Thorax

Front 1

Thoracic outlet/inlet:
bounded by what?
What unique feautes?
Has grooves for what and where?

Back 1

1st thoracic vertebrae, first rib,, sternum.
short, curved, only one facet,, has scalene tubercle and grooves for subclavian vessels on upper surface. Brachial plexus also goes along with subclavian here.
If a cervical rib is present, can compress subclavs or brach plex.

Front 2

Atypical ribs:
Which ones and how?
false ribs?

Back 2

1: only one facet, curved.
2: same as first but longer.
10-12: articulate only with corresponding vertebrae and only indirectly
false ribs are 8-10 (vertebrachondral)
11-12: no neck or tubercles

Front 3

Rib fractures:
Which ones are common and which ones not?
What can happen with multiuple fractures?

Back 3

frac of 1st not that common but if happpens brachial plex or subclav vessels can get hurt.
-flail chest: front or side of thoracic wall can move opposite to rest of chest. impairs ventilation and very painful.

Front 4

Thoractomy, intercostal space incision,, rib excision

Back 4

anterior one: make H-shaped cuts through perichondrium of COSTAL cartilage to access thoracic cavity.
posterior one: 5th -7th intercodstal spaces.
lateral approach is best: lay patient on side and abduct arm. socan reach under scapula (can remoive a lung and shit this way)

Front 5

how ribs connected to vertebrae and by what
what about T1?

Back 5

superior and inferior demifacets connect with heads of ribs.
facets (costal) connect with tibercles of ribs
[T1 doesn't have a demi-facet because c7 has none for c7 don't connect to no rib. so t1 is that ribs only articulation in da back]

Front 6

what is xyphoid process confused for later?

Back 6

some older people think its a tumor but its just xyphoid process which has ossified.

Front 7

Sternal fractures:

most common site?

main concern with these?

Back 7

not that common but happen like in car accidents.
often many places at once. pieces wont displace for invested in deep fascia and pecs keep in place.

-at sternal angle,, after the manubriosternal joint has fused.

-damage to heart (myocardial contusion, cardiac rupture, tamponade) or pulmonary injury.

Front 8

Median Sternotomy

Back 8

For surgeries in chest.
Breaking of sternum at median plane and retracting sides.
(works due to flexibility of ribs and costal cartilage).

Front 9

Sternal abnormalities:

Back 9

sometimes the two cartilaginous halves of sternum don't fuse as a fetus.
can leave opening or "sternal foramen"

Front 10

Thoracic inlet is and has:
Thoracic outlet is and has:

Back 10

both names for the superior thoracic aperature. called inlet when referred to as incoming location of food and ait and referred to as outlet when referring to arteries and t1 nerves that leave this area to hit lower neck and upper limbs.
remember extra rib here can cause problems...

Front 11

Types of joints in sternum:

Back 11

Vertebrae (intervertebral)
ribs and vert (costovertebral joints... heads of ribs and costotransverse joints)
ribs and costal cartilage (costochondrial joints)
costal cartilages (interchondral joints)
sternum and costal cartilages (sternocostal joints)
sternum and clavicle (sternoclavicular joints)
Manubriosternal and xiphisternal in young people before they fuse in oldies)

Front 12

Dislocation of ribs:
usually involved?

Separation of ribs?

Back 12

usually with 8-10 ribs.its a displacement of costal cartilage from sternum.
often injures underlying structures/.

-this is when the rib unattaches from its own cartilage (perichondrium and periosteum usually occurs)

Front 13

During passive expiration what happens?

during passive inspiration what happens? what does diaphragm do here?

Back 13

-in expiration, the diaphram intercostal muscles and other muscle srelax to decrease introthoracic volume and increase pressue.

-during inspiration, opposite happens. during inspir. the thoracic cavity vertical dimension reaches its heighest (as diaphragm contracts.)

Front 14

Pump handle movement?
mostly what ribs?

Back 14

at costovertebral joints, the necks of ribs cause the anterior ends of ribs to rise as intercostal muscles contract.
(mostly ribs 2-6).
enlarges cavity in A-P axis.

Front 15

Bucket handle movement:

Back 15

Transverse dimension of thorax enlarging.
increases when intercostal muscles contract (raise the outer most part of ribs)

Front 16

What does intervostal space contain?
how many are there?
WHERE does all this lie??!

Back 16

[there are 11 intercostal spaces]
each has 1 intercostal nerve,, its collateral branch,, 1 posterior intercostal artery,, its collateral branch, 2 anterior intercostal arteries and intercostal veins.
it all (this neurovascular bundle) lies in the subcostal groove,, near inferior margin of rib above).
[note, below 12th rib is subcostal space and has subcostal vessels and nerves].

Front 17

Paralysis of diaphragm?
what nerve controls it?

Back 17

can affect only one half because each half has separate nerve supply (both from phrenic.
you can detect it because the apralyzed dome ascends during inspiration instead of descending. (abdominal viscera just pushes it up).

Front 18

Surface anatomy of thoracic wall:
clavicles-
sternum at clavicle-
Manubrium-
Sternal angle-

Back 18

- division of lymph drainage: above
- jugular notch which is location of T2.
- at level of T3, T4 (to the right of it is merging of brachiocephalic veins to form Sup vena cava. to the left of it is the arch of the aorta)
- 2nd pair of costal cartilages, t4-t5 IV disc

Front 19

External Intercostal

Back 19

Attaches at inferior border of ribs.
Attaches inferiorly at superior border of ribs below.
Innvervated by intercostal nerve.
Elevates ribs during forced inspiration

Front 20

Internal intercostal

Back 20

Attaches at inferior border of ribs.
Attaches inferiorly at superior border of ribs below.
Innvervated by intercostal nerve.
Interosseous part depresses ribs and Interchondral part elevates ribs during ACTIVE (forced) respiration.

Front 21

Innermost Intercostal

Back 21

Attaches at inferior border of ribs.
Attaches inferiorly at superior border of ribs below.
Innvervated by intercostal nerve.

Front 22

Subcostal

Back 22

Internal surface of lower ribs near their angles.
Attaches inferiorly at superior borders of 2nd or 3rd ribs below.
Innvervated by intercostal nerve.
Act like intercostals.

Front 23

Transverse thoracic

Back 23

ATTACHES posterior surface of lower sternum and inferiorly attaches at internal surface of costal cartilages of ribs 2-6.

Innvervated by intercostal nerve.
Weakly depresses ribs.

Front 24

Dyspnea:

Back 24

Difficulty breathing