Escolar Documentos
Profissional Documentos
Cultura Documentos
Introduction to Thorax.
Thoracic CAGE (Skeleton of
Thorax).
Inlet of THORAX.
Outlet of THORAX.
Bony Landmarks of Thorax.
Intercostal Spaces.
Intercostal Muscles.
Intercostal Nerves.
Introduction to Thorax
@ Trunk of body is divided by diaphragm
into: an upper part: Thorax and
lower part: Abdomen.
@ Thorax is supported by a skeletal
framework (Thoracic Cage) and contains
principal(main) organs of respiration
(lungs) and circulation (heart).
@ Thoracic cage is an osseocartilagenous,
elastic cage which is primarily designed
for increasing and decreasing intrathoracic pressure, so that air is alternately
sucked into lungs during inspiration and
expelled out during expiration
* Anteriorly Sternum.
* Posteriorly 12 Thoracic vertebrae and intervening intervertebral discs.
* On each side 12 Ribs with their cartilages.
Shape:
@ Thorax resembles a truncated cone; which is narrow above and broad below.
@ Narrow upper end is continuous with root of neck; from which it is partly
separated by suprapleural membrane.
@ Broad lower end is almost completely separated from abdomen by diaphragm.
@ Thoracic cavity is actually much smaller than what it appears; because:
# Upper narrow part appears broad due to shoulders.
# Lower part is greatly encroached by abdominal cavity.
@ In transverse section, thorax is reniform (Kidney- shaped); with a greater
transverse diameter than anteroposterior.
Suprapleural Membrane
(Diaphragm of inlet of thorax)
@ It partly separates thorax from neck.
@ It is triangular in shape:
# Apex: is attached to tip of transverse
process of C7 vertebra.
# Base: is attached to inner border of
first rib and its cartilage.
# Function: it provides rigidity to
thoracic inlet so that root of neck is
not puffed up and down during
respiration.
@ Its inferior surface is fused to cervical
pleura, and its superior surface is
related to subclavian vessels and
other structures at root of neck.
@ It is broad lower end of thorax, which surrounds upper part of abdominal cavity,
but it is separated from it by diaphragm.
Boundaries:
Intercostal Spaces
@ Ribs are separated by intercostal spaces, which are 11 on each side.
@ Typically, each intercostal space contains:
# 3 Intercostal muscles:
External intercostal, Internal intercostal & Transversus thoracis.
# 3 Other intercostal sturctures:An artery, a vein & a nerve.
Intercostal
Muscles
@ Arranged in 3 layers, like 3 layers of
muscles of anterior abdominal wall.
@ In both thorax and anterior abdominal
wall, nerves and vessels lie between
internal and innermost layers.
External intercostal:
Internal
intercostal:
Transversus thoracis:
Transversus thoracis
@ Formed of 3 parts:
2) Intercostalis intimi(innermost):
@ in middle 2/4 of space.
Origin: from inner surface of upper rib.
Insertion: into inner surface of lower rib.
3) Sternocostalis:
Nerve Supply:
Intercostal nerve or nerves.
Actions:
1) Elevators of ribs.
2) Main action of intercostal muscles is to prevent retraction during
inspiration and bulging during expiration of intercostal spaces.
@ Such movements are indicative of paralysis of intercostal
muscles.
Intercostal Nerves
@ Anterior (ventral) primary rami of: T1 - T11 nerves are called
intercostal
nerves.
@ T12 is subcostal nerve, because it runs below last rib.
@
@
Branches:
Muscular:
* Numerous branches, supply intercostal muscles and transversus thoracis.
* Collateral branch arises near angle of rib, runs in lower part of space, to supply
muscles of space, parietal pleura and periosteum of ribs.
Cutaneous:
* Lateral cutaneous branch: Pierces intercostal muscles and body wall along
midaxillary line, distributed to skin after dividing into anterior & posterior branches.
* Anterior cutaneous branch: Emerges on side of sternum to supply overlying skin
after dividing into medial and lateral branches.
Communicating:
# Each nerve is connected to thoracic sympathetic ganglion by:
* A white preganglionic ramus to corresponding ganglion.
* A grey postganglionic ramus from corresponding ganglion.
# Nerve is also connected to adjoining intercostal nerves, chiefly in posterior part of
space.