Anatomy Department

2st Sem. 1nd Year

Faculty of Medicine
Hebron University

ANATOMY I
By
Dr. Ziyad M. Al Zeer
Orthopedic Surgeon
MD.Phd
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 General Characteristics of a Vertebra
The typical vertebra consists of:
• A rounded body anteriorly and a
vertebral arch posteriorly.
• These enclose a space called the
vertebral foramen, through which
run the spinal cord and its
coverings.
• The vertebral arch consists of
 a pair of cylindrical pedicles,
which form the sides of the arch
 a pair of flattened laminae,
which complete the arch
posteriorly
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 General Characteristics of a Vertebra
The vertebral arch gives rise to
seven processes:
• The spinous process, or spine, is
directed posteriorly from the
junction of the two laminae.
• The tow transverse processes
are directed laterally from the
junction of the laminae and the
pedicles.
 Both the spinous and transverse
processes serve as attachments
of muscles and ligaments)
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 General Characteristics of a Vertebra
• The four articular processes
are vertically arranged and
consist of two superior and
two inferior processes.
 The two superior articular
processes of one vertebral
arch articulate with the two
inferior articular processes of
the arch above.

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 General Characteristics of a Vertebra
• The pedicles are notched on their
upper and lower borders, forming
the superior and inferior
vertebral notches.
• On each side, the superior notch
of one vertebra and the inferior
notch of an adjacent vertebra
together form an intervertebral
foramen.
 These foramina, in an articulated
skeleton, serve to transmit the
spinal nerves and blood vessels. 6
 Characteristics of a Typical Thoracic
Vertebra
• The body is medium size
and heart shaped.
• The vertebral foramen is
small and circular.
• The spines are long and
inclined downward.
• Costal facets are present on
the sides of the bodies and
the transverse process for
articulation with the heads
of the ribs. 7
 Referred Pain
• Above the level of the sternal angle, the
cutaneous innervation of the anterior chest wall is
derived from the supraclavicular nerves (C3 and
4).
• Below this level, the anterior and lateral
cutaneous branches of the intercostal nerves
supply oblique bands of skin in regular sequence.
• The skin on the posterior surface of the chest wall
is supplied by the posterior rami of the spinal
nerves. The arrangement of the dermatomes
• An intercostal nerve not only supplies areas of
skin, but also supplies the ribs, costal cartilages,
intercostal muscles, and parietal pleura lining the
intercostal space.

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 Referred Pain
• Furthermore, the 7th to 11th intercostal nerves
leave the thoracic wall and enter the anterior
abdominal wall so that they, in addition, supply
dermatomes on the anterior abdominal wall,
muscles of the anterior abdominal wall, and
parietal peritoneum. This latter fact is of great
clinical importance because it means that disease
in the thoracic wall may be revealed as pain in a
dermatome that extends across the costal margin
into the anterior abdominal wall.
For example, a pulmonary thromboembolism or a
pneumonia with pleurisy involving the costal parietal
pleura could give rise to abdominal pain and
tenderness and rigidity of the abdominal
musculature. The abdominal pain in these instances
is called referred pain.

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 Suprapleural Membrane
• It is a dense fascial layer that closes the
thoracic outlet
• This tent-shaped fibrous sheet is attached
:
 laterally to the medial border of the first
rib and costal cartilage.
 Superiorlly: to the tip of the transverse
process of the seventh cervical vertebra
 Medially to the fascia investing the
structures passing from the thorax into
the neck.
• Function:
 It protects the underlying cervical pleura
 Resists the changes in intrathoracic
pressure occurring during respiratory
movements.
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Suprapleural Membrane

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 Endothoracic Fascia

Endothoracic Fascia
• It is a thin layer of loose
connective tissue that
separates the parietal pleura
from the thoracic wall.

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 The suprasternal notch
• It is the superior margin
of the manubrium
sterni
• it is easily felt between
the prominent medial
ends of the clavicles in
the midline.
• It lies opposite the
lower border of the
body of the 2nd
thoracic vertebra
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The suprasternal notch

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 The subcostal angle
• It is situated at the
inferior end of the
sternum,
• It lies between the
sternal attachments of
the 7th costal cartilages

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 The costal margin
• It is the lower boundary of
the thorax
• It is formed by the
cartilages of the 7th, 8th,
9th, and 10th ribs and the
ends of the 11th and 12th
cartilages
• The lowest part of the
costal margin is formed by
the 10th rib and lies at the
level of the third lumbar
vertebra.
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 Ribs
• The first rib lies deep to the clavicle
and cannot be palpated.
• The lateral surfaces of the remaining
ribs can be felt by pressing the fingers
upward into the axilla and drawing
them downward over the lateral
surface of the chest wall.
• The 12th rib can be used to identify a
particular rib by counting from below.
• However, in some individuals, the
12th rib is very short and difficult to
feel. For this reason, an alternative
method may be used to identify ribs
by first palpating the sternal angle and
the second costal cartilage
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 Anterior and posterior Axillary folds
• The anterior fold is formed
by the lower border of the
pectoralis major muscle
 This can be made to stand
out by asking the patient to
press a hand hard against the
hip.
• The posterior fold is formed
by the tendon of the
latissimus dorsi muscle as it
passes around the lower
border of the teres major
muscle.

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 Nipple
• In the male, the nipple
usually lies in the 4th
intercostal space about
4 in. (10 cm) from the
midline.
• In the female, its
position is not constant.

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 Lines of Orientation
• Midsternal line: Lies in the
median plane over the
sternum
• Midclavicular line: Runs
vertically downward from
the midpoint of the clavicle
• Anterior axillary line: Runs
vertically downward from
the anterior axillary fold
• Posterior axillary line: Runs
vertically downward from
the posterior axillary fold

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 Lines of Orientation
• Midaxillary line: Runs
vertically downward from
a point situated midway
between the anterior
and posterior axillary
folds
• Scapular line: Runs
vertically downward on
the posterior wall of the
thorax, passing through
the inferior angle of the
scapula (arms at the
sides)

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Diaphragm
 Diaphragm

• It is a dome shaped thin muscular

and tendinous septum that
separates the chest cavity above
from the abdominal cavity below .
• The diaphragm is the most
important muscle of respiration.
• It is consists of
 A peripheral muscular part,
which arises from the margins of
the thoracic opening,
 A centrally placed tendon.

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 Diaphragm
• The origin of the diaphragm
can be divided into three parts:
 A sternal part arising from the
posterior surface of the xiphoid
process .
 A costal part arising from the
deep surfaces of the lower six
ribs and their costal cartilages .
 A vertebral part arising by
vertepral columns

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 Diaphragm
Shape of the Diaphragm
• As seen from in front, the
diaphragm curves up into right and
left domes.
 The right dome reaches as high as
the upper border of the fifth rib
 The left dome may reach the lower
border of the fifth rib.
 The central tendon lies at the level
of the xiphisternal joint.
• The domes support the right and
left lungs, whereas the central
tendon supports the heart.
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 Diaphragm
• The diaphragm is lower when a
person is sitting or standing;
• It is higher in the supine
position and after a large meal.
• When seen from the side, the
diaphragm has the appearance
of an inverted J
 The long limb extending up from
the vertebral column
 The short limb extending
forward to the xiphoid process

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 Nerve Supply of the Diaphragm
• Motor nerve supply: The
right and left phrenic nerves
(C3, 4, 5)
• Sensory nerve supply:
 The phrenic nerve (The
central surfaces of the
diaphragm)
 The lower six intercostal
nerves (The periphery of the
diaphragm)
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 Action of the Diaphragm
• On contraction, the
diaphragm pulls down its
central tendon and increases
the vertical diameter of the
thorax.

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 Functions of the Diaphragm

• Muscle of inspiration:
 The diaphragm is the most
important muscle used in
inspiration.
 On contraction, the diaphragm pulls
its central tendon down and
increases the vertical diameter of
the thorax.
• Muscle of abdominal straining: The
contraction of the diaphragm assists
the contraction of the muscles of
the anterior abdominal wall in
raising the intra-abdominal pressure
for micturition, defecation, and
parturition.

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 Functions of the Diaphragm

• Weight-lifting muscle: Assists in raising

the intra-abdominal pressure to such an
extent that it helps support the vertebral
column and prevent flexion.
 Needless to say, it is important to have
adequate sphincteric control of the
bladder and anal canal under these
circumstances.
• Thoracoabdominal pump: The descent
of the diaphragm decreases the
intrathoracic pressure and at the same
time increases the intra-abdominal
pressure.
 This pressure change compresses the
blood in the inferior vena cava and
forces it upward into the right atrium of
the heart.
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 The 3 Openings in the Diaphragm

• The aortic opening lies

anterior to the body of
the 12th thoracic
vertebra.
 It transmits
 The aorta,
 The thoracic duct,
 The azygos vein.

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 Openings in the Diaphragm

The esophageal opening lies

at the level of the 10th
thoracic vertebra .
 It transmits
 The esophagus,
 The right and left vagus
nerves,
 The esophageal branches
of the left gastric vessels,
 The lymphatics from the
lower third of the
esophagus.

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 Openings in the Diaphragm

• The caval opening lies

at the level of the
eighth thoracic vertebra
 It transmits
 The inferior vena cava
 Terminal branches of
the right phrenic nerve.

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THANK YOU
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