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The Thoracic Wall:
Bony Thoracic Cage
Thoracic Wall
• Structure:
skin fascia muscle bone
blood vessels & nerves
• Functions:
1. protection of thoracic
viscera
2. provides the mechanical
function of breathing
Thoracic Cage
The bony part of thoracic The bony part of thoracic wallwall
- 12 pairs of ribs & CC- 12 pairs of ribs & CC
- 12 thoracic vertebrae- 12 thoracic vertebrae
- Sternum- Sternum
Ribs
- Flat curved bones with high - Flat curved bones with high resilienceresilience
- Form most of the thoracic cage- Form most of the thoracic cage
-3 types:3 types:
1. True (11. True (1stst – 7 – 7thth))
2. False (82. False (8thth – 10 – 10thth))
3. Floating (113. Floating (11thth & 12 & 12thth))
Features of Typical Ribs
1. Head: wedge-shaped with 2 articular facets
2. Neck: connects the head with the body
3. Tubercle: articular & non-articular parts
4. Shaft (Body): angle & costal groove
Typical Ribs
33rdrd – 9 – 9thth ribs are considered ribs are considered typicaltypical
1.1. Articular facets Articular facets
2.2. Crest of HeadCrest of Head
3.3. NeckNeck
4+5. Tubercle4+5. Tubercle
6. Angle6. Angle
7. Costal groove7. Costal groove
8. shaft8. shaft
Atypical Ribs
• 1st rib
Flat, scalene tubercle & grooves for subclavian v.
• 2nd rib
rough tuberosity for serratus anterior m.
• 10th rib
one facet on the head
• 11th & 12th
one facet on the head & no neck or tubercle
1st Rib
1.1.Flat ribFlat rib
2. Scalene Tubercle2. Scalene Tubercle
3. Grooves for 3. Grooves for subclavian vesselssubclavian vessels
4. One Facet on the 4. One Facet on the headhead
Clinical: Cervical Rib
• Extra rib arise from C7 vertebra
• Present in 1% of people
• Complications:
Causes pressure on nerves & arteries supplying the
upper limb
Tingling & numbness Partial paralysis
ischemic muscle pain (due to?)
Cervical Rib
Rib Fractures
• Common chest injuries (middle ribs, 5-10)
• Mostly in weakest part (the angle)
• Present as a sever localized pain
• Complications: inj. to underlying structures
pneumothorax (air in pleural cavity)
Structure of Vertebrae
BodyBody
Vertebral archVertebral arch
(P & L)(P & L)
7 processes 7 processes
Distinguishing Features of Thoracic Vertebrae
Sternum
((G, Sternon: chest boneG, Sternon: chest bone))
Flat, vertically elongated Flat, vertically elongated bone that forms the middle bone that forms the middle anterior part of the thoracic anterior part of the thoracic cagecage
3 parts:3 parts:
ManubriumManubrium
BodyBody
Xiphoid processXiphoid process
Manubrium
ShapedShaped
(L, Handle)(L, Handle)
* Several notches:* Several notches:
Jugular Jugular Clavicular Clavicular Costal Costal
* Manubriosternal Joint:* Manubriosternal Joint:
22oo fibrocartilaginous fibrocartilaginous
Sternal angleSternal angle
Sternal Angle
Angle of louisAngle of louis
Manubriosternal Manubriosternal jointjoint
Easily palpatedEasily palpated
Opposite to T4-Opposite to T4-T5 discT5 disc
2nd costal cartilage:2nd costal cartilage:Counting the ribs & intercostal Counting the ribs & intercostal
spacesspaces
Body:Body: T5 – T9, costal notches 3 T5 – T9, costal notches 3rdrd – 7 – 7thth
Xiphoid process:Xiphoid process: T10, hyaline cartilage T10, hyaline cartilage
ossifiedossified
Openings of Thoracic Wall
Boundaries of superior Boundaries of superior thoracic opening:thoracic opening:
T1, T1,
11stst rib, rib,
manubriummanubrium
Boundaries of inferior Boundaries of inferior thoracic opening:thoracic opening:
T12, T12,
1111thth & 12 & 12thth ribs, ribs,
7-10 CC, 7-10 CC,
xiphisternal jointxiphisternal joint
Thoracic Outlet Syndrome
• On the superior thoracic opening (anatomical inlet)
• Compression of subclavian art. between the clavicle & 1st rib
(Costoclavicular syndrome)
• Pale color & coldness on the skin of upper limb
• Diminished radial pulse
Joints of Thoracic Cage
Posteriorly:Posteriorly:
1.1. Intervertebral joints Intervertebral joints
(2(2oo cartilaginous) cartilaginous)
2. Costovertebral joints2. Costovertebral joints
(synovial plane)(synovial plane)
3. Costotransverse joints 3. Costotransverse joints
(synovial plane)(synovial plane)
1
2
3
Joints of Thoracic Cage
Anteriorly:Anteriorly:
1.1. Costochondral joints Costochondral joints
(1(1oo cartilaginous) cartilaginous)
2. Sternocostal joints2. Sternocostal joints
(synovial plane, (synovial plane,
except 1except 1stst CC CC))
3. Manubriosternal joint 3. Manubriosternal joint
(2(2oo cartilaginous) cartilaginous)
4. Xiphisternal joint4. Xiphisternal joint
(1(1oo cartilaginous) cartilaginous)
Intercostal Muscles
3 layers3 layers of m. that cover intercostal spaces of m. that cover intercostal spaces
From outside to inside:From outside to inside:
1. External intercostal m.:1. External intercostal m.:
runs downward toward sternum (runs downward toward sternum (your ant. your ant.
pocketspockets))
replaced replaced anteriorly anteriorly by membraneby membrane
2. Internal intercostal m.:2. Internal intercostal m.:
runs downward toward VC (runs downward toward VC (your post. your post.
pocketspockets))
replaced replaced posteriorlyposteriorly by membrane by membrane
3. Innermost intercostal & Transversus 3. Innermost intercostal & Transversus ThoracicThoracic
IIm:IIm:
on lateral sides onlyon lateral sides only
TTm:TTm:
4-5 slips of muscles4-5 slips of muscles
From post. surface of sternumFrom post. surface of sternum
To 2To 2ndnd-6-6thth costal cartilages costal cartilages
Bld. Vessels & nerves run between:
Internal & innermost IMs
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