THORACIC AND Chest Wall

Objectives
 Identify the sternum and ribs with their characteristic
features.

 Define intercostal space with its contents.

 Describe intercostal muscles with their nerve supply

and actions.

 Enlist the respiratory muscles with their actions.

 Explain the Bucket handle and pump handle

movements.
Thoracic cage
 THORACIC CAGE
Conical in shape
 Formed of:
 Sternum & costal cartilages:
anteriorly
 Twelve pairs of ribs: laterally
 Twelve thoracic vertebrae:
posteriorly
Has 2 apertures (openings):
1. Superior (thoracic inlet):
narrow, open.
2. Inferior: wide, closed by
diaphragm
 Articulations
Manubriosternal
(fibrocartilagenous J.)
Small angular
Movement possible
Costovertebral
(Synovial joint)
Costochondral
(cartilagenous J.)
no movements
possible

Sternocostal
Xiphisternal (synovial),
(fibrocartilagenous J.) fixed
no significant
movements
 Thoracic outlet
Boundaries:
a. Anterior: Xiphoid
process.
b. On each side: Lower six
costal cartilages & Last two
ribs.
c. Posterior: Last thoracic
vertebra.
- It is closed by the
diaphragm which separates
it from the abdominal
cavity.
 Ribs
Classification according to their attachments to the sternum:
Total number of Ribs: 12 pairs
A: True ribs: Upper seven ribs (Directly attached to the sternum).
B: False ribs: Lower five ribs (Indirectly attached to the sternum).
The lower two ribs (11th & 12th) are called the Floating ribs because
they are free anteriorly.
Classification of ribs according to their structure:
A: Typical: 3rd - 9th ribs.
B: Atypical:1st, 2nd, 10th, 11th, and 12th ribs. (first two and last 3) ribs.
Typical rib
 Atypical ribs
First rib (general features)
Shortest C- Shaped
Ant end: cup shape.
Post end: It has Head,
neck and tubercle.
Head: One facet
Surfaces: Sup. &
Inferior
Borders: Outer (lateral)
& Inner (medial).
 Second rib
-Twice the length of 1st
- Head has 2 facets
 Tenth rib
a. Single articular facet on
the head.
 Eleventh rib
a. Single articular facet
on the head.
b. No tubercle.
 Twelveth rib

a. Single articular facet on the head.

b. No tubercle.
c. No neck.
d. No costal groove.
e. Large head.
f. Tapering anterior end.
Sternum
 Sternum
 3 PARTS: Manubrium, Body *
Xiphoid process.
 Manubrium: Lies opposite T3,4.
 Body: T5 toT8
 Xiphoid T9
  Intercostal Spaces
 There are 9 anterior and 11
posterior
 Each space contains:
 1- Intercostal muscles:
(External, Internal and
transversus thoracicus)
 2- An Intercostal nerve.
 3- Intercostal vessels:
 a. Intercostal arteries
(Anterior & Posterior)
 b. Intercostal veins
(Anterior & Posterior).
Respiratory Movements
A- Movements of Diaphragm
Inspiration
Contraction (descent)
of diaphragm

Increase of vertical diameter

of thoracic cavity

Expiration
Relaxation (ascent)
of diaphragm)
 Respiratory Movements
B- Movements of Ribs
PUMP HANDLE MOVEMENT BUCKET HANDLE MOVEMENT
Elevation of ribs
Elevation of ribs

Increase in lateral diameter of

Increase in antero-posterior thoracic cavity
diameter of thoracic cavity
 Inspiratory Muscles
Diaphragm (most important muscle)
External intercostal muscles Rib elevators:
Accessory muscles (only used during forced
inspiration):
1. Scalene muscles
2. Pectoralis major
3. Sternomastoid
 EXTERNAL INTERCOSTAL

 Attachments: from
lower border of rib
above to upper
border of rib below
 Direction of fibers:
downward &
medially
 Nerve supply:
intercostal nerves
 Action: rib elevators
(inspiratory)
 Internal Intercostal
• Is partly traversed by the
nerve & vessels, which
splits each muscle into 2
parts:
• Outer: Internal Intercostal
• Inner: Innermost Intercostal
• (In the middle of the space)
• Transversus thoracicus
• The most inner layer of
thoracic wall
• It is formed of 3 muscles
• 1- Innermost Intercostal.
• 2- Sternocostalis.
• 3- Subcostalis
 RIB DEPRESSORS
1. Internal intercostal 3. Subcostal
2. Innermost intercostal 4. Transversus thoracis
Direction: upward & medially Nerve supply: intercostal nerves
(ventral rami of T1-T11)

3
1 2

4
 Sternocostalis
• 4 to 5 slips which arise from
inner surface of lower part of
body of sternum and costal
cartilages
• Inserted into inner surface of
costal cartilages from 2 to 6.

• Subcostalis
Thin muscle
bands of muscle fibers.
• Mainly in lower 6 spaces.
• Only in post. part of spaces.
• Origin: Inner surface & lower
border of rib above.
• Insertion: Upper border of 2nd
or 3rd rib below.
 Expiratory Muscles
Act only during forced expiration
• Rib depressors:
 Internal intercostal
 Innermost intercostal
 Subcostals
 Transversus thoracis
• Anterior abdominal wall muscles:
 External oblique
 Internal oblique
 Transversus abdominis
 Rectus abdominis
It contains:
1- Intercostal muscles.

2- Intercostal nerves.

3- Intercostal arteries.

4- Intercostal veins.
 Intercostal muscles
I. Outer layer: External intercostal muscle

II. Intermediate layer: Internal intercostal muscle

III. Inner layer: Transversus thoracis group: subdivided

into:

a. Innermost inter-costalis

b. Sterno-costalis

c. Sub-costalis
 Transversus thoracis group
Arrangements and extension of the muscles
Thank you