A) Ribs 1-7

B) Ribs 8-10

C) Ribs 11-12

A) True Ribs

B) False Ribs

C) Floatinf Ribs

Sternum

3 parts

Superior to Inferior (1-3)

1. Manubrium

2. Body

3. Xiphoid process

True Ribs

1. another name for them

2. where they articulate anteriorly

1. 1-7 vertebrocostal ribs

2. Anteriorly they have a costal catilage and articulate directly to the Sternum

 false ribs

1. another name

2. articuation anteriorly

1. vertebrochondral ribs (11-12)

2. Anteriorly have a costal cartilage that articulates with  the 7th rib (indirectly attached to the sternum)

Floating Ribs

1.numbers?

2. articulate anteriorly

1. 11-12

2. only articulate with the vertebral column, anteriorly they are free, do not articulate directly or indirectly with the sternum

The medial portion of the clavical articulates with the manubrium

-clavicle is not part of the thoracic skeletal system

1. what vessels does the anterior scalene muscle seperate

2. where does this muscle attach inferiorly and where do these vessels lie as they pass the scalene mucle.

1. seperates the subclavion vein and subclavion artery ( the artery is posterior)

2. on the first rib (prominent grooves for the vessels on firt rib)

Typical Rib (6-8)

-vertebral end of the rib

1.articulates

2. name the parts

1. posterior portion that articulates with the vertebrae

2. head, neck and tubercle located here

-superior and inferior facets located on the head.

-aticular part located on tubercle

Rib1-articulates with the manubrium

rib2-Sternal angle or manubrial sternal joint

rib3-6-body

rib7-xiphoid process

1. Where is the costal groove

2. what does it provide

1. inferior, internal surface

2. provides protection to the nuerovascular bundle b/w the ribs, the intercostal vessels and nerves.

-The rib articulates with the vertebrae with the same number and the vertibrae superior to it

-the inferior facet of the head of the rib articulates with the superior costal facet or demifacet of the vertebrae with the same number (eg=rib7-T7)

-the superior facet of the rib articulates with the inferior costal facet or demifacet of the superior vertebrae (eg=rib7-T6)

-the articular part of the tubercle of rib articulates with the facet on the transverse process of the vertebrae with the same number (eg=rib7-T7)

1. all the joints at the vertebrae are?

2. name of the joint of the tubercle of the rib and the transverse process of the vertebrae

3. where are the demifacets located on a vertebrae

1. synovial joints

2. costotransverse joint

3. on the body

1. Sternal angle or manubriosternal joint

2. the 2nd costal cartilage of rib2

Superior thoracic  aperture

1. orientation

2. boney borders

3. what goes thogh it

1. not in the horizontal plane, it is obliquely oriented, posterior part is more superior than the anterior portion (ribs corse inferiorly from posterior to anterior)

2. Body of T1, First rib with costal cartilage and the Superior border of manubrium

3. Esophogus, trachea, phrenic nerve, vagus nerve, vessels etc.

Inferior thoracic apeture

1. Borders

2. major attachment

1. Costal Margin-(cartilage of the inferior ribs) which goes from the xiphisternal joint or infrasternal(subcostal) angle anteriorly to the tip of the 11th rib hen posteriorly to the 12th rib and T12

2. diaphram attaches in some places here and liver (in upper right quad)

Diaphram

1. describe

2. where does it insert

3. innervation

4 what areas does it rise to

-unsymetrical, voluntary skelatal muscle that inserts onto the central tendon

-innervated by the phrenic nerve

-2 domes

right dome- rises to the 4th intercostal space ateriorly and the 7th rib posteriorly

Left dome- rises to the 5th intercostal space anteriorly and the 7th intercostal space posteriorly

Pectoralis Major (muscle of the upper extremity)

1. Actions

2. parts and where they take origin and insert

3. innervation

1) 3 basic actions for the shoulder joint

1. adduction of shoulder joint-bringing the humerus toward the midline

2. flexion of shoulder joint- moving the humerus anteriorly

3. medial rotator of shoulder joint- of shoulder joint

2) two heads, clavicular head-taking origin from the clavicle and the Sternocostal head taking origin from the sternum and the costal cartilages and both inserting onto the proximal end of the humerus

3.brachial plexus

Pectoralis Minor

1. origins

2. actions

3. innervation

1. originates from ribs 3,4,5 and insert onto the corocoid process

2. depresses the scapula wen it contracts

3. brachial plexus

1. intercostal muscles are deep to and used for

2. External intercostal muscles

3. Internal intercostal muscles

4. innervation of 1+2

4. External intercostal membrane

1. pec muscles

2. derection is down and forward, muscles of inspiration

3. directed down and out, muscles of expiration.

4. intercostal nerves, branches of the ventral primary rami in the thoracic region

5. this is the medial portion of the external intercostal that attaches to the sternum

1. Internal thoracic vein and artery or mammary vessels

2. Internal thoracic artery branches from

3. Internal thoracic vein branches from

1. bilaterally located about 1cm lateral to the sternum, deep to the rib cage (inside rib cage)

2. Internal thoracic artery branches from the first part of the subclavion artery (used in cardiac bypass)

3. Internal thoracic vein branches from the brachiocephalic vein

1. Posterior (dorsal) primary ramus (branches first)

2. Anterior (ventral) primary ramus (branches after DPR)

1. innervates the deep muscles of the back, then the dermatomes of the posterior aspect of the thoracic region.

2. longer, travels in the intercostal space, Intercostal nerves only travel in one spinal level (no plexus), then innervates the anterior and lateral thoracic dermatomes.

1. runs posteriorly with posterior intercostal arteries comming of of it that split into 1 and 2

1. posterior branch (of posterior intercostal artery) goes to posterior part of body

2. intercostal branch- anastimos with the anterior intercostal arteries which are branches from the internal thoracic artery 

Posterior arteries are larger

Intercostal major neurovascular bundle

1. located

2. order

3.Collateral Branch order and location

1. inferior portion of the rib partially protected by he costal groove

2. van-(vein artery nerve) (superior to inferior)

3. The bundle branches with vein first artery second and nerve third, and these branches are located on the superior portion of the ribs, NAV-superior to inferior

Anterior aspect Imaginary lines

1. Anterior median (midsternal) Line

2. Midclavicular lines

1. vertical line through the Jugular (suprasternal notch) sternal angle and naval

2. vertical line in the middle of the clavicle, just medial to nipples

Lateral Aspect imaginary lines

1. Anterior axillary line

2. Midaxillary line

3. Posterior axillary line

1. vertical line through the anterior axillary fold formed by lateral pec major

2.vertical line through the middle of the axillary fossa or axilla (arm pit)

3. vertical line at latissimus dorsi

Posterior Aspect imaginary lines

1. posterior median (midvertebral) line

2. Scapuar lines

1. vertical line, use the spinous process of C7

2. through the inferior angle of the scapula 

extension of the superior lateral quadrant of the breat that extents into the axilla

large amount of breast tissue

breast

1. location and structure

-superficial to pectoralis major and minor

breast is not attached to the muscles deep to it, free tissue.

 -Retromamary space- b/w breast tissue and fascia over pec muscles. 

-suspensory ligaments-connective tissue for support- divides breast tissue into lobes.

Breast blood supply

3

1. Medial mammary branches of the internal thoracic artery pierce the aanterior abdominal wall and supply the medial aspect of the breast.

2. Axillary artery, continuation of the subclavion artery, has a large branch called the lateral thoracic artery with lateral mammary branches that supply the lateral aspect of the breast.

3. Branches from the intercostal arteries

Nodes that drain the breast

3

1. axillary lymph nodes drain the majority of the breast tissue (drains the tail of spence)- lateral breast drainage

2. Parasternal Lymph nodes- medial brest drainage, and connect to contralateral breast and ipsilateral breast

3. inframedial quadrant- worst prognosis for breast cancer (may drain down into the abdomen)

CLASP

Central lymph nodes-

Lateral- close to the humerus

Apical- superior

Subscapular- posterior

Pectoral- anterior

1. Nerve that innervate the serratus anterior muscle

-located lateral thoracic

2. what if you cut this nerve

1. a branch of the brachial plexus, that runs along the lateral aspect of the thoracic wall accompanying the lateral thoracic artery.

2. if u cut this nerve you get winged scapula

1. Where do lymphatic systems drain

2 major connections

1. Into the veins

1. right lymphatic duct- joins at the venous angle and drains the Right-head, neck, thorax and upper extremity (1/4 of the body- Right superior to the diaphram on right side)

 2. The thoracic duct- also dumps into venous angle and drains the left-(head neck thorax and upper extremity) and everything below the diaphram (3/4 of the body- Left superior to diaphram and left and right below the diaphram.

the junction of the internal jugular vein and the subclavion vein two branches of the brachiocephalic

-bilateral structure