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SDLS 2008
Medicine for the intoxicated
File Created on 8/12/2004 04:01 PM Transcriber(s): Put the name(s) or groups here Editors: JC Tayco, Mark Lomboy THORAX – a.k.a. CHEST - superior part of the trunk between neck and abdomen - formed by:  12 pairs of ribs  Sternum  2 thoracic vertebrae  Costal cartilages  Surrounds thoracic cavity  Also supports the pectoral girdle  Formed together with the skin, fascia, and muscles  Provides attachment for the muscles of the neck, thorax, upper limb, abdomen, and back • Functions:  Protection for the contents on the thoracic cavity  Breathing – by the muscles of the thorax elavate and depress the thoracic cage • Surface Anatomy: Imaginary Lines  Anterior Median (Midsternal) line – intersection of the median plane with the anterior chest wall  Midclavicular lines (MCL) – pass the midpoints of the clavicles, parallel to the anterior median line  Anterior axillary line – runs vertically along the axillary fold; formed by the border of the pectoralis major as it spans from the thorax to the humerus Topic: Thorax Lecturer: Dr. Karl Leverne S. Jole-jole No. of pages: 3

The Bony Thorax • 12 pairs of ribs and costal cartilages • 12 thoracic vertebrae and IV discs • Sternum

Midaxillary line – from apex of axilla; parallel to anterior axillary line  Posterior axillary line – along posterior axillary fold formed by latissimus dorsi and teres major  Posterior median line – vertical line described by the tips of the spinous process  Scapular line – parallel to posterior median line and cross the inferior angle of the scapula

Ribs and Costal Cartilages • True (vertebrocostal)  1st to 7th pair of ribs • False (vertebrochondral)  8th to 10th pair of ribs • Floating (free)  11th to 12th pair of ribs Typical Ribs • 3rd to 9th  Head  Neck  Tubercle o Articular part o Non-articular part  Shaft o Internal surface: costal groove

o o o

Smallest, most variable part of the sternum thin, elongated Lies at level of T10  Inferior limit of thoracic cavity  Site of infrasternal (subcostal) angle of inferior thoracic aperture  Marker – liver, central tendon of diaphragm, inferior border of heart

Atypical Ribs • 1st rib  Broadest, shortest, and most sharply curved  Single facet for articulation with T1 vertebra  Has grooves for subclavian vessels • 2nd rib  Longer than the 1st rib  Has 2 facets for articulation with bodies of T1 and T2 • 10th to 12th ribs  Contains a single facet on their head Thoracic Vertebra • Costal facets/demifacets – articulate with head of ribs • Costal facets on transverse processes – articulate with tubercles of ribs • Long spinous process Costal Cartilages • Extends the ribs anteriorly • Contributes to elasticity of the thoracic wall • Hyaline cartilage • 1st to 7th articulate with the sternum • 8th to 10th articulate with the cartilage superior to them Sternum • Flat, elongated bone • Forms the middle of the anterior part of thoracic cage • Parts  Manubrium o Aka handle o Level of T3 and T4 o Widest and thickest o Jugular notch – palpable concave center at superior Clavicular notch o Fuses laterally with costal cartilage of the 1st rib o Manubrio-sternal joint

Thoracic Apertures • Superior Thoracic Aperture  Communication of the neck with the thoracic cavity  Oblique  Kidney-shaped  12.5 cm transversely and 6.5 cm anteroposteriorly  Where trachea, , esophagus, and other important structures pass through  Borders o Posterior: T1 vertebra o Lateral: 1st pair of ribs and costal cartilages o Anterior: Superior border of the manubrium • Inferior Thoracic Aperture  More spacious than superior thoracic aperture  Large, irregular outline  Oblique  Closed off by the diaphragm  Boundaries o Posterior: T12 vertebra o Lateral:11th and 12th pair of ribs o Lateral: Costal cartilages of ribs 7-10 o Anterior: Xiphisternal joint Articulations of the Thorax • Costovertebral Joints  Joints of heads of ribs  Costotransverse joints • Costochondral joints

 Forms sternal angle (of Louis)
 Serves as a landmark for the 2nd pair of costal cartilages  Body o Longer, narrower, and thinner o Transverse ridges –represents lines of fusion of segments of sternum  Xiphoid process

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Interchondral joints Sternocostal joints o

 Superior part joins brachial plexus  Inferior part becomes 1st intercostal nerve 2nd intercostal  Larger branch of ventral ramus of T2 spinal nerve  Smaller branch joins brachial plexus

Arteries of the Thoracic Wall • Blood supply is derived from the following arteries:  Thoracic aorta – via posterior intercostal and subcostal arteries  Subclavian artery – via internal thoracic and supreme intercostal arteries  Axillary artery – via superior and lateral thoracic arteries Veins of the Thoracic Wall • Intercostal veins – accompany intercostal arteries and nerves Movements of the Thoracic Wall • Pressure changes result in air drawn in and out through nose, mouth, larynx, trachea, and lungs • The vertical diameter of the central part of the thoracic cavity increases during inspiration (as diaphragm descends) • Inspiration increases intrathoracic volume and diameters • Passive expiration respiratory muscles relax which decreases intrathoracic volume (increasing intrathoracic pressure) • During expiration, the diameter returns to normal as elastic recoil of lungs produce subatmospheric pressure • Diaphragm ascends When the intercostal muscles contract… • Transverse diameter of the thorax increases slightly, raising the middle of the ribs (bucket handle movement) • The antero-posterior diameter of the thorax also increases: the ribs move at the costovertebral joints about an axis passing through the neck of the ribs causes the sternal ends of the ribs to rise (pump handle movement) Applied Anatomy  Question: What are the contents of the intercostal space?  Question: In performing a thoracentesis, what structures must the performer be aware of to prevent injury? That’s All Folks! Please get ¼ sheet of yellow pad paper… Kablaawak amin nga gagayem ko! Sapay kuma ta pumasa tayo amin…. (patranslate nyo kay Bernard or kay Patrick!!! Gud luck s pagtratranslate!!)

Muscles of the Thoracic Wall • Serratus posterior muscles  Serratus posterior superior  Serratus posterior inferior • Levatores costarum muscles • Intercostal muscles  External intercostal muscles  Internal intercostal muscles  Innermost intercostals • Transversus thoracis Nerves of the Thoracic Wall • Intercostal Nerves - ventral rami of T1 – T11 nerves  Typical – 3rd to 6th o Branches of typical:  Rami communicantes  Collateral branches  Lateral cutaneous branches  Anterior cutaneous branches  Muscular branches  o Atypical 1st intercostal  No anterior cutaneous branch  No lateral cutaneous branch  Ventral ramus divides into large superior and small inferior part

Editors’ note! Tranx ng sinabi ni joza: hello sa mg kaibigan ko sana pumasa tayo lahat AMEN!

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