Thepectoralismajorandpectoralisminorandtheinferiorpartoftheserratusanterior,mayalsofunctionasaccessorymusclesof

respiration,helpingelevatetheribstoexpandthethoraciccavitywheninspirationisdeepandforceful

Thescalenemusclesoftheneck,whichdescendfromvertebraeofthenecktothe1stand2ndribs,actprimarilyonthevertebralcolumn.
However,theyalsoserveasaccessoryrespiratorymusclesbyfixingtheseribsandenablingthemusclesconnectingtheribsbelowtobe
moreeffectiveinelevatingthelowerribsduringforcedinspiration.

Thetruemusclesofthethoracicwallaretheserratusposterior,levatorescostarum,intercostal,subcostal,andtransversusthoracis.

theserratusposteriorsuperiorwassaidtoelevatethesuperiorfourribs,thusincreasingtheAPdiameterofthethoraxandraisingthe
sternum.Onthebasisofitsattachmentsanddisposition,theserratusposteriorinferiorwassaidtodepresstheinferiorribs,preventing
themfrombeingpulledsuperiorlybythediaphragm.

Thelevatorescostarummuscles(L.levator,alifter)are12fanshapedmusclesthatelevatetheribs(Fig.1.17),buttheirrole,ifany,in
normalinspirationisuncertain.

Theexternalintercostalmuscles(11pairs)occupytheintercostalspacesfromthetuberclesoftheribsposteriorlytothecostochondral
junctionsanteriorly(Figs.1.111.13,and1.15).Anteriorly,themusclefibersarereplacedbytheexternalintercostalmembranes.The
externalintercostalsaremostactiveduringinspiration.

Theinternalintercostalmuscles(11pairs)rundeeptoandatrightanglestotheexternalintercostalsBetweentheribsposteriorly,
medialtotheangles,theinternalintercostalsarereplacedbytheinternalintercostalmembranes.Theinternalintercostalsweaker
thantheexternalintercostalmusclesaremostactiveduringexpirationespeciallytheirinterosseous(vs.interchondral)portions.

Thesubcostalmusclesarevariableinsizeandshape,usuallybeingwelldevelopedonlyinthelowerthoracicwall.Thesethin
muscularslipsextendfromtheinternalsurfaceoftheangleofoneribtotheinternalsurfaceofthesecondorthirdribinferiortoit.
Crossingoneortwointercostalspaces,thesubcostalsruninthesamedirectionastheinternalintercostalsandblendwiththem

Althoughtheexternalandinternalintercostalsareactiveduringinspirationandexpiration,respectively,mostactivityisisometric
(increasestonuswithoutproducingmovement);theroleofthesemusclesinproducingmovementoftheribsappearstoberelated
mainlytoforcedrespiration.Thediaphragmistheprimarymuscleofinspiration.Expirationispassiveunlessoneisexhalingagainst
resistance

The(thoracic)diaphragmisasharedwall(actuallyfloor/ceiling)separatingthethoraxandabdomen.Althoughithasfunctionsrelated
tobothcompartmentsofthetrunk,itsmostimportant(vital)functionisservingastheprimarymuscleofinspiration.

alargeportionofthedeepfasciaoverlyingtheanteriorthoracicwalliscalledpectoralfasciaforitsassociationwiththepectoralis
majormuscles(Fig.1.16).Inturn,muchofthepectoralfasciaformsamajorpartofthebedofthebreast

Deeptothepectoralismajoranditsfasciaisanotherlayerofdeepfasciasuspendedfromtheclavicleandinvestingthepectoralisminor
muscle,theclavipectoralfascia.

Nerves

The12pairsofthoracicspinalnervessupplythethoracicwall.AssoonastheyleavetheIVforaminainwhichtheyareformed,the
mixedthoracicspinalnervesdivideintoanteriorandposterior(primary)ramiorbranches.TheanteriorramiofnervesT1T11formthe
intercostalnervesthatrunalongtheextentoftheintercostalspaces.TheanteriorramusofnerveT12,coursinginferiortothe12thrib,
isthesubcostalnerve.Theposteriorramiofthoracicspinalnervespassposteriorly,immediatelylateraltothearticularprocessesof
thevertebrae,tosupplythejoints,deepbackmuscles,andskinofthebackinthethoracicregion.

TYPICAL INTERCOSTAL NERVES

The3rd6thintercostalnervesenterthemedialmostpartsoftheposteriorintercostalspaces,runninginitiallywithintheendothoracic
fasciabetweentheparietalpleura(serousliningofpulmonarycavity)andtheinternalintercostalmembranenearlyinthemiddleofthe
intercostalspaces.Neartheanglesoftheribs,thenervespassbetweentheinternalintercostalandtheinnermostintercostalmuscles.

Collateralbranchesofthesenervesariseneartheanglesoftheribsandrunalongthesuperiorborderoftheribbelow.

Nearthesternum,thenervesturnanteriorly,passingbetweenthecostalcartilagestobecomeanteriorcutaneousbranches.

Thegroupofmusclessuppliedbytheposteriorramusandanteriorramus(intercostalnerve)ofeachpairofthoracicspinalnerves
constitutesamyotome.Themyotomesofmostthoracicspinalnerves(T2T11)includetheintercostal,subcostal,transversusthoracis,
levatorescostarum,andserratusposteriormusclesassociatedwiththeintercostalspacethatincludestheanteriorramus(intercostal
nerve)ofthespecificspinalnerve,plustheoverlyingportionofthedeepmusclesoftheback.
 Thebranchesofatypicalintercostalnerveare(Fig.1.15A&B):

Ramicommunicantes,orcommunicatingbranches,thatconnecteachintercostalnervetotheipsilateralsympathetictrunk.

Collateralbranches

LateralcutaneousbranchesthatariseneartheMAL,piercetheinternalandexternalintercostalmuscles,anddivideinturninto
anteriorandposteriorbranches.Theseterminalbranchessupplytheskinofthelateralthoracicandabdominalwalls.

Anteriorcutaneousbranchespiercethemusclesandmembranesoftheintercostalspaceintheparasternallineanddivideintomedial
andlateralbranches.Theseterminalbranchessupplytheskinontheanterioraspectofthethoraxandabdomen.

Muscularbranches

ATYPICAL INTERCOSTAL NERVES

Althoughtheanteriorramusofmostthoracicspinalnervesissimplytheintercostalnerveforthatlevel ,theanteriorramusofthe1st
thoracic(T1)spinalnervefirstdividesintoalargesuperiorandasmallinferiorpart.Thesuperiorpartjoinsthebrachialplexus,the
nerveplexussupplyingtheupperlimb,andtheinferiorpartbecomesthe1stintercostalnerve.Otheratypicalfeaturesofspecific
intercostalnervesincludethefollowing:

ThoracicVasculature

Withtheexceptionofthe10thand11thintercostalspaces,eachintercostalspaceissuppliedbythreearteries:alargeposteriorintercostalartery
(anditscollateralbranch)andasmallpairofanteriorintercostalarteries.

Theintercostalveinsaccompanytheintercostalarteriesandnervesandliemostsuperiorinthecostalgrooves