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Thorax Is Upper Part of Trunk •Study of Thorax by Studying: –Wall of the Thorax –Contents of Thorax Wall of Thorax

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Thorax Is Upper Part of Trunk •Study of Thorax by Studying: –Wall of the Thorax –Contents of Thorax Wall of Thorax Thoracic cage Intercostal Space Blood vessels & Nerves. General Overview •Thorax is upper part of trunk •Study of thorax by studying: –Wall of the thorax –Contents of thorax Wall of thorax •Skeletal framework-Thoracic cage •Muscles, membrane & ligaments Thoracic cage Thoracic Cage • Conical in shape with truncated apex • Boundaries: • Anteriorly : Sternum • Posteriorly: Twelve Thoracic Vertebrae • On sides : Twelve pairs of Ribs & Costal Cartilages Thoracic cage • The thoracic wall is covered from outside to inside by • skin • superficial facia • deep fascia & • extrinsic muscle. • Muscles of the upper limb: • Pectoralis major Pectoralis minor • Trapezius, Serratus anterior, lattisimus dorsi • Levator scapulae, Rhomboideus major & minor • Serratus posterior superior & Inferior. • Muscles of the abdomen: • Rectus abdominis & external oblique • Muscle of the back: Erector spinae Ribs • True Ribs: articulating with sternum anteriorly – Vertebrosternal ribs: 1-7 ribs • False Ribs: Do not articulate with sternum anteriorly – Vertebrochondral ribs: 8-10 ribs – Floating ribs: 11-12 ribs Ribs First & 12th ribs Apertures of thorax • Superior Aperture (Inlet of Thorax) communicates thorax & neck. Structures passing between neck & thorax are contents of inlet. Partly covered by suprapleural membrane. • Inferior Aperture: Closed by Diaphragm. Structures passing between thorax & Abdomen pass through openings in diaphragm Joints of thorax Joints Joints Joints of thorax • Intervertebral joints: joints between bodies of vertebrae. It is Symphyseal type of joint. • Joint between articular processes of vertebrae is Plane synovial joint • Costovertebral joint: It is plane synovial joint between rib & vertebrae. • Manubriosternal joint: Between manubrium & Body of sternum, Symphyseal joint. • Xiphisternal joint: Between body of sternum & xiphoid process, symphyseal joint Joints of thorax • Sternocostal joints: – First Sternocostal joint between first rib & sternum is primary cartilaginous joint which is responsible for movement of sternum during respiration. – All other sternocostal joints are plane synovial joints. – Costoschondral joints between ribs & costal cartilages are primary cartilaginous joints. Intercostal Space Muscles Intercostal Space • Space between ribs is known as intercostal space. • There are 11 intercostal spaces • Contents of Intercostal Spaces: – Intercostal Muscles – Intercostal blood vessels – Intercostal Nerves Intercostal Muscles • There are three intercostal Muscles. – External Intercostal Muscle – Internal Intercostal Muscle – Transversus Thoracis Muscle- has three parts: – intercostalis intimi – Subcostalis – Sternocostalis Intercostal Muscles External Intercostal Muscle • Origin: Lower border of rib • Insertion: Outer lip of upper border of next lower rib • Direction of fibers: Downwards, Forwards & Medially • Anteriorly it is replaced by Anterior Intercostal Membrane Internal Intercostal Muscle • Origin: Floor of costal groove of rib • Insertion: Inner lip of upper border of next lower rib • Direction of fibres: Downwards, Backwards & Laterally • Posteriorly it is replaced by Posterior Intercostal Membrane Transversus Thoracis • Three Parts: – Intercostalis Intimi: • Only seen in middle 2/4th part of space • Origin: Ridge bounding the groove • Insertion: Inner lip of upper border of next lower rib • Direction: Downwards, Backwards & Laterally – Subcostalis: • Only seen in posterior part of lower ribs – Sternocostalis: • Only seen in anterior part from sternum to ribs Nerve supply of Intercostal Muscles • Intercostal nerve of the space supplies the muscles Actions of Intercostal Muscles • When first rib is fixed- all muscles elevate the ribs for inspiration • When last/12th ribs is fixed-all muscles depress the ribs for expiration Intercostal Arteries • Posterior Intercostal arteries • Anterior Intercostal arteries. Posterior Intercostal arteries Posterior Intercostal arteries • There are 11 posterior intercostal arteries. – 1st & 2nd post. int. arteries are branches of superior intercostal artery (A branch of Costocervical trunk.) – 3rd to 11th post. int. arteries are branches of Descending thoracic aorta. – Course & relations: • Right artery is longer than the left. • Runs on parietal pleura in posterior part of space. • Runs in costal groove between vein & nerve between Internal intercostal & intercostalis intimi. • Terminate by anastomosing with anterior intercostal artery – Branches: • Collateral branch • Dorsal branch • Muscular branches • Lateral & Anterior branches Anterior Intercostal arteries Anterior Intercostal arteries • There are 11 pairs of anterior intercostal arteries. – 1st to 6th Ant. int. arteries are branches of Internal thoracic artery (Br of Subclavian artery) – 7th to 11th ant. int. arteries are branches of Musculophrenic artery (Br of Internal thoracic artery. – Course & relations: • Located in anterior part of Intercostal space. • Terminate by anastomosing with Post. intercostal artery & collateral branch Internal thoracic artery • Branch of first part of subclavian artery • Runs vertical course behind the costal cartilages • Divide in 6th space into Superior epigastric & musculophrenic artery • Branches: – Pericardiophrenic artery- – for pericardium & diaphragm – Anterior intercostal arteries- – for intercostal space – Perforating branches - for breast. – Terminal Branches: •Superior epigastric artery: enters in rectus sheath in abdomen & anastomosis with inferior epigastric artery. •Musculophrenic artery supplies lower intercostal spaces & diaphragm. Intercostal Veins Intercostal veins Intercostal veins First intercostal vein drains in to Brachiocephalic vein. Intercostal veins on the right side drains into Azygos vein which terminates in Superior vena cava (SVC). • Intercostal veins in upper spaces on the left side drains into Accessory Hemiazygos vein. This vein terminates in Azygos vein. • 5th – 8th Intercostal veins on left side drains in to Accessory hemi-azygos vein which terminates in Azygos vein. • 9th to 11th Intercostal veins in the lower spaces on left side drains into Hemiazygos vein. This vein terminates in Azygos vein. Termination of posterior intercostal vein Veins On right side On left side 1st Right Brachiocephalic Left Brachiocephalic vein vein 2nd 3rd & 4TH Joins to form rt.sup. Join to form left sup. intercostal v. Intercostal vein which drains into which drains into left azygos vein. Brachiocephalic vein. 5th to 8th. Azygos vein Accessory Hemiazygos vein 9th to 11th, & Azygos vein Hemiazygos vein Subcostal. Intercostal Nerves Intercostal Nerves: • Nerves for the intercostal spaces are intercostal nerves • Formation: Formed by continuation of anterior primary rami of spinal nerve. • It is divided into: – Typical spinal nerve: Nerve only restricting to its own space. T4,5,6 are typical spinal nerves. – Atypical spinal nerve: Nerve supplying areas apart from intercostal space. • Course & Relations: • Runs on parietal pleura in post. Part of space. • Runs in costal groove below vein & artery between Internal intercostal & intercostalis intimi. • Terminate by forming anterior cutaneous nerve. • Branches: – Muscular branches for muscles of space – Lateral cutaneous nerve supplies skin of lateral aspect of trunk. – Anterior cutaneous nerve supplies skin of anterior aspect of trunk. Relation: • In the costal groove the arrangement of the structures from above downwards are • (VAN) • Posterior intercostal vein. • Posterior intercostal artery. • Intercostal nerve. Thanks.
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