Term
| 2 Main Functions of Thoracic Wall |
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Definition
1. Protection of internal organs
2. Breathing
-Acheived by alternating arrangement b/t:
(a) ribs and
(b) intercostal muscles |
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Term
| Thoracic Wall Reference Planes |
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Definition
-Midsternal line
-Miclavicular line
-Anterior Axillary line
-Midaxillary line
-Posterior Axillary line
-Scapular Line (angle of scapula)
-Posterior median line (spinous process of C7)
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Term
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Definition
Abnormal anterior/posterior morphology
-Normally compressed
-Emphysema (COPD) expanded ant/post |
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Term
| Superior Thoracic Aperture |
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Definition
-T1 vertebrae
-1st rib
-Superior border of manubrium
Location of Thoracic Outlet (syndrome) |
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Term
| Inferior Thoracic Aperture |
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Definition
-T12 vertebra
-11th and 12th ribs
-7th-10th costal cartilage
-Xiphisternal joint |
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Term
| Thoracic Outlet Syndrome (1) Causes, (2) Effects, and (3) location of injury |
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Definition
-Compression of neurovascular structures exiting Superior Thoracic Aperture (T1 nerve, Subclavian A.)-
*occurs outside aperture
Causes: anatomical defect (extra rib), poor posture, heavy weight and trauma
5 P's:
-Puleslessness, Parasthesia, Paralysis, Pallor, Pain |
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Term
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Definition
Concatve depression of thoracic wall
Cause: intrauterine pressure on the chest wall during development
Complications: heart and lungs |
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Term
| Pectus carinatum (1) causes and (2) complications |
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Definition
Protrusion of sternum and costal cartilages
Cause: CT disorders
Complications: scoliosis and congential heart disease |
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Term
| Layers of Thraic Wall (superficial to deep) |
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Definition
- Skin
- Superficial fascia (fat)
- Intercostal muscles
- External
- Internal
- Innermost
- Endothoracic fascia
- Parietal pleura
- Pleural space
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Term
| Location of neurovasculature in Thoracic Wall |
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Definition
| B/t internal and innermost intercostal muscles |
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Term
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Definition
Target space b/t:
- Internal intercostal muscle
-Innermost intercostal muscle |
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Term
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Definition
Insert into pleural cavity, b/t:
-Parietal pleura
-Visceral plurae |
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Term
| Most fractures occur immediately anterior to the... |
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Definition
| Costal angle- weakest part of rib |
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Term
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Definition
-Atypical
-Boardest, shortest, sharpest curved
-Single facet
-Grooves for subcubclavian A. and V. and scalene (neck) muscle tibercle |
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Term
1st rib rarely fractured because...
If it is fractured, most likely damage... |
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Definition
Protected by clavicle
Internal organs if fractured |
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Term
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Definition
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Term
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Definition
| Tuberosity for serratus anterior and middle scalene muscles |
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Term
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Definition
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Term
| Atypical 11th and 12th ribs |
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Definition
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Term
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Definition
Extra cervical ribs- can cause Thoracic Outlet Syndrome
Extra lumbar ribs
Both associated with misidentification |
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Term
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Definition
True ribs- 1-7- direct articulation with s ternum
False ribs- 8-10 via costal cartilage
Floating ribs 11-12- no articulation |
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Term
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Definition
| Most occur at body of sternum due to seat belt |
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Term
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Definition
| For bone marrow- if you can't at the iliac of hip bone |
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Term
| Rib dislocation vs. Seperation |
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Definition
Dislocation- displace sternocostal joint (b/t ribs and sternum)
-Synovial Joint
Separation- costochondral joints
-Ribs 3-10
-Cartilage Synchondrosis joint |
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Term
| Thoracic Wall movements- anteroposterior |
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Definition
Anteroposterior dimension- pump-handle movement
-Ribs 2-6 at costovertebral joint (round joint)
-Facilitated by inferior sloping ribs |
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Term
| Thoracic Wall movements- lateral dimension |
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Definition
Bucket-handle movement
-Ribs 7-10
-No direct attachment to sternum
-Costal cartilage
-Flat joint |
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Term
| Thoracic Wall movements- superior-inferior |
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Definition
| Right always tops=dome higher on right side than on left |
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Term
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Definition
-Part of innermost intercostals
-Span 2 ribs
-Positioned inferioposteriorly |
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Term
| Transverse thoracic muscles |
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Definition
-Span 2nd-6th intercostal spaces
-Muscle fibers run inferioanteriorly |
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Term
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Definition
-Part of innermost intercostals
-Run inferio-posteriorly
-Span 2 ribs |
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Term
| Transverse Thoracic Muscles |
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Definition
-Span intercostal spaces 2-6
-Run iferior-anteriorly |
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Term
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Definition
Passive:
-Diaphragm
-External intercostals
Active:
-Scalene muscles
-Sternocleidomastoid muslces
-Serratus anterior muscles
-Pectoral muscles |
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Term
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Definition
Passive: elastic recoil of lungs
Active:
-Internal intercostals
-Innermost intercostals
-Abdominal muscles |
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Term
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Definition
Due to: multiple fractures detach part of the thoracic wall from rib cage
-Detached part subjected to unopposed inta-pleural pressure resulting in paradoxical motion
*Life threatening |
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Term
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Definition
-Anterior and Posterior Intercostal Arteries
Major Arteries:
-Thoracic Aorta
-Internal Thoracic Artery- can be used in coronary bypass
L. Subclavian A.-->LAD (LCA)
-Musculophrenic-supply diaphragm
-Supreme Thoracic- supplies 1st + 2nd intercostals from posterior end (NOT thoracic aorta)
*Postductal coarctation of aorta- stenosis of aorta after ductus arterioles; blood travels L Subclavian Artery-->Internal Thoracic A.--> Anterior IC A.--> Posterior IC A.-->Thoracic/Descending Aorta
-1st and 2nd IC A. not involved-Supreme thoracic A.
Causes rib notching of rib margins 4-8 due to dilated vessels |
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Term
| Where do posterior intercostal veins drain |
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Definition
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Term
| What is the general rule about subclavian v. drainage? |
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Definition
| Generally, any artery that branches off of the subclavians, its accompanying vein will drain into the braciocephalic v. |
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Term
| Intercostal nerves are composed of what type of nerves? |
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Definition
| Sensory, motor, and parasympathetic fibers- NOT sympathetic |
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Term
| Why does a MI have referred pain in the arm? |
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Definition
| Intercostobrachial nerve derived from the 2nd intercostal nerve-->dermatome of medial arm |
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Term
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Definition
T4- nipple
T6- xyphoid process
T8- costal margin
T10- umbilicus (belly button)
T12- ASIS |
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Term
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Definition
1. Lubricate pleural surfaces
2. Provide surface tension to help lung adhere to thoracic wall
3. Separate lungs from each other in air tight cavities- no anatomical connection |
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Term
| Parietal Pleura- sites prone to injury |
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Definition
1. Cervical pleura- projects above suprior thoracic aperture
2. R. Infrasternal Angle- pleura descends below costal margins (pokes out beneath R. side of ribs)
3. R & L Costo-vertebral angle- no costal coverage medial to 12th rib; exposes pleura
-Vulnerable to damage during kidney surgery |
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Term
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Definition
1. Costo-diaphragmatic
2. Costo-mediastinal |
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Term
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Definition
-Hilum of lung: point where mediastinal section of the parietal pleura becomes the visceral pleura
-Allows movement of pulmonary vessels and bronchi during respiration |
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Term
| (1) Function and (2) Location of thoracocentesis |
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Definition
(1) Obtain fluid samples from pleural cavity
(2) Location: middle of IC space
a. Midclavicular line - b/t 6th and 8th ribs
b. Mixaxillary line- b/t 8th and 10th ribs
c. Paravertebral line- b/t 10 and 12th ribs
Needle angled upward to avoid injuring diaphragmatic pleura and diaphragm |
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Term
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Definition
Remove fluid, blood, pus, air
-Inserted 5th or 6th IC space at mixaxillary line DURING EXPIRATION
Fluid- costo-diaphragmatic space
Air- cerival pleura |
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Term
| Used to treat recurrent spontaneous secondary pneumothorax |
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Definition
| Pleurodesis- slclerosing (hardening) againt causes pleural adhesion |
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Term
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Definition
| Surgical removal or of pleura or obliteration by infection of pleural cavity |
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Term
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Definition
-Inflammation of pleura
-Sharp and localized chest pain with deep breath or cough (irritation of parietal pleura innervated by IC nerves)
-Pleura rub against each other
-Rough, grating sound- rolling hair b/t fingers |
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Term
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Definition
Mediastinal pleura (C3, 4, 5 keeps lung alive) -Referred pain to root of neck and over shoulder
And diaphragm |
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Term
| Periphery of diaphragmatic domes innervated by |
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Definition
| Lower 6 IC nerves- associated with localized sharp pain |
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Term
| Costal pleura innervated by |
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Definition
ICN 1-12
Highly sensitive to heat, temperature, touch, and pressure |
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Term
| Visceral pleura innervated by |
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Definition
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