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Anatomy, Lecture 3, The Thoracic Wall (Lecture Notes)
Anatomy, Lecture 3, The Thoracic Wall (Lecture Notes)
Anatomy, Lecture 3, The Thoracic Wall (Lecture Notes)
It’s the region located between the neck and the abdomen … its composed of many layers … first we have the
skin … then the superficial fascia or (subcutaneous tissue)... then we have the deep fascia... Which covers the
muscles, and muscles are attached to bones … and in between these structures we have blood vessels and
nerves.
Usually when we study anatomy we start from the superficial to the deep but here we will start with the deepest
part of the wall which is the skeletal part...
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
as you can see "slide 3" the skeletal part forms a cage and this cage is mainly composed of 12 pairs of ribs (a
curved flat bones as you can see in the pic), they are attached to the manubrium and sterni " which is the anterior
portion of this cage by the costal cartilages " and they are united posteriorly by the thoracic segments of the
vertebral column which is 12 thoracic vertebrae.
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
Each rib is a flat curved bone, and this curve adds to it resilience... you know when we have a straight object and
a force is applied to it the force will be concentrated... this curve decreases the stress and increases the resilience
of bones and it forms a greater portion of the thoracic cage.
Based on ….. ?!
Depending on how they are attached to the sternum … if they're attached by their own costal cartilages we call
them true... & they are (1, 2, 3,4,5,6 and 7).
If they are attached through merging with the costal cartilage on top like the 10th 9th and 8th their costal
cartilages are merged together and then merging with the costal cartilage of the 7th so we call them false.
Or they don't make any attachment anteriorly like 11th and the 12th we call them floating they end up in the
abdominal muscles "in kids we can actually feel those".
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
We have typical ribs and atypical " a: for negation (no typical)"
They have a head which is a wedge-shaped so it's pointed, it has two articular facets {facet means a flat
surface}... It has a Neck which is a constriction that occurs just before the head...
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
We have a tubercle it's an elevation on the bone surface this tubercle has 2 parts:
Then we have a Shaft (Body) which is the longest portion of the rib.
If we look at "slide 6" we can see a sharp curve in each rib we call it the angle. The top border is rounded it's not
sharp, the inferior border is sharp and it over hangs ( )له حافه, this is essential for housing the costal vein artery and
nerve we call it the "costal groove".
The Thoracic Wall 29-10-2010 By: Nada Nammas
So ribs from 3-9 are considered typical and they share these features … "slide 6" {tubercle has 2 numbers to
indicate that we have Articular part and non-articular part}.
They are special each has something that prevents us to say that it's typical …
The Thoracic Wall 29-10-2010 By: Nada Nammas
The first rib: 1st … its flat, it's not rounded... it has a tubercle it's called a scalene tubercle... Whenever a muscle
attaches to a bone there should be something there a process for this attachment,
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
And one of the neck muscles the scalenus muscle it attaches to the 1st rib, and it has a tubercle there,
So its exclusive for the 1st rib, also it (1st rib) has grooves for subclavian vein, "whenever blood vessels pass on
top or under bones it leaves marks and this what we are talking about the grooves are marks for the subclavian
artery".
The second rib 2nd which is also atypical it makes an attachment for the serratus anterior muscle.
The tenth rib 10th it has only one facet on the head {usually when we have a rib articulating with the vertebral
column it will articulate with the corresponding vertebrae and the one on top of it so it will make articulation with
The Thoracic Wall 29-10-2010 By: Nada Nammas
two vertebral bodies, so they have two facets}, but the tenth it has only one facet because it makes articulation
with only the tenth vertebra.
Now:
11th and 12th they are different from the others, they are floating, with one facet on the head like the 10th
because they just articulate with one vertebra and no neck or tubercle.
There are some people they are unlucky they have an extra rib we call it the Cervical Rib it articulates with the
last cervical vertebra, why they are unlucky because this rib compress the nerves and blood vessels that pass on
The Thoracic Wall 29-10-2010 By: Nada Nammas
Actually they make condition that happens almost in 1% of people, and the Complication as you can see when
press on arteries the blood supply will be decreased to the muscle so we start having an ischemic pain, it is a
visceral pain that we feel when there is lose of blood supply, it will also press on nerves so you will have Tingling
sensations, and sometimes you will lose sensations in the respective area innervated by the compressed nerve,
one of the treatments is to have the rib surgically removed.
So if u see slide # 10 the 1st rib is the flat one... and the cervical rib is clear on the left side.
The Thoracic Wall 29-10-2010 By: Nada Nammas
Another medical condition related to the anatomy of the thoracic cage and it happens sometimes in violence
activity and accidents which is rib fractures most commonly the most affected the most prominent ones which
are the middle ones {from 5 to10} and like anything else it will break at the weakest area which the angle it will
Present as a sever localized pain, a serious complication that accompany the fracture is "pneumothorax" When
the rib penetrates through the pleural cavity that surrounds the lungs and allows the air to enter that cavity ..
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
And this is serious because you can't empty your lungs as hard as you try to blow air out of your mouth, because
your lungs are surrounded with negative pressure that keeps sucking air the negative pressure is the pressure
within the pleural membrane if you tear this membrane and allow air to go inside you will lose this negative
pressure and you might end up with a collapsed lung ore lung segment.
We talked about the ribs... because they make the major part of the thoracic cage.
Slide #12 it’s the anatomical position we are looking from a superior view, the vertebra is composed of a body
which is in the case of thoracic vertebrae is heart shaped, it's is also composed of the vertebral arch, or we call
it the neural arch .. The neural arch is composed of two pedicles and two lamina... The bone between the body
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
and the transverse process we call it pedicle, the one between the transverse process and the spinous process we
call it lamina... so two lamina and two pedicles they make the vertebral arch...
We have spinous process going posteriorly that’s usually very long and inclined inferiorly if we looked from a
sagittal view we will see that...
We have two transverse processes, two superior articular facets, and two inferior articular facets.
Q: assume that a vertebra is t5 the superior articular facets what are they going to articulate with?
The Thoracic Wall 29-10-2010 By: Nada Nammas
A: with t4 …
Once again …
?Q: the inferior articular facets of t5 will articulate with what vertebra
You should be able in the lab to distinguish between thoracic, lumbar, and cervical vertebrae.
The cervical vertebrae are very easy to be distinguished which has special features … they have two transverse
.foramina... these are only present in the cervical vertebrae
Now if we look at the thoracic and the lumbar vertebrae you will see the spinous process in the thoracic is longer
.and inclined inferiorly, where as in the lumbar its very blunt, short, and straighter … it's not inclined inferiorly
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
If you look at the arch you see that the vertebral arch looks like a part of a circle which center is in the middle of
.the vertebral body but in the lumbar it's something different
It's time for the interior portion of the thoracic cage "w b3deen bet7ebo n9eer en6ale3 barah !! ele 7ka ah
"yetfadal :P
:The interior portion it’s a flat bone we call it the Manubrium sterni, the sternum which is composed of 3 parts
The Thoracic Wall 29-10-2010 By: Nada Nammas
The top part we call it the Manubrium sterni … the body … "slide 14" and here we have a piece of hyaline
.cartilage that gets ossified during age we call it the xiphoid process
Slide 15 >> the Manubrium (1st part) it has several notches {and in the lab you should be able to determine
them}, we have on top the Jugular notch, on the sides we have Clavicular notch {for articulation with the clavicle}
.… there is a part that articulates with the first rib >> first costal cartilage, and with part of the 2nd rib
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
The joint between the manubrium and the body of the sternum we call it Manubriosternal Joint it’s a
fibrocartilaginous joint, if we take a side view we notice that the manubrium and the body they are not on a
straight line they make an angle we call it the sternal angle …this is important for clinicians when you need to
make an injection in the thorax or you want to know where are you in the thorax?! You start counting the ribs
from the angle; the angle opposes the second rib, so you pass your finger through the Jugular notch until you
reach an elevation this is the angle and you move laterally then you start counting it’s the second rib …this angle
is opposite to the t4 and t5 or the intervertebral disk between those two. This also something during your study
The Thoracic Wall 29-10-2010 By: Nada Nammas
you need to pay attention to you have a structure and the position of this structure is related to the vertebral
.column you need to memories that
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
The body of the sternum opposes t5 – t9 it has several notches here we call them the costal notches, its several
.costal notches corresponds to costal cartilage from 3rd- to 7th
.The joint the external joint it opposes t9 it a hyaline cartilage as we said and it gets ossified with age
We have a superior aperture and an inferior aperture, the boundary for the superior one we have
thoracic vertebra #1, the 1st rib, the costal cartilage, and the manubrium … the boundaries for the inferior
The Thoracic Wall 29-10-2010 By: Nada Nammas
aperture {which we call the outlet} are t12, the 11th & the 12th ribs, and from 7-10 costal cartilages ..
.They make a great portion of the boundary plus the xiphisternal joint
And if you notice this cage is inclined anteriorly so some of the structures inside this cage will appear
.through the superior aperture like the apex of the lung
Its where the blood vessels and the nerves are squeezed between the clavicle & 1st rib, usually the
therapy for that is conservative physical therapy 50-90% of people they end up doing surgery to remove
.the 1st rib to relief this pain
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
The Thoracic Wall 29-10-2010 By: Nada Nammas
Please from your grand atlas study the thoracic wall for the lab the supervisor of the lab will not be
walking with you telling you which is which most of the lab is self learning.
The Thoracic Wall 29-10-2010 By: Nada Nammas