Pines City Colleges

SCHOOL OF MEDICINE 2025

STERNUM AND SURROUNDING
2. Body. “Mesosternum”
-aka Gladiolus
Lecturer: Dr. Dahilan -long & flat; largest portion
November 23, 2021 -articulates with:
- manubrium(superiorly) = manubriosternal joint
- xiphoid process (inferiorly) = xiphisternal joint noargon
I. Sternum *both cartilaginous joint movement
II. Ribs seen
-* Facets
III. Costal Cartilage -articulation for ribs 3-6
IV. Joints -*Demifacet
V. Ligaments - partial articulation; 2nd rib & 7th rib
VI. Neurovascular supply
VII. Clinical correlation
3. Xiphoid process. “Xiphisternum”
-thin plate of cartilage; usually pointed (variable)
I. STERNUM
Bs internalthoracicArtery -Becomes ossified at its proximal end during adult life
-most inferior; smallest part
-“Breastbone” -tip is located at T10 level, NO ribs or costal cartilages are attached.
-Flat bone located on the anterior chest; Lies in the midline of the
chest
vesselsairways
-protect the internal thoracic viscera (heart,great
lungs, esophagus, etc.) II. RIBS

articulate a -set of 12 paired bones forming the protective cage of the thorax
i
clavicle costal
cartilage the
of
-articulate with the vertebral body posteriorly and terminate
anteriorly as costal cartilage 0
appertains - 3 Types:
truerins
I
upper 7 pair
1. Typical false n ssaatacota
-long, twisted, flat bone having a rounded, smooth
superior border and a sharp, thin inferior border
-Inferior border has the costal groove accommodating the
intercostal vessels and nerve
-Parts:
a) Head
-two facets for articulation with numerically
corresponding vertebral body and the vertebral
body above b
-*Posterior end of the rib
sp and
Ti ra
Parts: (3) b) Neck
1. Manubrium -constricted portion situated between the head
-Upper part of the sternum; lies above the body of the sternum groves and the tubercle
-trapezoid; Quadrangular
sarge nah c) Tubercle
angular
-Articulates with: am on -prominence on the outer surface of the rib that
-(body) manubriosternal joint (Sternal angle/ Angle of has facet for articulation with the transverse
Louis) process of the numerically corresponding
-Clavicle vertebra
-Ist costal cartilage
-2nd costal cartilage (upper part) d) Shaft or Body
-* Sternal Angle (Angle of Louis) -flat and curve; has a costal groove that contains
-articulation to the sternal body
-felt as transverse ridge in the chest
a manubrium the neurovascular supply (located in the inferior
surface) of the thorax, protecting the vessels and
-marks the level of the 2nd costal cartilage (2nd rib) and aids in nerve
counting the ribs
-lies @ lvl of T 4
important for
landmark counting
ribs
-*Jugular Notch (Suprasternal Notch)
-concave depression on the superior aspect of manubrium
-lateral to this is a fossa lined with cartilage which articulates
with the medial ends of the clavicle forming the
sternoclavicular joints

stun
Facet- cartilage lined depressions on the lateral border of the manubrium/body of

y
sternum for articulation
- articulation with the costal cartilage of the 1st rib

Demifacet “Half-facet”
-partial articulation of 2nd rib

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 Pines City Colleges
SCHOOL OF MEDICINE 2025
STERNUM AND SURROUNDING
III. COSTAL CARTILAGE
-Bars of cartilage connecting the upper ribs to the lateral edge of the
sternum
-Contribute significantly on the elasticity and mobility of the thoracic
wall; In old age, some flexibility is lost due to superficial calcification

-*8-10th ribs have their cartilages connecting to the cartilage of the

7th rib
-*Cartilages of the 11-12th ribs ends in abdominal musculature

IV. JOINTS
A.Rib Joints
- for Articulations; (Posteriorly and Anteriorly)
2. Atypical- 5 in Humans *Posteriorly, all 12 ribs has posterior articulations.
a) 1st Rib notpalpable • COSTOTRANSVERSE Joint
-Shorter and wider than the other ribs - between the tubercle of the rib and the
-Only 1 facet for T1 (attachment site) oscammattacament transverse costal facet of corresponding
-*NONE for C7 vertebra
-marked by Two grooves on the superior surface for -**Absent on the 11th and 12th rib
subclavian vessels • COSTOVERTEBRAL Joint
-Between the head of the rib, superior costal
facet of the corresponding vertebra and the
inferior costal facet of the vertebra above
-**Absent in Ribs 1, 10, 11, 12 (Has a single
synovial joint with their corresponding vertebral body )

I
-***INTRAARTICULAR Ligament - connects the
nonaganzonangge
head to the intervertebral disc

*for Ribs 2-9, Synovial joint with articulation with the

corresponding vertebral body and the vertebral body
b) 2nd Rib above it ( Rib 2 articulates with T1 & T2, Rib 3 articulates
-Thinner and longer than rib 1 with T2 & T3 and so on…)
-Rough area on the superior surface from which serratus
a
*Anteriorly, Attachments vary
anterior muscle originates • Ribs 1-7 attach independently to the sternum
Éantanatintor • Ribs 8-10 attach to the costal cartilages superior to them
• Ribs 11 and 12 do not have anterior attachment and end
m in the abdominal musculature

B. Sternal Joint
1. MANUBRIOSTERNAL JOINT
-Cartilaginous joint between the manubrium and
the body of the sternum
-Small angular movement is possible during
c) 10th Rib respiration
- only one facet for articulation with corresponding vertebra, T10 2. XIPHISTERNAL JOINT

gym
-Cartilaginous joint between the sternal body
d) 11th & 12th Ribs and the xiphoid process
-No neck; Only one facet for articulation with corresponding -Movement not possible
vertebra , T11 and T12 C. OTHERS:
Joints of the Ribs and Costal Cartilage
-all cartilaginous joints
-No movement is possible
Joints of Costal Cartilage & Sternum, Sternocostal joint. (reading
assignment)
1. 1st Costal Cartilage and Sternum
-Cartilaginous joint; No movement
2. 2-7th Costal Cartilage
-Synovial joint; 6th, 7th, 8th, 9th, and 10th costal
cartilages articulate with one another along their
border by small synovial joints

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 Pines City Colleges
SCHOOL OF MEDICINE 2025
STERNUM AND SURROUNDING
***STERNOCLAVICULAR JOINT (reading assignment) 2. Intra-articular Ligament
-Synovial joint between the clavicle and the sternum - connects the rib to the IV disc
-Only attachment of the upper limb into the axial skeleton - essentially divides the articulation of the head of the rib to the
vertebra

A Stenocostaljoint 3.Ligaments of the Costotransverse joints

-3 types:
connects the… to the…

✓ Costotransverse posterior surface of the transverse process of

ligament neck of the rib corresponding vertebra
-Structure:
● Articulating surfaces:

a
✓ Lateral non-articular part of the tip of transverse process
-Consists of the sternal end of the costotransverse ligament: rib corresponding vertebra
clavicle, manubrium of the sternum,
and part of the 1st costal cartilage
✓ Superior upper border of the neck inferior surface of the
-2 compartments separated by an costotransverse ligament: of the rib transverse process of the
articular disc vertebra immediately
● Joint capsule (Articular disc) above
➢ Divides the 2 compartments of the
sternoclavicular joint
✓ Outer: fibrous ● Costotransverse Ligament
✓ Inner: synovial membrane -fills the narrow interval between the vertebral transverse
-4 Ligaments: process and the rib neck
● 2 Sternoclavicular ligaments
-With 1 anterior and 1 posterior
fasciculi which strengthen the joint
anteriorly and posteriorly
● Interclavicular ligament
➢ Spans the gap of both sternal ends
of each clavicle and reinforces the joint ● Superior Costotransverse Ligament
superiorly -featured in all costotransverse joints (except the first one)
● Costoclavicular ligament
➢ Binds the 1st rib and its cartilage to the o o
-consists of two layers, anterior and posterior, separated
by the fibers of the external intercostal muscle.
anterior and posterior borders of the clavicle
➢ Main stabilizing force for the joint, resisting
elevation of the pectoral girdle
➢ Acts as pivot for movements of the clavicle
➢ Can be palpated by raising the shoulder; just
lateral or inferior to the sternal head

V. LIGAMENTS

(POSTERIOR CONNECTIONS )
1. Radiate ligament posteriorattachment

D
-Connects rib head to the vertebral body
-spans 3 directions
✓ Superiorly: connects the rib to the vertebral body above
✓ Horizontally: connects rib to the IV disc
✓ Inferiorly: connects to the corresponding vertebral body
(ANTERIOR CONNECTIONS)
1. Intra-articular sternocostal ligament
-Horizontal fibrocartilaginous plate found in the center of
the 2nd sternocostal joint
-Connects the tip of the costal cartilage to the fibrous
junction of the manubrium and the sternal body
-Functions like the intraarticular ligament connecting the
head towards the vertebral bodies
2. Radiate sternocostal ligament
- Fibrous bands that connects the sternal end costal
cartilage to the ventral part of the sternum
3. Costoxiphoid ligament
-Rather inconstant fibrous band that connects the 7th
(sometimes including the 6th) costal cartilage to the front
and back of the xiphoid process
-Stabilizes the 7th rib towards the area of the xiphoid
process

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 Pines City Colleges
SCHOOL OF MEDICINE 2025
STERNUM AND SURROUNDING
❖ Pectus excavatum
0
VI. NEUROVASCULAR SUPPLY OF JOINTS
-a.k.a Funnel / Sunken chest
1. Internal Thoracic Artery -Congenital chest wall deformity with the sternum and
2. Suprascapular Artery some ribs grow abnormally, producing a concave (sunken)
3. Medial Supraclavicular Nerve (C3 and C4) 4. Nerve to the appearance in the chest wall
Subclavius (C5 and C6) -In severe cases, appear as if the center of the chest has
been scooped out, leaving a deep dent
VII. CLINICAL CORRELATIONS
* Injured ligaments during dislocations would heal without surgical
repair if immobilized properly.

* Injuries to the bone would heal (remodeling), there might be

deformities but pain is not necessarily present.

* Healing of fractures takes about 3-6 months.

❖ Sternal Fracture
-Seen in severe blunt trauma, & in high speed motor
vehicular Accident

T
-Most common site of fracture is the Manubriosternal joint ❖ Pectus carinatum
-High mortality due to concomitant injury to underlying -a.k.a. Pigeon Chest
organs -opposite of pectus excavatum; occurs when the ribs and

E
Cs cardiac tamponade seeBeck'striad Hypotension
sternum grow abnormally, causing the sternum to
mum
i
-*Fragments are not usually displaced; attached to thedistended protrudes outwards
pectoralis muscle jugular - genetic disorder of the chest wall; bulging gives the chest
-Important to be done: a birdlike appearance
(1) X-ray to document the injuries and (2) CT scan for -a feature in many syndromes like: Down's syndrome,
evaluation of viscera underneath the area of the stern Marfan syndrome, and osteogenesis imperfecta.

***CERVICAL RIB
-A rib arising from the anterior tubercle of the transverse
process of the 7th cervical vertebra (Snell)
-extra rib that forms above the first rib, growing from the
base of the neck just above the collarbone
-*Importance: may cause pressure on the lower trunk of
the brachial plexus, causing pain down the medial side of
the forearm and hand and wasting of the small muscles of
the hand (Snell)
-can exert pressure on the underlying subclavian artery
and interfere with the circulation of the upper limb (Snell)
-An abnormality present from birth and may cause neck
pain as you age as it presses nearby nerves and blood
vessels known as Thoracic Outlet Syndrome
− TOS usually starts between 20-50 y/o and is
more likely to affect men than women

*Median sternotomy
-Sternum is cut in the midline

*Clamshell Thoracotomy
-Sternum is cut transversely

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sternum