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Gross Anatomy
Thoracic Wall and Diaphragm
25
Medical
Professional
10/14/2008

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Term
Features of Thoracic Vertebra
Definition
1. 12 of them
2. laminae overlap
3. spines are long and slender and directed inferiorly
4. costal facets: 2 on postero-lateral side of body and 1 on each transverse process (connect with ribs)
Term
Typical ribs
Definition
1. long, thin, C-shaped
2. head
3. neck
4. tubercle
5. body with angle
6. articular facets
7. costal groove
Term
Typical Ribs vs Atypical Ribs
Definition
1. 2-9 are typical
2. 1, 10, 11, and 12 are atypical
Term
Costal cartilage
Definition
bar of hyaline cartilage attached to anterior part of rib--costochondral joint
Term
Rib fracture
Definition
1. most common major trauma-induced thoracic injury
2. Can cause intrathoracic injury especially 1st rib
Term
Costovertebral joints
Definition
1. plane-type synovial joints
2. joints of head of rib: atypical articulate with vertebra of same number and one above; atypical articulate only with vertebra of same number
3. costotransverse joint: articulation between articular facet of tubercle with costal facet of transverse process of same numbered vertebra
4. 11th and 12th do not have costotransverse joints
Term
Three parts of sternum
Definition
1. manubrium (jugular, costal, clavicular notches)
2. body
3. xiphoid process
Term
Joints of sternum
Definition
1. sternoclavicular joints
2. manubriosternal joint (sternal angle)
3. xiphisternal joint (ossifies)
4. sternocostal joints (2nd throu 7th)
*1st is a primary cartilaginous joint
Term
Clinical Notes for Sternum
Definition
1. sternal fracture
2. contusion
3. median sternotomy
4. sternal biopsy
Term
Anterior articulations of ribs
Definition
1. true ribs--1 thru 7-->sternocostal joints
2. false ribs--8-10-->interchondral joints
3. ribs 11 and 12 have no anterior artic. (floating)
Term
Posterior articulations of ribs
Definition
1. rib-to vertebra:head of ribs and costotransverse joints
2. vertebra to vertebra: intervertebral discs and facet (zygapophyseal)
Term
Features of thoracic cage
Definition
1. cone shaped
2. tallest dimension is posterior
3. flattened from front to back
4. ribs descend from posterior to anterior
5. 11 intercostal spaces
6. superior thoracic aperture (T1 vertebra, 1st ribs, and manubrium)
7. inferior thoracic aperture (12th vertebra, 12th thru 7 ribs, xiphoid process)
8. costal margins (7th thru 10th ribs)
9. sternal angle
Term
Clinical Notes for Thoracic Cage
Definition
1. thoracic wall plasticity
2. slipping ribs
3. extra ribs(lumbar and cervical)
4. thoracic outlet syndrome
Term
Intercostal muscles
Definition
1. external
2. internal
3. innermost

* Function to draw ribs together, maintain structural integrity, protect underlying viscera
Term
Clinical Notes for intercostal muscles
Definition
1. thoracotomy
2. flail chest
Term
Nerves of thoracic cavity
Definition
1. intercostal nerve: anterior rami of T1 through T11, transverse space in costal groove
a. sympathetic, muscular, cutaneous, sensory to mammary
b. 1-6 end cutaneously; 7-11 go to abdominal cavity
2. subcostal nerve-anterior ramus of T12
3. posterior rami of T1-T12: sensory and muscular to mid back region
Term
Blood supply to thoracic wall
Definition
1. poster intercostal arteries: 1/IC space, from descending aorta, supply to intercostal muscles, upper limb muscles and skin, mammary glands
2. anterior intercostal arteries: 1/IC space, anastomsis with posterior ICA, shorter in length less blood supply, upper 6 from internal thoracic arteries, lower 5 from musculophrenic arteries
3. posterior intercostal veins: drain into azygos veins
4. anterior intercostal veins: drain into internal thoracic or musculophrenic veins
Term
Lymphatics of chest wall
Definition
1. superficial: lymph from structures not anatomically part of chest wall (muscles of limns, skin, mammary glands), flows to axillary nodes
2. deep: lymph from structures part of chest wall (intercostal muscles), flows to parasternal and intercostal lymph nodes
Term
Clinical Notes for Lymph Nodes
Definition
parasternal lymph nodes--mammary gland drainage--breast cancer
Term
General Features of Diaphragm
Definition
1. comprised of striated muscle and CT
2. principle muscle in quiet respiration
3. change pressure of abdominal cavity
Term
Components of Diaphragm
Definition
1. muscular part: sternal, costal, lumbar (medial and lateral arcuate ligaments for psoas major and quadratus lumborum, left and right crura)
2. central tendon
3. contour of diaphragm--two domes, right higher than left, looks like J
Term
Hiatuses of diaphragm
Definition
1. aortic: T12, descending thoracic aorta, thoracic duct, behind diaphragm
2. esophageal: T10, formed by right crus, esophagus and vagus nerve
3. caval foramen: T8, inferior vena cava, within central tendon
Term
Clinical Notes for Hiatuses of Diaphragm
Definition
1. hiatal hernia
Term
Neurovascular Supply of Diaphragm
Definition
1. right and left phrenic nerves (C3, C4, C5)
2. Arterial sources include pericardiacophrenic arteries, lower intercostal arteries, superior and inferior phrenic arteries
Term
Clinical Notes for Neurovascular supply of diaphragm
Definition
1. paralysis of phrenic nerves
2. diaphragmatic pacing
3. phrenic nerve block
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