University „Ovidius” of Constanta

Faculty of Dentistry

The Thoracic Cage

Name: Andreea Oprea

1st year, Group 3
The thoracic cage (rib cage) is the skeleton of the thoracic wall. It is formed by the 12 thoracic vertebrae, 12
pairs of ribs and associated costal cartilages and the sternum. The thoracic cage can also be described as
an osteocartilaginous cage formed by the sternum, 12 pairs of ribs and costal cartilages, 12 thoracic
vertebrae and the intervertebral (IV) discs interposed between them. It takes the form of a domed bird cage
with the horizontal bars formed by ribs and costal cartilages. It is supported by the vertical sternum or
breastbone (anteriorly) and the 12 thoracic vertebrae (posteriorly).

The thoracic cage, like skeletal tissue in most parts of the body, serves to support the thorax. It also has
several functions, such as: protecticting vital thoracic and abdominal internal organs from external forces,
resisting the negative internal pressures generated by the elastic recoil of the lungs and respiration-induced
movements, providing attachment for and supporting the weight of the upper limbs or providing the
anchoring attachment (origin) of many of the muscles that move and maintain the position of the upper
limbs relative to the trunk.

The rib cage has the shape of a cone trunk, flattened in the antero-posterior direction, with a large base
located lower. It has two holes, an upper one, which communicates widely with the neck regions, there is no
clear separation between the two areas and is called the upper thoracic opening, and a lower one, closed by
the diaphragm, called the lower thoracic opening.

During the intrauterine period of development, the rib cage begins to ossify. This process continues until
approximately the 25th year of extra-uterine life. Of all the three groups of bones forming the thoracic cage,
the vertebral and ribs ossification start by the end of the embryonic period (at approximately the 7th week of
gestation). Sternal ossification begins during the 5th month of fetal development.

Although ossification is complete, on average, by age 25 years, progressive calcification of the costal
cartilages can continue into old age. A notably significant development of the thoracic cage is the expansion
of the rib cage which contributes greatly to the broad shoulders observed particularly in males. In males,
expansion of the rib cage is caused by the effects of testosterone hormone during puberty; thus males
generally have broad shoulders and expanded thoraces, allowing them to inhale more air to supply their
muscles with oxygen.

The sternum (derived from the Greek word, sternon meaning chest) is a flat, elongated bone forming the
middle of the anterior part of the thoracic cage. The sternum consists of three parts, namely, the manubrium,
body of sternum and the xiphoid process.

The manubrium is a roughly trapezoidal bone. It is the widest and thickest of the three parts of the
sternum. Its superior border has an easily palpated concave centre, called the jugular
notch (or suprasternal notch). Lateral to the suprasternal notch are the clavicular notches, which receive
the sternal end (medial end) of the clavicle. In an articulated skeleton, the jugular notch is deepened by
the medial ends of the left and right clavicles.

The manubrium also articulates with the costal cartilage of the first rib – the synchondrosis of the first rib,
as well as the superior half of the articular surface of the costal cartilage of the second rib. The
manubrium and body of the sternum lie in slightly different planes superiorly and inferiorly to their
junction, the manubriosternal joint; hence, their junction forms a projecting sternal angle (of Louis).

The body of the sternum is longer, narrower and thinner than the manubrium. It is interposed between the
manubrium and the xiphoid process, and is located at the level of the T5 – T9 vertebrae. On the lateral
borders, the body articulates with the costal cartilages of the second to seventh ribs, and forms
a xiphisternal joint at its junction with the xiphoid process.

The xiphoid process is the smallest and most variable part of the sternum. It is thin, elongated and lies at the
level of the T10 vertebra. Although often pointed in some individuals, the process may be blunt, bifid,
curved or deflected to one side or anteriorly. The xiphoid process is small and cartilaginous in young people
but gets ossified in adults older than age 40, with severe pains accompanying the process of ossification.
Ossification of the xiphoid process in the elderly people may also cause fusion of the xiphoid process with
the sternal body.

The xiphoid process is an important landmark in the median plane, indicating the inferior limit of the central
part of the thoracic cavity. This inferior limit corresponds to the xiphisternal joint, and it is also the site of
the infrasternal angle (subcostal angle) of the inferior thoracic aperture. Additionally, the xiphoid process is
a midline marker for the superior limit of the liver, the central tendon of the diaphragm, and the inferior
border of the heart.

The thoracic vertebrae are a group of 12 small bones that form the vertebral spine of the thorax. They are
intermediate in size between those of the cervical region and lumbar region, to which they are also
interposed, and increase in size from above downwards.

They are mostly typical vertebrae in that they are independent, have bodies, vertebral arches, and seven
processes for muscular and articular connections. Most of them also have costal facets on their transverse
processes for articulation with the tubercles of ribs. They are also characterized with bilateral costal facets
(demifacets) on their bodies, and long, inferiorly slanting spinous processes Atypical thoracic vertebrae
have “whole costal facets” in place of demifacets. The T1 vertebrae, T10, T11 and T12 are all atypical,
having only single whole costal facets.
The ribs (derived from the Latin word costae) are curved, long bones connecting the sternum and most of
the thoracic vertebrae (specifically T1-T10). They make up the highest number of bones forming the
thoracic cage. They are remarkably light in weight yet highly resilient to pressure from within the thorax,
e.g., pressure generated during inspiration.

There are three types of ribs, and all groups have a spongy interior containing bone marrow (hematopoietic
tissue), which forms blood cells. All of the ribs that articulate (rib 1-10) with the sternum are prolonged
anteriorly, with their attached costal cartilages with which they articulate with the sternum. These costal
cartilages also contribute to the elasticity of the thoracic wall, providing a flexible attachment for their
anterior or distal ends.

The cartilages of the first 8 ribs increase in length in descending order, with the length then decreasing after
the 8th. The first seven (and sometimes the 8th) cartilages attach directly and independently to the sternum.
The 8th, 9th and 10th cartilages articulate with the costal cartilages just superior to them, forming a
continuous, articulated, cartilaginous costal margin of the rib cage. The ribs can be divided into two
groups, typical and atypical.

The typical ribs include ribs 3 to 9th and are composed of wedge shaped head with two facets, separated by
the crest of the head, neck connecting the head with the body at the level of the tubercle, a tubercle at the
junction of the neck and body, which and has a smooth articular part for articulating with the transverse
process of the corresponding vertebra and a thin, flat and curved body (shaft), most markedly at the costal
angle where the rib turns anterolaterally.

The atypical ribs are the 1st, 2nd, and the 10th – 12th ribs characterized with the following features: have
one or two facets, and a rough area on the superior surface, e.g, the tuberosity for serratus anterior of the
second rib.

All 12 pairs of ribs can also be divided into the following types or groups:

• True (Vertebrocostal) ribs: The 1st to 7th ribs fall under this group, and they attach directly to the
sternum through their own costal cartilages.
• False (vertebrochondral) ribs: The 8th, 9th, and 10th ribs are referred to as false ribs because their
cartilages are connected to the costal cartilage of the rib above them; thus their connection with the
sternum is indirect.
• Floating (vertebral, free) ribs: The 11th and 12th ribs are grouped as floating ribs. They articulate
only to the vertebral column, thus hanging freely. Some authors group the 10th rib with the floating
ribs; and the rudimentary cartilages of these floating ribs do not connect even indirectly with the
sternum, instead they end in the posterior abdominal musculature.
The bones forming the thoracic cage are arranged in a pattern that allows some space between them. Those
spaces are referred to as the intercostal spaces . The intercostal spaces separate the ribs and their costal
cartilages from one another and allow smooth expansion of the cage during inspiration. The spaces are
named according to the rib forming the superior border of the space, for example, the 4th intercostal space
lies between the 4th rib and 5th rib; therefore, there are 11 intercostal spaces in the rib cage.

Intercostal spaces are occupied by intercostal muscles and membranes, 11 intercostal nerves and two sets
(main and collateral) of intercostal blood vessels also identified by the same number assigned to the
intercostal space. Below the 12th rib, is referred to as the subcostal space and the anterior ramus of
the spinal nerve T12 runs through this space, and it is thus referred to as the subcostal nerve.

The thoracic cavity contains the heart, lungs, large vessels and other organs.
The thorax has a sagittal diameter of 18-19 cm and a transverse diameter of 24-26 cm. The vertical diameter
is variable depending on the person's waist: in children it looks like a funnel overturned due to abdominal
breathing

The rib cage does not constantly have the same shape, there are visibly differences from one age to another,
between the sexes, depending on the constitutional type of the individual, but also in relation to respiratory
movements. Also, chest deformities are highlighted in some congenital or acquired diseases.

The thoracic box in the newborn apnea is piriform, slightly strangled at the ribs 4 and 5 and wider at the
base, where the diaphragm is raised above by the presence of abdominal viscera in the supramesocolic
floor.

The chest of the newborn who breathed takes the form of a funnel, through the expansion of the lungs, the
ascent of the ribs and the enlargement of the intercostal spaces.

The thoracic box in adults varies according to theire conformation. The stenic type of conformation
corresponds to the wide and short thorax, with a relatively large thoracic perimeter, an upper thoracic
opening of relatively small diameter and an obtuse epigastric angle, open at 120 degrees. The asthenic type
corresponds to the narrow and long thorax, characterized by a relatively low thoracic perimeter, with an
upper thoracic opening of relatively large diameter and an epigastric angle of 90-100 degrees.
Associated pathologies:
- barrel chest: occurs in pulmonary emphysema due to widening of the intercostal spaces and bulging of the
sternum
- chest in the hull: in rickets, together with the rib mats
- gibbosity: represents the exaggerated accentuation of the thoracic kyphosis.
- rib ruptures
- costochondritis

Examination-diagnosis
1. Objective examination: anamnesis, physical examination
2. Paraclinical and laboratory investigations to establish the primary pathology that determined the
structural modification of the thorax
 Bibliography

1. "Anatomia omului", V. Ranga, editura Cerma, pg 13-17

2. https://anatomie.romedic.ro/toracele
3. https://anatomie.romedic.ro/cutia-toracica-coastele
4. https://www.kenhub.com/en/library/anatomy/thoracic-cage
5. https://open.oregonstate.education/aandp/chapter/7-5-the-thoracic-cage/
6. https://courses.lumenlearning.com/nemcc-ap/chapter/the-thoracic-cage/