Dat Thorax Tho

University of St Jef

Osteology
and borders

Bones consist of the ribs,

sternum and thoracic
vertebrae
Superiorly and inferiorly
you have the 1st rib and
diaphragm
Apertures (super/infer) are
basically the openings at
these points

Ribs

1-7 attach directly to the sternum, (7th is down to the xiphisternal joint)
8-12 are false ribs (not directly attaching to sternum)
11 & 12 are floating, no costal cartilage attachment to other ribs but covered with
hyaline cartilage

Ribs Cont

1st rib connects with T1,

on superior surface is a Scalene tubercle for the scalenus anterior attachment
Medialy is groove for subclavian vien
Laterally is subclavian artery
Posteriorly is Inferior trunk of Brachial plexus

These structures all cross the superior aperture and are vulnerable to compression
This is called Thoracic outlet syndrome

Thoracic
outlet
syndrome
Can be result of elevation of
1st rib due to increased
tension of Scalenus Anterior
& Medius
Symptoms: tingling in ulnar
distribution of hand,
weakness in hypothenar
and interosseous muscles,
pain in anterior chest

Thorax joint

Costal Cartilage attachment to sternum- cartilaginous synchondrosis

Rib neck attaching to transverse process- Costotransverse ligament, (Can be
super,lateral, proper)
Head of rib and costal facet form costovertebral joint and is covered and supported
by the radiate ligaments

Aging sucks : (

When we age the costal cartilages can ossify

This results in decreased expansion of chest and ability to respirate during exercise
Costochondritis occurs when costal cartilages get inflamed

This is due to trauma and overuse of pec major, serratus anterior, external oblique
This leads to anterior (upper) chest pain during inspiration or things like
coughing/sneezing

Thoracic muscles
Extrinsic group: attach to thoracic cage, humerus, scapula, vertebrae or pelvis
Ex: pecs, obliques, scalenuses, serratus anterior
Scalenus anterior and medius elevavate 1 st rib, scalenus posterioir elevates 2 nd rib

Intrinsic group: attach only to thoracic cage

Ex: serratus posteriors, intercostals (external, internal, innermost), transversus thoracis,
subcostals
Actions here mostly include elevation of ribs for inspiration and rib depression for expiration
External intercostal does inspiration while internal and innermost do expiration

Diaphragm

Thin sheet of muscle at originates at border of inferior thoracic aperture to a central

tendon
When the muscle contracts the central tendon is lowered, this increases thoracic
volume during inspiration
It is innervated by the Phrenic N(C4-C5) and has 4 openings

Diaphragm Openings

Vena Caval Foramen-around T8-T9 area

Esophageal Hiatus-T10 area, also allows passage of R/L vagal trunks,(continuations of
vagus N)
Aortic Hiatus-T12 is the posterior border, median arcuate ligament is anterior while
sides are formed by the R/L crus of the diaphragm. Thoracic duct and azygos vein also
pass through here
Psoas Gap- occurs at same T12 level but lateral to each crus
Genitofemoral, ilioinguinal Nerves and Sympathetic trunk also pass through

Hiatal Hernia

Occures when stomach slips through esophageal hiatus

This leads to indigestion, worse when lying supine
An inclined position can discomfort

Intercostal Nerves

These come from Ventral Rami of T1-T11 and run along with intercostal arteries
and veins to innervate costal grooves of each rib
Innervates intercostal Muscles and provides cutaneous sensation
The ventral rami of T12 is below the 12th rib and is called the subcostal N
The intercostal N,A,V(inf to sup) exist in the neurovascular bundle between
innermost and internal muscles

Post. Intercostal Arteries and Veins

Posterior intercostal As 1&2 are a branch of supreme intercostal artery from the
costocervical trunk, (of subclavian A)
Posterior intercostal As 3-11 are a branch of the decending aorta
Posterior intercostal V drains into (accesory) hemiazygos vein on Left and azygos vein
on Right

Ant. Intercostal Arteries and Veins

Anterior intercostal A 1&2 arise from highest thoracic artery(first part of axillary)
Anterior intercostal As 2-6 arise from Internal Thoracic A, lie along lateral edge of
sternum, deep to transverse thoracic muscle
At level6/7 the internal thoracic artery divides into musculophrenic A and superior
epigastric A
Musculophrenic A- gives the anterior intercostal As to ICS 7-9 and the diaphragm
Superior Epigastric A- diaphragm and upper rectus abdonimis m
ICS 10&11 have no anterior intercostal A, just posterior

What are the two major cutaneous branches directly of the intercostals nerve?
Anterior and lateral
Anterior and medial
Anterior and posterior
Medial and lateral