ANATOMY WorkbookWeek 1:Specimen Workshops1. Components of the thoracic cage (noting rib parts, articular surfaces and grooves)a.

12 ribsi. Typical (3-9): head (2facets), neck (tubercle), Body (angle [greates curvature],costal groove [underneath = intercostals V,A,N])ii. Atypical(1,2 and 10-12): y 1 st = 1 facet at head (articulate with T1), no angle, no costal groove(because T1 is part of brachial plexus so no intercostal nerve), scalenetubercle (superior surface) anterior scalene muscle (anterior to tubercle= groove for subclavian vein, posterior to tubercle = groove forsubclavian artery) y 2 nd = rough area on its upper surface, the tuberosity for serratus anterior,from which part of serratus anterior (innervations =Long thoracic N) y 10 th and 12 th = one facet at head (articulate with one vertebra 10 and 12) y 11th and 12 th = have no neck or tubercle y 12 th = no costal groove (12

th intercostals VAN is actually sub-costal VAN)iii. True (vertebrocostal) ribs (1 st -7th ribs): They attach directly to the sternumthrough their own costal cartilages.iv. False (vertebrochondral) ribs (8th, 9th, and usually 10th ribs): Theircartilages are connected to the cartilage of the rib above them; thus theirconnection with the sternum is indirect.v. Floating (vertebral, free) ribs (11th, 12th, and sometimes 10th ribs): Thecartilages of these ribs do not connect even indirectly with the sternum;instead they end in the posterior abdominal musculature.b. sternum (manubrium [sterna angle] body, xiphoid)i. sternal angle (angle of louis), T4-5, 2 nd costal cartilage, beginning and end of the arch of aorta (at sterna angle), end of the azygos vein (collects bloodfrom abdo and breasts),c. Costal Cartilage2. Boundaries of superior and inferior thoracic apertures(openings)a. Superior thoracic aperturei. Post: T1, Lat: 1 st rib, Ant: manubriumii. Passageway for all the vessels and nerves to the headiii. STA syndrome where the vessels are compressed due to inflam, etc.iv.

Lung extends though it slightlyb. Inferior thoracic aperturei. Post: T12, Post Lat: 11 th

and 12 th , Ant Lat: 7-10 costal cartilage, Ant:xyphisternal jointii. Diaphragm innervated by phrenic nerveiii. Esophagus and IVC pass through diaphragm3. Position, Parts and attachments of the diaphragma. Right side extends higher above Left because of Liverb. Inserts into central tendon, which is fused with the fibrous pericardium, also coveredby pleura on either sidec. Inspiration: rises to 4 th intercostals space and 5 th costal cartilage d. Expiration:e. Phrenic N (c3, c4, c5)f. Most common hernia is oesophageal opening4. hiatus hernia where a small part of the stomach protrudesthrough the

Structures transmitted via (major and minor) opening in the diaphragma. Major Openingsi. Inferior Vana Caval (T8) y IVC y

Right Phrenic Nerveii. Oesphageal (T10) y Oesophagus y Vagal trunks y Branches of left gastric vesselsiii. Aortic (T12) y Aorta y Azygos vein y thoracic ductb. Minor Openingsc. Phrenic nerve pierces through the diaphragm without using a hiatus5. Contents of an intercostal space (noting layers and sites of neurovascular bundle)a. Intercostal VANb. Collateral branches (run on superior border of rib below) (given off from intercostalvessels)c. External intercostal muscle, internal intercostal muscle, VAN, innermost intercostalmuscle6. Course and branches of thoracic spinal nerves (noting associated dermatomes)a. Thoracic Spinal nerves become the intercostals nerves through the intervertebralforaminab.

Intercostal nerve gives off lateral (mid-axillary line) and anterior (mid-clavicular line)cutaneous branchc. Posterior cutaneous branch comes off the posterior ramus of the spinal nerve7. Course of internal thoracic arterya. Supplies the anterior chest wall and breastsb. Arises from subclavianc. Divides into musculophrenic and superior epigastric artery at 6 th intercostal space8. Position and structure of the breasts (noting their associated nerves and vessels)a. Arteriesi. Medial mammary branches of perforating branches and anterior intercostalbranches of the internal thoracic artery, originating from the subclavianartery.ii. Lateral thoracic and thoracoacromial arteries, branches of the axillary artery.iii. Posterior intercostal arteries, branches of the thoracic aorta in the 2nd, 3rd,and 4th intercostal spaces.b. Veinsi. Axillary veinii. Some internal thoracic veinc. Lymph i. Subareolar lymphoid plexus => axillary lymph nodesii. Parasternal lymph nodes =>d.

Nervesi. Anterior and lateral cutaneous branches of the 4 th -6 th intercostal nervesApplied Anatomy Tutorial1. Contrast the mechanisms involved with inspiration and expiration (noting the accessorymuscles of respiration and the significance of them being enlisted)a. Inspirationi. Diaphragmii. External intercostals fibres go down and forward (hands in pockets). Theyassist in deep inspiration by increasing the anterioposterior diameter of thechestiii. Internal intercostals fibres go backward and downward (back pocket).They assist in expiration by pulling the ribcage downiv. Innermost intercostals similar to internal intercostals in fibre direction.They lift ribs during contraction. Also aid in forced expiration.b. Expirationi. During quiet breathing, little muscle involvement. Driven by elastic recoil of the lungs. During exercise, abdominal muscles and innermost intercostalmusclesc. Accessory Musclesi. Accessory muscles are typically only used when the body needs to processenergy quicklyii. Muscles include: sternocleidomastoid (elevaed sternum) and scalene (ant,middle and post)iii. Can become engaged and overused in everyday breathing if a breathingpattern disorder exists2. Indicate the costal cartilages associated with each part of the sternum (noting the sternalposition in funnel chest and pigeon chest variants) and the site of the sternal anglea.

Sternal angle is second costal cartilage and T4/5 vertebrab. Pectus Excavatum (funnel chest):i. Sunken appearance of the sternumc. Pectus carinatum (pigeon chest):i. Protrusion of the sternum and ribs3. Explain the diagnosis and significance of a fractured rib (noting the mechanisms and effect of chest in multiple rib fractures)a. Symptomsi. Pain when breathing or with movementii. A portion of the chest wall moves independently from the rest of the chestiii. A grating sound with breathing or movementb. Treatmenti. c. Flail chest flail