ANATOMY I 20/03/20 THORACIC CAGE AND RIBS LESSON 7

RECAP OF 20/03/2020:
Spine and difference between types of vertebra
What are the joints and ligaments involved

THE RIB CAGE IS A STRUCTURE CLOSELY RELATED TO THE SPINE AND TO THE
VERTEBRAL COLUMN.

THE THORACIC CAGE

The thoracic cage has a conical shape and it forms a conical enclosure for the
organs that are located inside it: the lungs, the heart, the spleen, a part of the
liver and the two superior parts of the kidneys, that are protected by the ribs of
the cage.
It also provides attachment for the pectoral girdle, which is the part of the
upper limb closer related to the cage, and upper limb.

STRUCTURE OF THE THORACIC CAGE:

• It has a broad base and a narrower superior apex;
• It is rhythmically expanded by the respiratory muscles to create a
vacuum that draws air into the lungs.
• The inferior border of the thoracic cage is formed by a downward
archmade of the last ribs is called the costal margin.

COMPONENTS OF THE THORACIC CAGE:

• the sternum
• the ribs
• the costal cartilages (connects the ribs to the sternum)
• the thoracic vertebrae (that are 12 and closely related to the ribs of
the cage in the posterior part of the cage)

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THE STERNUM
- It is a flat bone with 3 main parts:
- manubrium sterni(superior part)
- gladiolus (body)
- xiphoid process (last part)

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THE MANUBRIUM STERNI
It is the superior part of the sternum and its largest part.
- Jugular/ suprasternal notch (a depression present in the superior part)
- It articulates with clavicles ribs 1 and 2.
o With the 1st it has two articular facets on both sides
o With the 2ndrib it articulates with the manubrium of the sternum in
the superior part, and the body of the sternum in the lower part, so
there are two demi facets for the articulation of the second rib
- It has two articular facets on both the sides for the articulation of the 2
clavicles of the pectoral girdle.
- Lies opposite to T3 and T4 vertebrae
- In the inferior part there is the Manubriosternal joint inferiorly -called
sternal angle / angle of Louis (side of thearticulation with 2nd rib) divided
between the manubrium of the sternum and the body, at the level of
intervertebral disc, located between T4 and T5 vertebrae. (The 2nd rib is
divided by the manubrium of the sternum and the body). This area is at
the level of the intervertebral disc.

BODY / GLADIOLUS
- Articulates with ribs 2-3-4-5-6-7
- Xiphisternal joint (for the connection of the body of the sternum with the
last part)is located inferiorly-opposite to T9 vertebra located

XIPHOID PROCESS
- It’s cartilaginous and in the first steps of development calcifies through
time
- It allows attachment of muscles of the thoracic part
- Tip of xiphoid is opposite to the level of T10 (thoracic vertebra)

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CLINICAL ANATOMY
In some pathological condition the bone marrow analyses are important:

- Diagnosis and staging of some hematological disease, or for the

assessment of the bone marrow cellularity
- At the level of the manubrium of the sternum can be performed the bone
marrow biopsy:
the bone marrow can be aspirated at the level of the manubriumof the
sternum to take a sample of bone marrowand can be cultivated, and the
cells that compose it can be analyzed. These procedures can be used to
study the cellular complement. (ex. In the case of leukemia).
- At the level of the manubrium of the sternum can be performed the
median sternotomy
It is considered a gold standard incision in cardiac surgery, in particular
because it results in a low failure rate and excellent prove in long term of
the patients during the thoracic surgery
Procedures: the sternum is split in half, longitudinally along the midline
(known as median sternotomy). With this operation it is possible to get
access to the thoracic organs.

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RIBS
The ribs are the main components of the thoracic cage and can be divide
according to 2 different classifications:

The 1st classification divides the ribs into:

1. True ribs
2. False ribs
3. Floating ribs

1. true ribs:from the 5thto the 7th pairs of ribs. They are attached
anteriorly to the sternum by their costal cartilage (reason why they
are known as true ribs).
2. false ribs: 8th, 9th and 10th pairs of ribs. They are not attached to the
sternum, but they are attached anteriorly to each other with their
costal cartilage, and to the7th rib, which is attached to the sternum.
3. Floating ribs: the 11th and 12th pairs have no anterior attachment; their
costal cartilage is floating in the abdominal cavity. In some cases they
are embedded in the abdominal muscles.

The 2nd classification divides the ribs into:

1. Typical ribs

2. Atypical ribs

1. Typical ribs have some common features,the presence of:

- Head

- Neck

- Tubercle

- Angle

- Shaft

- Subcostal groove

2. Atypical ribs are the 1,2,10,11,12, they have some atypical features
different from the typical ribs.

- Rib 1- short, flat, and have subclavian grooves for supports Subclavian
vessels

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 - Ribs 1-10-11-12articulate with only 1 vertebra because above the ribs
n 1 there is not another vertebra as in the case of the rib n. 12

- Ribs 11 and 12 are known as “floating ribs” and do not articulate with
transverse processes of the vertebra or the sternum in the anterior part

COSTAL CARTILAGES
The ribs are connected to the sternum thanks to the costal cartilages.

Costal cartilages are bars of hyaline cartilage connecting the upper seven
ribs to the lateral edge of the sternum, and connect the ribs 8 9, and 10ribs to
the cartilage immediately above (cartilage of the vertebra n.7)

The cartilages of the 11 thand 12thribs end in the abdominal musculature.

The ribs 11th and 12th are not attached to the sternum but are floating in the
abdominal cavity or are embedded in the abdominal musculature.

Function of the costal cartilage:

- Connects the ribs to the sternum

- Contributes significantly to the elasticity and mobility of the thoracic

cage.

The thoracic wall is able to expand thanks to the elasticity given by the
costal cartilage during the inspiration and expiration. In elderly
subjects the costal cartilage tends to lose flexibility because it calcifies,
this results in a decrease of expansion ability of the thoracic cage.

TYPICAL RIBS

Features:

They are long, twisted, flat bones and every rib has 3main parts:

1. The anterior end with the costal cartilage is responsible for the connection
with the sternum some cases, and for the connection between the ribs.

It also carries a cup shaped depression on the anterior surface, at the level
of the connection between the rib and the costal cartilage; this is the site
where it is located the costochondral joint, that connects the bony part of
the vertebra to thecostal cartilage.

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2. Posterior end is composed of:

- Head – located posteriorly –contains two facets for articulation of the

thoracic vertebra – one for the corresponding vertebral body below
andtheotherforthevertebral bodyabove it.

- Neck–between the head and the tubercle. (narrower than the head)

- Tubercle – is a prominence on the outer surface of the rib, it attaches at

the junction of the neck with the shaft. Is located in the posterior part of
the posterior end of the rib. It has a facet for the articulation with the
transverse process of the corresponding vertebra.

- Angle –is at the level of the connection between the posterior end and
the shaft of the rib, it is where the shaft of the rib bends sharply forward.

3. The Shaft is the longest part of the rib and goes between the anterior and
posterior ends. It has a rounded, smooth superior border and, a sharp, thin,
inferior border which has costal groove that accommodates the intercostal
vessels and nerves (costal artery, costal vein, and costal nerve)

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RECAP AND ANATOMICAL POSITION

• The ribs have a posterior end, having head, neck, and tubercle, and is
directed posteriorly, its concavity faces medially, and its sharp border is
directed inferiorly.

• In an anatomical position, the posterior end is higher and nearer the

median plane in relation to the anterior end.

THE ATYPICAL RIBS

Are the 1st, 2nd ,10th,11th and 12th ribs.

THE FIRST RIB

• Highest is the first one,

• Shortest

• Strongest it is thicker with respect to the others

• Flattest

• Most curved

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 • Most fixed it is the less movable one because the lower part of the
cage contains the medial part of the lungs that.

• Broadest

• The shaft slopes obliquely downwards and forwards to its sternal end.

• It only has one facet on its head because there are no thoracic
vertebrae above

• The upper surface has two grooves for the accommodation of the
subclavian artery and subclavian vein, and are separated by the
scalene tubercle for the attachment of the scalene anterior muscle
(one of the most important muscle of the cage)

• The Lower Surface is related to the costal pleura.

• It has no angle it is very short

• There is no costal groove of the sharp of this rib, but there are two
grooves forthe subclavian vessels

Grooves: in the structure of the typical rib the groove is located along the
share and function as the accommodation as costal vessels (arteries and
veins).

THE SECOND RIB

• Thinner and longer twice the1strib

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 • It has two articular facets on the head as normal, because there is a
thoracic vertebraabove and a thoracic vertebra below, to which is
connected by the articular facets.

• It has a roughened area (or tubercle)in the upper surface on its upper
surface, where the serratus anterior muscle attaches. This area is known
as tuberosity as for the serratus anterior muscle

• Its shaft is sharply bent and not twisted

• The posterior part of internal surface presents a short costal groove

which is very poorly developed with respect to the other ribs.

THE TENTH RIB

Last rib Attached with costal cartilage to the others and with the sternum

• It has single articular facet on its head, which articulates with the body of
corresponding thoracic vertebra

• It is somewhat shorter in relation to the conventional rib.

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THE ELEVENTH RIB

Together with the 12 is known as floating rib because it is not attached to the
sternum in their interior end

• It has single large, articular facet on its head.

• It has no neck and no tubercle.

• Its anterior end is pointed and tipped with cartilage, this costal cartilage
doesn’t have to be attached to the sternumso in this is why in this case
the costal cartilage is tipped and pointed and anteriorly directed

• It has a little angle and a shallow costal groove.

• Its inner surface is pointed upwards and inwards, with respect to the
others that are more curved

THE TWELFTH RIB

The 12th rib has identical features as the 11th with the exception of that:

• It has no neck, no angle, no tubercle, no costal groove on its shaft.

• It is considerably shorter than the11 th rib in particular in females,

because females have a smaller rib cage and this is a specific structure.
(this happens alsoin other bones that are peculiar on the females assome
skull bones like the supraciliary arch that are more prominent in males).

• It is as short as the1strib. ( wehave to remember that the 1st rib has a

completely different structure)

• Its end is pointed anteriorly and is directed anterolaterally and wider

postero-medially.

• The concave internal surface faces inwards and upwards.

• Its sharper border (the superior one) is directed inferiorly.

RECAP TYPICAL RIBS FEATURES

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Ribs have 3 main parts:

1. Anterior end: end that is connected to the sternum and to other ribs
thank to costal cartilage, there is the costachondro joint with bony part
of the rib and the costal cartilage
2. Posterior end
a. Head with 2 articular facets(that allows the connection with
articular processes located on both sides of the body of the
thoracic vertebrae) with the thoracic vertebrae connected with the
rib.
b. Neck (narrower part close to the head)
c. Tubercle (on the posterior surface has an articularfacet that is for
the connection of the transverse process of the thoracic vertebrae)
d. Angle (twisted part) that separates the posterior part to the shaft
(longest part of the vertebra)
3. Shaft: contains a costal groove with function: accommodate costal
vessels and the costal nerves.

RECAP ATYPICAL RIBS

• Ribs 1, 2, 10 11 and 12 are ‘atypical’ as they have features that are not
common to all the ribs.
• Rib 1 is shorter and wider, stronger than the other ribs. It is the only one
to have one facet on its head for articulation with its corresponding
vertebrae (there isn’t a thoracic vertebrae above it). The superior surface
is marked by two grooves, which make way for the subclavian vessels
(subclavian artery and subclavian vein).

• Rib 2 is thinner and longer than rib 1, and has two articular facets on the
head, as normal. It has a roughened area on its upper surface, where the
serratus anterior muscle attaches.

• Rib 10 only has one facet – for articulation with its numerically
corresponding vertebrae. (shorter than the others)

• Ribs 11 and 12 have no neck, and only contain one facet, which is for
articulation with their corresponding vertebrae. (n 12 has no neck, no
costal groove)

RIB FRACTURES:

Pathological conditions that can affect the ribs

• Most commonly occur in the middle ribs, as a consequence of crushing

injuries or direct trauma. A common complication of a rib fracture is
further soft tissue injury (the lungs, spleen or diaphragm).

• Fracture of 1st and 2nd ribs are associated with complications as soft tissue
injuries because the fractures ends can injury the organs that are located

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 inside the ribs as the pleura that convers the lungs inside the thoracic
cage.

• If two or more fractures occur in two or more adjacent ribs, the affected
area is no longer under control of the thoracic muscles. It displays a
paradoxical movement during lung inflation and deflation. This condition
is known as flail chest. It impairs full expansion of the ribcage, thus
affecting the oxygen content of the blood. Flail chest is treated by fixing
the affected ribs, preventing their paradoxical movement, this atypical
and uncontrolled movement.

There are also other pathological conditions as metastatic cancer at the

level of the ribs and they also can result in a broken rib.

CERVICAL RIB

In some cases we can have another rib at the level of the cervical part, above
the first rib.

• The costal component of the C7 vertebra may elongate to create a

cervical rib thatpresent in about 5% of people.

• This pathological condition might be unilateral or bilateral. It takes place

more commonly unilaterally and somewhat more frequently on the right
side of the neck.
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 • The cervical rib might have a blind tip, or the tip might be joined to the
1st rib by fibrous group or cartilage or bone. It might compress the lower
trunk of brachial plexus and subclavian artery (in the area of superior
surface of the 1 st rib is located the subclavian vessels)

• The compression generates

1. (a) pain along the medial side of forearm

2. (b) interference in the circulation of the upper limb.

ARTICULATIONS OF THE RIB CAGE

Connection between the articulation present in the rib cage

There are a lot of connection in our rib cage and can be between the:

• Ribs and vertebrae (known as costovertebral joints) are joints of heads

of ribs and costotransverse joints, joints among the tubercle among the
posterior part of the posterior end of the rib and the transvers process of
the thoracic vertebrae.

• Ribs and costal cartilages (in the anterior part prevalently, known as
costochondral joints).

• Costal cartilages (of the last vertebrae(8-9-10)this cartilage is

connected to the cartilage of the 7th are connected to the vertebra n.
7interchondral joints).

• Sternum and costal cartilages (known as sternocostal joints).

• Parts of the sternum (manubriosternal and xiphisternal joints) in young

people the manubriosternal (and sometimes the xiphisternal) joint
usually fuses in the elderly. (present in young but fuses in elderly)
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 XIPHISTERNAL JOINT: joint between the body of the sternum and the
xiphoid process

MANUBRIOSTERNAL JOINT: is the joint between the manubrium of the

sternum and the body

ARTICULATIONS AMONG THE RIBS

The majority of the ribs have an anterior and posterior articulation.

Anterior attachment of ribs is different among the different ribs:

• From the 5th to the 7th rib in the anterior end they are attached
independently to the sternum thanks to the sternum costal joint
The anterior attachment of the ribs varies:

• Ribs 1-7 attach independently to the sternum (sternocostal joint).

• Ribs 8 -9- 10 attach to the costal cartilages of the rib n 7 thanks to the
costochondral joint. And then the chondro-cartilages are attached to the
cartilage of the 7 th rib thanks to the intercostal condrojoint.

• Ribs 11 and 12 do not have an anterior attachment because they are

floating in the abdominal wall and end in the abdominal musculature,
they are called “floating ribs”.

Articulations of the ribs Posterior attachment of ribs

All of the twelve ribs articulate posteriorly with the vertebrae of the
spine.

Each rib forms two joints:

• – Costovertebral joint – Between the head of the rib with costal facet.
The superior costalfacet of the head of the rib is connected to
thecorresponding vertebrae, and the inferior costal facet of the head of
the ribis connected with the facet of the vertebra that is locatedabove.

• – Costotransverse joint – located in the posterior part of the rib.

Between the articular facet on the tubercle of the rib located in the
posterior part of the posterior end of the rib, and the articular facet of the
transverse of the corresponding vertebrae.

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FEATURES OF THE COSTOVERTEBRAL JOINT:

• Connects the costal end to the circumference of the articular

surfacewhich is formed by an intervertebral disc and the 2 demifacets of
two adjacent vertebrae.

• The fibrous capsule is located in the external part and covers this kind of
joint.

LIGAMENTS OF COSTOVERTEBRAL JOINT

Radiate ligaments connect the anterior parts of each costal head to the
bodies of two vertebrae and their intervertebral discs.

It is formed by:

• Superior fibers ascend to the vertebral body above from the head of the
rib
• Intermediate fibers, are located in the middle part, are shortest and least
distinct, are horizontally directed and are attached to the disc.

The radiate ligament associated with the first rib is attached to the seventh
cervical vertebra and to the first thoracic vertebrae because there are no
thoracic vertebrae above the 1st rib.

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 In the joints of the tenth to twelfth ribs, which articulate with single
vertebrae, this ligament is attached to the numbered vertebra and the one
above, as in the case of the others.

Intra-articular ligament

The intra-articular ligament is a short flat band, attached laterally to the

crest(prominence between the 2 articular facets) between the costal articular
facets and medially to the intervertebral disc, dividing the joint in a superior
and an inferior half.

The ligament is absent from the first and tenth to twelfth joints.

Another ligament: Costotransverse joint that has Fibrous capsule

The fibrous capsule is thin and attached to articular peripheries; it has a

synovial lining It is outside the joint as for the cases of all synovial joint.

Peculiarity of the fibrous capsule of the costotransverse joint is thinner with

respect to the capsule of the costovertebral joint. But we have to remember
that the fibrous capsule covers the joint from outside.

LIGAMENTS OF COSTOTRANSVERSE JOINT

Costotransverse ligament are the ligaments involved in this case

• Fills the costotransverse foramen between the neck of the rib and its adjacent
corresponding transverse process.

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• Its short fibers extend back from the posterior surface on the neck to the
anterior surface of the transverse process.

The costotransverse ligament is rudimentary or absent in the eleventh and

twelfth ribs.

Superior costotransverse ligament is located in the superior part of the rib

Anterior and posterior layers:

• The anterior layer is attached between the crest of the costal neck of the
rib and lower aspect of the transverse process above

• The posterior layer is attached inferiorly on the costal neck, ascending

posteromediallyto the transverse process above

The first rib has no such ligament.

LATERAL COSTOTRANSVERSE LIGAMENT

It is short, thick and strong with respect to the superior costotransverse

ligament
• It passes obliquely from the apex of the transverse process to the non-
articular part of the adjacent costal tubercle.

We have to consider that behind this ligament there is the costal tubercle

ACCESSORY LIGAMENT (CAN BE PRESENT OR ABSENT IN OTHER CASES)

• It is usually present

• It lies medially to the superior costotransverse ligament

• These bands are variable in their attachments, butusually pass from a

depression medial to a costal tubercle to the inferior articular process
immediately above.

• Some fibers also pass to the base of the transverse process.

COSTOCHONDRAL JOINT

They are the joint that connect the bony part of the ribs to the cartilaginous
part of the ribs

• Primary cartilaginous joint

• Articulation of lateral end of costal cartilage with ribs end

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 • Cartilage and boneare bound together by periosteum because on the
surface of all the long and flat bones there is the periosteum
(membrane).

• No movement normally occurs with this type of articulation. The

cartilaginous parts allow a kind of elasticity but not at this level.Theonly
movement is the enlargement of the rib cage but there are no
movements between the bony part of the ligament and the cartilaginous
part because they are connected by the costochondral joint.

INTERCHONDRAL JOINTS

Joint among the costal cartilages of our ribs

• 6th to the 9th costal cartilages enter into contact with one another and
articulate with every other by number of small synovial plane joints

• The cartilaginous part of the cage gives elasticity, but not at this level,
the only movement is the enlargement of the costal rib cage. But not
movement between the bony part and the cartilaginous part

This are the joints among the costal cartilages

This joint connects the cartilage of the 10 th vertebra to the 11th, and they are
respectively connected to the 9 th and 8th. All these three cartilages are
connected to the cartilage of the 7 th vertebra and are all connected to the
sternum.

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The 7th vertebra has the both the interchondral and sternocostal joints, while
the 8th, 9th and 10th have only the interchondral joint.

STERNOCOSTAL JOINT

Joint that connects the cartilaginous part of the ribs but on the side with
respect to the costochondral joint.

Connects several parts of the cartilage to the sternum.

• 1st vertebra primary cartilaginous joint (synchondrosis) articulation of

1° costal cartilages with manubrium of sternum

• From the 2nd to the 7th vertebrae synovial plane Joints:they allow the
articulation of the costal cartilage of these tins to the sternum.

FIBROUS CAPSULES

Located outside the joints as in all cases.

The fibrous capsules surround the second to seventh sternocostal joints.

They are thin, blended with the sternocostal ligaments, and strengthened

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 above and below by fibers that connect the costal cartilages to the
sternum.

The fibrous capsules of the synovial joint of the sternocostal connections

are surrounded by a fibrous capsule, thin and blended with sternocostal
ligaments that connects the cartilage with the sternum.

RADIATE STERNOCOSTAL LIGAMENTS

They are involved in the connection between the costal cartilage and the
sternum.

Broad, thin bands that radiate from the anterior and posterior surfaces of the
sternal ends of the costal cartilages of the true ribs to the corresponding
sternal surfaces.

Collectively, these tissues form a thick fibrous membrane around the sternum
that is more marked inferiorly. Because they radiate from the costal cartilage,
this covering is more marked in the inferior part of the sternum

INTRA-ARTICULAR LIGAMENTS

It is present only for the corresponding 2nd ribs

This ligament is at the level the connection between the costal cartilage of the
2nd rib and the cartilage of the manubriosternal joint. only present at the level
of the connection between the articular cartilage of the 2 tib and the cartilage
involved in the connection of the manubrium of the sternum and the body of
the sternum. manubriosternal joint

Are located, as in the case of the connection of costovertebral joint, in the

posterior part. It is located in the middle part of the joint and divides it in an
anterior and posterior part.

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COSTOXIPHOID LIGAMENTS
• connect the anterior and posterior surfaces of the seventh (and sometimes
sixth) costal cartilage to the same surfaces of the xiphoid process.

MANUBRIOSTERNAL JOINT

It’s the joint that allow the connection of the manubrium of the sternum and
body of the sternum.

• Secondary cartilaginous joint (symphysis)

• Articulation between manubrium and body of sternum

This joint often fuses and becomes a synostosis in older individuals, because
the cartilage involved can calcify and can transform this joint in synostosis.

XIPHISTERNAL JOINT

They are other joint that connect the body of the sternum and the xiphoid
processes

• Primary cartilaginous joint (synchondrosis)

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 • Articulation between xiphoid process and body of sternum

• This kind of joint can calcify within the ages and can become a synostosis
in the elderly

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