Thorax regional anatomy Flashcards

Sternum
Terms Definitions
Cylindrical thorax consists of what?
Wall, two pleural cavities, the lungs, and mediastinum.
What are mammary glands
Modified sweat glands in the superficial fascia anterior to the pectoral muscles and the anterior thoracic wall.
What's the mammary gland consist of?
15-20 lactiferous ducts which open independently onto the nipple, surrounded by the areola.
What do the connective tissue make?
Suspensory or coppers ligaments which are continuous with the dermis of the skin and support the breast.
Carcinoma of the breast causes what?
Pitting of the skin by putting tension on the coopers ligaments.
Non lactating women have what?
A lot of fat, while glandular tissue is more abundant in lactating women.
Retromammary space?
A layer of loose connective tissue separating the breast from deep fascia.
Upper lateral region of the breast can project around what
The lateral margin of the pec major and into the axilla.
Axillary process may what?
May perforate deep fascia and extend as far superiorly as The apex of the axilla.
Arterial supply of the breast is by what?
Laterally - vessels from the axillary artery like superior thoracic, thoracoacromial, lateral thoracic, and sub scapular.
What else?
Medially, branches from the internal thoracic artery
And finally?
Second to fourth intercostal arteries via branches that perforate the thoracic wall and overlying muscle
Veins drain into what?
They parallel the Arteries and drain into the axillary, internal thoracic, and intercostal veins.
Innervation of the breast? (hint: branching)
Anterior and lateral cutaneous branches of the second to sixth intercostal nerves.
Innervation of nipple?
Fourth intercostal nerve
75 percent of lymph drains into what?
The axillary nodes
Most of the others?
Parasternal nodes deep to the anterior thoracic wall. Intercostal nodes near the head and necks of ribs.
Where do the nodes drain to?. (Axillary, Parasternal, and intercostals...)
Axillary to subclavian, para sternal to bronco mediastinal, and intercostal drain into thoracic duct or into bronchomediastinal.
Pec major.
O: medial half of the clavicle and anterior surface of sternum, first seven costal cartilages, aponeurosis of external oblique. I: lateral lip of inter tubercular sulcus.
Pec major innervation and function
Medial and lateral pectoral nerves, adduction, medial rotation, and flexion of the humerus at the shoulder
Subclavius
O: rib 1 at junction between rib and costal cartilage. I: groove on the inferior surface of middle third of clavicle. N: nerve to subclavius. F: pull clavicle medially to stabilize sternoclavicular joint.
Pec Minor
O: anterior surfaces of the third, fourth, and fifth ribs. I: coracoid process of scapula. N: medial pectoral nerves. F: depress tip of shoulder and protracted scapula
Clavipectoral fascia? (enclose whta, attach what)
Deep fascia that encloses subclavius and pec minor muscles and attaches to the clavicle above and to the floor of the axilla below.
Articulation with ribs from vertebrae
Two demifacets located on superior and inferior aspects of the body known as superior costal facet which articulates with the head of its own rib and inferior costal facet articulating with the part of the head below. An oval facet known as transverse costal facet articulates with the tubercle of its own rib.
Vertebra 1
Only has a single facet on the head of its own rib - in other words, the head of rib 1 does not articulate with vertebrae C7
Vertebra 10
Only with its own ribs and therefore lacks inferior demifacets
Vertebra 11 and 12
Only with the head of its own rib and lack transverse costal facet.
True ribs, false ribs
First seven, last 5, floating ribs are 11 and 12
Costal cartilages of 8 to 10 articulates with what?
The costal cartilages of the ribs above.
Ribs 11 and 12?
No anterior connection with other ribs or with the sternum. Thus floating
Describe the head, neck, and tubercle of the rib.
Head is expanded and has two articular surfaces separated by a crest. Smaller superior surface with the inferior costal facet while bigger inferior surface with the superior costal facet of its own vertebra. Neck is short flat region separating head from tubercle. Tubercle is posterior from the neck with the shaft and has two regions
Which two regions of the tubercle?
Articular surface is medial and has facet for transvestism process of the associated vertebra. Raised non articular part is roughened by ligament attachment.
Angle? Forms what?
Shaft bends laterally to the tubercle at the angle which has a gentle twist around its longitudinal axis so the external surface of the anterior part of the shaft is somewhat superior relative to the posterior part, forming a costal groove.
Rib 1
Slopes inferiorly to its attachment at the manubrium. Attaches only with the body of T1. It then goes subclavian vein, anterior scalene muscle, subclavian artery, middle scalene muscle.
Characteristics of rib 11 and 12
No necks, tubercles and are short, little curve, n pointed anteriorly
Sternum is made of what?
Manubrium, body, and xiphoid process
Manubrium of the sternum forms?
Part of the bony framework of the neck and thorax. It expands laterally and bears a distinct and palpable notch known as the jugular notch in the midline.
Immediately inferior to the fossa for articulation with clavicle?
Is a facet for the attachment of the first costal cartilage.
Body of sternum
Has facets for inferior rib 2 to superior rib 7.
Xiphoid process
Smallest part and has facet for inferior rib 7
Joint with head of rib
Divides into two synovial compartments by an intraarticular ligament attaching to the crest of the IV.
Costotransverse joint
Transverse process and tubercle of the rib
Joint is stabilized by two strong extracapsular ligaments.
Costotransverse ligament which is medial to the joint and attaches the neck of the rib to the transverse process. Lateral costotransverse ligament is lateral to the joint and attaches the tip of the transverse process to the roughened nonarticular part of the tubercle of the rib.
Superior costotransverse ligament?
Attaches the superior surface of the neck of the rib to the transverse process of the vertebrae above.
Joint between first rib and manubrium (type of joint?)
Tat is fibrous not synovial while the other 6 are.
Interchondral joints
Joints between costal cartilages of adjacent ribs, prominent in 7 to 10. Usually synovial.
Manubriosternal and xiphisternal joints
Usually symphysis. The prior is the sternal angle, rib 2. The latter ossifies with age.
Intercostal spaces and costal groove?
Between adjacent ribs and are filled with intercostal muscles. The groove is between the inner and innermost muscles and has superior vein, middle artery, and inferior nerve is out
What does that mean for the nerve?
Most prone to injury
What is often present superior to the inferior rib below?
Small collateral branches of the major intercostal nerves and vessels.
Deep to the intercostal spaces and ribs
Endothroacic fascia consisting of fat mostly.
Superficial to that?
Deep fasica, Superficial fascia, and skin
External intercostal muscles
Pass inferiorly anterior. Most active during inspiration.
Internal intercostal muscles
Pass inferior posteriorly, most active during expiration.
Innermost intercostal muscles
Same orientation as internal.
Subcostales
Same orientation as internal intercostal muscles and may depress ribs.
Transverse thoracis muscles
Found on the deep surface of the anterior thoracic wall and in the same plane as the innermost intercostals. They depress costal cartilages 3 to 6.
Upper two posterior intercostal arteries on each side is from
The supreme intercostal artery which descends into the thorax as a branch of the costocervical trunk, a posterior branch of the subclavian arty.
Anterior intercostal arteries arise from where?
Lateral branches from the internal thoracic arteries
Internal thoracic artery arises from?
A major branch of the subclavian artery in the neck. Divides into the superior epigastric arty to the anterior abdominal wall and the musculophrenic artery which penetrates diaphragm and ends near The last intercostal space.
Which supply the upper six intercostal spaces and which the Lower 6?
Anterior intercostal arteries and musculophrenic artery branches.
What's in each intercostal space? (arteries)
Two branches from anterior intercostal arteries: one passes below the upper rib, the other above the margin of the lower rib and meets a collateral branch of the posterior intercostal artery.
Central intercostal veins drain to where?
Azygos system of veins or into internal thoracic veins which connect with the brachiocephalic veins in the neck.
Left superior intercostal vein empties to what?
Left superior intercostal vein empties to left brachiocephalic vein.
Right
Right superior intercostal vein empties into Azygos vein.
Lymphatics drain to where?
Para sternal nodes, intercostal nodes, and diaphragmatic nodes.
Where do para sternal nodes go (upper thorax and lower thorax drain to?)
Bronchomediastinal trunks and those in the upper thorax also drain into bronchomediastinal trunks, whereas intercostal nodes in the lower thorax drain into thoracic duct.
Superficial regions of the thoracic wall (lymph)
Axillary lymph nodes in the axilla or the parasternal nodes.
Innervation of thoracic wall
Intercostal nerves, anterior rami of spinal nerves t1 to T11 and lie in the intercostal spaces.
Anterior ramus of T12?
The us costal nerve is inferior to rib 12
Lateral cutaneous branch off of where?
Branch off of intercostal nerve and pierces the lateral thoracic wall and divides into an anterior branch and posterior branch that innervated skin.
Intercostal nerves end as?
Anterior cutaneous branches innervating skin on the anterior abdominal wall.
Where are small collateral branches
Intercostal space running along the superior border of the lower rib.
What do the intercostal nerves carry?
Somatic motor innervation to muscles. Somatic sensory innervation from the skin and parietal pleura. Postganglionic sympathetic fibers to the periphery.
Intercostal nerves innervated other regions (T1 and intercostobrachial nerve)
Anterior ramus of T1 is brachial plexus. Intercostobrachial nerve contributes to the cutaneous innovation of the medial surface of the upper arm.
Ehat about low intercostal nerves?
Supply muscles, skin, and peritoneum of the abdominal wall.
Safe triangle for chest tube
Anterior border of Lars, lateral border of pec major, and the apex below the axilla.
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