the Aorta
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congenital narrowing of the aorta
-results in anastomosing vessels that can cause notching of the ribs that shows up in Xrays |
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Venous drainage of thoracic wall
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Internal thoracic vein (anteriorly)
Azygous system (posteriorly) -Azygos vein (right thoracic wall to SVC) -Hemiazygos vein (inferior left thoracic wall to Azygos vein) -Accessory Hemiazygos vein (superior left thoracic wall to azygos vein) |
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land marks for nipples
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T4 dermatome always
4th intercostal space in a fit individual |
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retro mammary space
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space between breast & pectoralis major muscle
breast is in superficial fascia if breast moves with muscle it can be a sign of metastisis of breast cancer through the retro mammary space |
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Extension of breast tissue into the axilla is called
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axillary tail
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Mammary glands
Origin: What do they do: |
are modified sweat glands
-enlarge at puberty -can lactate |
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structures of the milk canal
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Lactiferous ducts expand into the sinuses
-milk travels from ducts to sinuses and is expressed through the pores common site of cancer origin |
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Breast fibrous CT and its relation to dimpling
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Suspensory ligaments
Tumors can place traction on ligaments causing dimpling |
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Polymastia
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supernumery breasts (extra)
will develop along milk lines like on an animal with many breasts (dog etc) |
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Polythelia
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supernumeray nipples (extra)
will develop along milk lines like on an animal with many breasts (dog etc) |
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Amastia
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No development of breast, nipple is present but no breast tissue
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breast quadrants
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upper outer (always has axillary tail)
Upper inner lower outer lower inner also use clock face to describe and delineate |
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Arterial supply of the breast
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Medial
-Internal thoracic artery branches into medial mammary branches Lateral -Lateral thoracic artery & posterior intercostal arteries give rise to lateral mammary branches |
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venous drainage of breast & link to cancer
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parallels arterial supply
-Most to axillary vein -Some to internal thoracic vein -Some to lateral mammary vein which drain into posterior intercostal veins Can transport cancer to CNS via internal vertebral plexus |
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axillary lymph nodes
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Axillary pyramid:
Pectoral (anterior) nodes, Humeral (lateral) nodes, & Subscapular (posterior) nodes all drain up to the central & then the apical nodes -early area of metastasis of breast cancer |
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lymphatic drainage of breast
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Axillary lymph nodes: 75% of breast lymph
Parasternal lymph nodes: most of remaining breast lymph Supraclavicular lymph nodes: very little direct breast lymph but considered sentinel nodes alternate pathways for breast lymph: -subcutaneous paths to other breast -paths to subdiaphragmic nodes/liver |
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Breast cancer warning signs
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Orange peel sign: rough surface indicating tumor blocked lymphatic ducts
Recent inversion of nipples: from blocked areolar lymph nodes Recent dimpling or abnormal contours: tumor pulling on suspensory ligaments Also be concerned with: -recent asymmetry in breast size -Discharge from nipples -redness of skin of breast |
