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Region of the body between the neck and abdomen Flattened in front and behind, but rounded on the sides The bony framework of the walls is called the thoracic cage, which is formed of: Vertebral column posteriorly Ribs & intercostal spaces on the sides Sternum and costal cartilages anteriorly
Suprapleural membrane
Tent shaped dense fascial sheet that covers the apex of each lung. An extension of the endothoracic fascia Extends approximately an inch superior to the superior thoracic aperture It is attached: Laterally to the internal border of the first rib & costal cartilage At its apex to the transverse process of C7 vertebra. Medially to the fascia covering the structures passing through the superior thoracic aperture
Suprapleural Membrane
Inferiorly: It
communictes with the abdomen through a large opening bounded:
Posteriorly by the 12th thoracic vertebra Laterally by curving costal margin Anteriorly by xiphisternal joint
12
The thoracic cage: Protects the lungs, heart and large vessels Provides attachment to the muscles of thorax, upper limb, abdomen & back The cavity of thorax is divided into: A median partition, the mediastinum Laterally placed pleurae & lungs
Cutaneous Nerves
Anterior wall:
Above the level of sternal angle: Supraclavicular nerves Below the level of sternal angle: Segmental innervation by anterior and lateral cutaneous branches of the intercostal nerves
Posterior wall:
Segmental innervation by posterior rami of the thoracic spinal nerves nerves
Thoracic Dermatomes
Intercostal Space
It is the space between two ribs Since there are 12 ribs on each side, there are 11 intercostal spaces.
Each space contains: Intercostal muscles Intercostal neurovascular bundle Lymphatics
Intercostal muscles
Each intercostal space has three muscles: External Intercostal Internal Intercostal Innermost Intercostal Supplied by corresponding intercostal nerves Action: Tend to pull the ribs nearer to each other Strengthen the tissue of the space
Costo-chondral junction
CC
costochondral junction
Endothoracic Fascia
It is the extrapleural fascia that lines the wall of the chest It is located between the muscles and bones of the thoracic wall and the parietal pleura, extends over the apex (cupola) of the pleura as the suprapleural membrane, and forms a thin layer between the diaphragm and the pleura.
Intercostal Nerves
Twelve pairs Are the anterior primary rami of the thoracic spinal nerves. 1-6 distributed in the intercostal spaces, 7-11th supply the anterior abdominal wall Anterior ramus of 12th nerve runs forward in the abdomen as the subcostal nerve
Branches:
Rami communicantes Collateral branches Lateral cutaneous Anterior cutaneous Muscular branches Pleural Peritoneal (7th-11th)
Intercostal Arteries
Each intercostal space contains: A single posterior & Two anterior intercostal arteries Each artery gives off branches to the muscles, skin, parietal pleura (& breast)
Intercostal Veins
Accompany intercostal arteries and nerves Each space has posterior & anterior intercostal veins Eleven posterior intercostal and one subcostal vein Lie deepest in the costal grooves Contain valves which direct the blood posteriorly
Lymphatics
Lymph vessels of the intercostal space conform to the general rule, that deep lymphatics follow arteries Anteriorly drain into anterior intercostal nodes that lie along the internal thoracic artery Posterioly drain into posterior intercostal nodes that lie in the posterior mediastinum
Applied Anatomy
Sternum: used for marrow biopsy May be split to make surgical access to heart, great vessels and thymus Sternal angle as an important landmark for counting ribs, costal cartilages and intercostal spaces Thoracic outlet syndrome: Compression of nerves /vessels at the superior aperture of thorax Cervical rib Referred pain: Disease in the thorax may reveal pain in the anterior abdominal wall Why?