Evaluation of Vertebral Level of Sternal Angle and Sternal Notch Using MRI
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The Structure and Function of Breathing
CHAPTERCONTENTS The structure-function continuum 1 Multiple Influences: biomechanical, biochemical and psychological 1 The structure and Homeostasis and heterostasis 2 OBJECTIVE AND METHODS 4 function of breathing NORMAL BREATHING 5 Respiratory benefits 5 Leon Chaitow The upper airway 5 Dinah Bradley Thenose 5 The oropharynx 13 The larynx 13 Pathological states affecting the airways 13 Normal posture and other structural THE STRUCTURE-FUNCTION considerations 14 Further structural considerations 15 CONTINUUM Kapandji's model 16 Nowhere in the body is the axiom of structure Structural features of breathing 16 governing function more apparent than in its Lung volumes and capacities 19 relation to respiration. This is also a region in Fascla and resplrstory function 20 which prolonged modifications of function - Thoracic spine and ribs 21 Discs 22 such as the inappropriate breathing pattern dis- Structural features of the ribs 22 played during hyperventilation - inevitably intercostal musculature 23 induce structural changes, for example involving Structural features of the sternum 23 Posterior thorax 23 accessory breathing muscles as well as the tho- Palpation landmarks 23 racic articulations. Ultimately, the self-perpetuat- NEURAL REGULATION OF BREATHING 24 ing cycle of functional change creating structural Chemical control of breathing 25 modification leading to reinforced dysfunctional Voluntary control of breathing 25 tendencies can become complete, from The autonomic nervous system 26 whichever direction dysfunction arrives, for Sympathetic division 27 Parasympathetic division 27 example: structural adaptations can prevent NANC system 28 normal breathing function, and abnormal breath- THE MUSCLES OF RESPIRATION 30 ing function ensures continued structural adap- Additional soft tissue influences and tational stresses leading to decompensation. -
Part 1 the Thorax ECA1 7/18/06 6:30 PM Page 2 ECA1 7/18/06 6:30 PM Page 3
ECA1 7/18/06 6:30 PM Page 1 Part 1 The Thorax ECA1 7/18/06 6:30 PM Page 2 ECA1 7/18/06 6:30 PM Page 3 Surface anatomy and surface markings The experienced clinician spends much of his working life relating the surface anatomy of his patients to their deep structures (Fig. 1; see also Figs. 11 and 22). The following bony prominences can usually be palpated in the living subject (corresponding vertebral levels are given in brackets): •◊◊superior angle of the scapula (T2); •◊◊upper border of the manubrium sterni, the suprasternal notch (T2/3); •◊◊spine of the scapula (T3); •◊◊sternal angle (of Louis) — the transverse ridge at the manubrio-sternal junction (T4/5); •◊◊inferior angle of scapula (T8); •◊◊xiphisternal joint (T9); •◊◊lowest part of costal margin—10th rib (the subcostal line passes through L3). Note from Fig. 1 that the manubrium corresponds to the 3rd and 4th thoracic vertebrae and overlies the aortic arch, and that the sternum corre- sponds to the 5th to 8th vertebrae and neatly overlies the heart. Since the 1st and 12th ribs are difficult to feel, the ribs should be enu- merated from the 2nd costal cartilage, which articulates with the sternum at the angle of Louis. The spinous processes of all the thoracic vertebrae can be palpated in the midline posteriorly, but it should be remembered that the first spinous process that can be felt is that of C7 (the vertebra prominens). The position of the nipple varies considerably in the female, but in the male it usually lies in the 4th intercostal space about 4in (10cm) from the midline. -
Structure of the Human Body
STRUCTURE OF THE HUMAN BODY Vertebral Levels 2011 - 2012 Landmarks and internal structures found at various vertebral levels. Vertebral Landmark Internal Significance Level • Bifurcation of common carotid artery. C3 Hyoid bone Superior border of thyroid C4 cartilage • Larynx ends; trachea begins • Pharynx ends; esophagus begins • Inferior thyroid A crosses posterior to carotid sheath. • Middle cervical sympathetic ganglion C6 Cricoid cartilage behind inf. thyroid a. • Inferior laryngeal nerve enters the larynx. • Vertebral a. enters the transverse. Foramen of C 6. • Thoracic duct reaches its greatest height C7 Vertebra prominens • Isthmus of thyroid gland Sternoclavicular joint (it is a • Highest point of apex of lung. T1 finger's breadth below the bismuth of the thyroid gland T1-2 Superior angle of the scapula T2 Jugular notch T3 Base of spine of scapula • Division between superior and inferior mediastinum • Ascending aorta ends T4 Sternal angle (of Louis) • Arch of aorta begins & ends. • Trachea ends; primary bronchi begin • Heart T5-9 Body of sternum T7 Inferior angle of scapula • Inferior vena cava passes through T8 diaphragm T9 Xiphisternal junction • Costal slips of diaphragm T9-L3 Costal margin • Esophagus through diaphragm T10 • Aorta through diaphragm • Thoracic duct through diaphragm T12 • Azygos V. through diaphragm • Pyloris of stomach immediately above and to the right of the midline. • Duodenojejunal flexure to the left of midline and immediately below it Tran pyloric plane: Found at the • Pancreas on a line with it L1 midpoint between the jugular • Origin of Superior Mesenteric artery notch and the pubic symphysis • Hilum of kidneys: left is above and right is below. • Celiac a. -
Thoracic Cage EDU - Module 2 > Thorax & Spine > Thorax & Spine
Thoracic Cage EDU - Module 2 > Thorax & Spine > Thorax & Spine Thoracic cage • Protects the chest organs (the heart and lungs). Main Structures: The sternum (aka, breastbone) lies anteriorly. 12 thoracic vertebrae lie posteriorly. 12 ribs articulate with the thoracic vertebrae. Sternum • Manubrium (superiorly) • Body (long and flat, middle portion) • Xiphoid process - Easily injured during chest compression (for CPR). • Sternal angle - Where manubrium and body meet - Easily palpated to find rib 2 • Sternal indentations: - Jugular notch (aka, suprasternal notch) is on the superior border of the manubrium. - Clavicular notches are to the sides of the jugular notch; these are where the clavicles (aka, collarbones), articulate with the sternum. - Costal notches articulate with the costal cartilages of the ribs ("costal" refers to the ribs). Rib Types • True ribs - Ribs 1-7; articulate with the sternum directly via their costal cartilages. • False ribs - Ribs 8-12; do not articulate directly with the sternum. - Ribs 11 and 12 are "floating ribs," do not articulate at all with the sternum. 1 / 2 Rib Features • Head - Articulates with the vertebral body; typically comprises two articular surfaces separated by a bony crest. • Neck - Extends from the head, and terminates at the tubercle. • Tubercle - Comprises an articular facet, which is where the rib articulates with the transverse process of the vertebra. • Shaft - Longest portion of the rib, extends from tubercle to rib end. • Angle - Bend in rib, just lateral to tubercle. Rib/vertebra articulation • Head and tubercle of rib articulate with body and thoracic process of vertebrae. Intercostal spaces • The spaces between the ribs • House muscles and neurovascular structures. -
1 the Thoracic Wall I
AAA_C01 12/13/05 10:29 Page 8 1 The thoracic wall I Thoracic outlet (inlet) First rib Clavicle Suprasternal notch Manubrium 5 Third rib 1 2 Body of sternum Intercostal 4 space Xiphisternum Scalenus anterior Brachial Cervical Costal cartilage plexus rib Costal margin 3 Subclavian 1 Costochondral joint Floating ribs artery 2 Sternocostal joint Fig.1.3 3 Interchondral joint Bilateral cervical ribs. 4 Xiphisternal joint 5 Manubriosternal joint On the right side the brachial plexus (angle of Louis) is shown arching over the rib and stretching its lowest trunk Fig.1.1 The thoracic cage. The outlet (inlet) of the thorax is outlined Transverse process with facet for rib tubercle Demifacet for head of rib Head Neck Costovertebral T5 joint T6 Facet for Tubercle vertebral body Costotransverse joint Sternocostal joint Shaft 6th Angle rib Costochondral Subcostal groove joint Fig.1.2 Fig.1.4 A typical rib Joints of the thoracic cage 8 The thorax The thoracic wall I AAA_C01 12/13/05 10:29 Page 9 The thoracic cage Costal cartilages The thoracic cage is formed by the sternum and costal cartilages These are bars of hyaline cartilage which connect the upper in front, the vertebral column behind and the ribs and intercostal seven ribs directly to the sternum and the 8th, 9th and 10th ribs spaces laterally. to the cartilage immediately above. It is separated from the abdominal cavity by the diaphragm and communicates superiorly with the root of the neck through Joints of the thoracic cage (Figs 1.1 and 1.4) the thoracic inlet (Fig. -
The Axial Skeleton Visual Worksheet
Biology 201: The Axial Skeleton 1) Fill in the table below with the name of the suture that connects the cranial bones. Suture Cranial Bones Connected 1) Coronal suture Frontal and parietal bones 2) Sagittal suture Left and right parietal bones 3) Lambdoid suture Occipital and parietal bones 4) Squamous suture Temporal and parietal bones Source Lesson: Cranial Bones of the Skull: Structures & Functions 2) Fill in the table below with the name of the bony opening associated with the specific nerve or blood vessel. Bones and Foramina Associated Blood Vessels and/or Nerves Frontal Bone 1) Supraorbital foramen Ophthalmic nerve, supraorbital nerve, artery, and vein Temporal Bone 2) Carotid canal Internal carotid artery 3) Jugular foramen Internal jugular vein, glossopharyngeal nerve, vagus nerve, accessory nerve (Cranial nerves IX, X, XI) Occipital Bone 4) Foramen magnum Spinal cord, accessory nerve (Cranial nerve XI) 5) Hypoglossal canal Hypoglossal nerve (Cranial nerve XII) Sphenoid Bone 6) Optic canal Optic nerve, ophthalmic artery Source Lesson: Cranial Bones of the Skull: Structures & Functions 3) Label the anterior view of the skull below with its correct feature. Frontal bone Palatine bone Ethmoid bone Nasal septum: Perpendicular plate of ethmoid bone Sphenoid bone Inferior orbital fissure Inferior nasal concha Maxilla Orbit Vomer bone Supraorbital margin Alveolar process of maxilla Middle nasal concha Inferior nasal concha Coronal suture Mandible Glabella Mental foramen Nasal bone Parietal bone Supraorbital foramen Orbital canal Temporal bone Lacrimal bone Orbit Alveolar process of mandible Superior orbital fissure Zygomatic bone Infraorbital foramen Source Lesson: Facial Bones of the Skull: Structures & Functions 4) Label the right lateral view of the skull below with its correct feature. -
Axial Skeleton 214 7.7 Development of the Axial Skeleton 214
SKELETAL SYSTEM OUTLINE 7.1 Skull 175 7.1a Views of the Skull and Landmark Features 176 7.1b Sutures 183 7.1c Bones of the Cranium 185 7 7.1d Bones of the Face 194 7.1e Nasal Complex 198 7.1f Paranasal Sinuses 199 7.1g Orbital Complex 200 Axial 7.1h Bones Associated with the Skull 201 7.2 Sex Differences in the Skull 201 7.3 Aging of the Skull 201 Skeleton 7.4 Vertebral Column 204 7.4a Divisions of the Vertebral Column 204 7.4b Spinal Curvatures 205 7.4c Vertebral Anatomy 206 7.5 Thoracic Cage 212 7.5a Sternum 213 7.5b Ribs 213 7.6 Aging of the Axial Skeleton 214 7.7 Development of the Axial Skeleton 214 MODULE 5: SKELETAL SYSTEM mck78097_ch07_173-219.indd 173 2/14/11 4:58 PM 174 Chapter Seven Axial Skeleton he bones of the skeleton form an internal framework to support The skeletal system is divided into two parts: the axial skele- T soft tissues, protect vital organs, bear the body’s weight, and ton and the appendicular skeleton. The axial skeleton is composed help us move. Without a bony skeleton, we would collapse into a of the bones along the central axis of the body, which we com- formless mass. Typically, there are 206 bones in an adult skeleton, monly divide into three regions—the skull, the vertebral column, although this number varies in some individuals. A larger number of and the thoracic cage (figure 7.1). The appendicular skeleton bones appear to be present at birth, but the total number decreases consists of the bones of the appendages (upper and lower limbs), with growth and maturity as some separate bones fuse. -
Protrusion of the Lung Apex Through Sibson's Fascia in Infancy
Thorax: first published as 10.1136/thx.33.3.290 on 1 June 1978. Downloaded from Thorax, 1978, 33, 290-294 Protrusion of the lung apex through Sibson's fascia in infancy MICHAEL GRUNEBAUM1 AND N. THORNE GRISCOM From the Department of Radiology, The Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts 02115, USA Grunebaum, M., and Griscom, N. T. (1978). Thorax, 33, 290-294. Protrusion of the lung apex through Sibson's fascia in infancy. Apical 'herniation' of the lung is an unusual protrusion of the lung and its pleural coverings through the superior aperture of the thorax. It is supposedly caused by weakness of Sibson's fascia. The phenomenon is an anatomical variation and not a disease entity; however, it must be recognised in order to avoid inappropriate surgery. The condition apparently disappears spontaneously with growth. Protrusion of the lung parenchyma into the neck After recovering from his respiratory distress, is uncommon (Reinhart and Hermel, 1951; which was thought to be due to croup, the infant Munnell, 1968), especially in children (Bronsther was sent for radiological investigation with the et al., 1968; Thompson, 1976). Descriptions of this referring diagnosis of laryngocoele. Plain films phenomenon during the first year of life are rare showed a gas-containing structure in front of and (Palazzo and Garrett, 1951; Cunningham and to the right of the trachea just above the supra- Peters, 1969). Of the eight patients with protru- sternal notch. The trachea seemed to be displaced http://thorax.bmj.com/ sion of the apex of the lung through Sibson's backwards and slightly narrowed (Fig. -
Sternal Angle Revisited E from Anatomy to Radiology
journal of the anatomical society of india 62 (2013) 95e97 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/jasi Editorial Sternal angle revisited e From anatomy to radiology V.K. Arora a,*, Vishram Singh b a Professor, Head Respiratory Medicine and Vice-Chancellor, Santosh University, Ghaziabad, NCR-Delhi, India b Professor and Head, Department of Anatomy, Santosh Medical College, Ghaziabad, NCR-Delhi, India The sternum, a dagger-shaped bone, which forms the anterior advent of studies in latest radiological techniques many part of the thoracic cage consists of three parts, cranial ma- notable individual variation have been reported.5 nubrium, intermediate body and caudal xiphoid process. In normal stance, sternum slopes down and slightly forward. It is very narrow at the manubriosternal joint. The sternum con- 1. Radiology tains highly vascular trabecular bone enclosed by a compact 1 bone which is thickest in the manubrium. Computed tomography (CT) is the modality of choice to The manubrium is a quadrilateral bone which is at level evaluate anatomic detail as well as pathologic conditions of 1 with third and fourth thoracic vertebra. Suprasternal notch is the sternum, sternoclavicular joints, and adjacent soft tissues. the superior margin of manubrium sterni and is easily felt CT allows differentiation of the cortex from the medulla; de- between the prominent medial ends of clavicle in the midline. picts normal speculations and pits, among other variants; and It lies opposite the lower border of second thoracic vertebrae allows normal variants to be differentiated from pathologic 2 which act as an anatomical landmark. -
BREASTPLATE: Sternum RIBS
Lab 4 FUNCTIONAL HUMAN ANATOMY LAB #4 THORACIC CAVITY THORACIC OSTEOLOGY: BREASTPLATE: Manubrium The joint between the Manubrium and the Sternum is called the manubrialsternal joint. This point is also a surface landmark called the sternal angle (which can be easily palpated). This is clinically Sternum important because it is located at the level of the second rib. Once the sternal angle has been palpated, the intercostal spaces may be Xiphoid process identified. RIBS: Head Neck Ribs 1-7 are true ribs (have direct connection to the sternum); 8-12 Tubercle are false ribs (no direct connection to the sternum); 11-12 are also floating ribs (have no anterior connection at all). Each rib articulates Angle with the thoracic vertebre in two places. The head of the rib articulates with the body of a vertebre and the tubercle of the rib articulates with Costal groove the tranverse process of a vertebre. There are costal facets present at these articulation points. Sternal end Costal chondrial joint THORACIC MUSCULATURE: Pectoralis major Medial attachment: consists of three heads (clavicular, sternal and Proximal end of clavical, body of sternum and the middle few ribs abdominal); only identify for now, we will discuss the function of this muscle in the Lateral attachment: upper extremity lab Lateral lip of interturbicular (bicipital) groove Function: Flexion of the arm at shoulder (clavicular head); horizontal adduction (sternal head); flexion of arm at shoulder from a hyperextended position (abdominal head); horizontal adduction and internal -
Thorax Syllabus
THORAX COURSE CONTENT COMPETENCIES The first year medical student should be able to understand and describe the gross anatomy of thoracic wall, mediastinum and the contents of thoracic cavity, correlate the anatomical basis of clinical manifestations /clinical procedures pertaining to thorax and describe the radiological anatomy of thorax. REGIONS AND ORGANS THORACIC WALL THORACIC INLET Boundaries and contents Level 2: Details Level 3: Thoracic outlet syndrome THORACIC OUTLET Boundaries, diaphragm,attachments, major openings and their vertebral levels Level 2: Functional correlation; Minor openings Level 3: Development and congenital anomalies RIB CAGE THORAX Typical intercostal space – Boundaries and contents; Atypical intercostal space; Movements of respiration Level 2: Accessory muscles of respiration Level 3: Applied aspects: Barrel chest, pectus excavatum, rickety rosary MEDIASTINUM Divisions and major contents Level 2: Details Level 3: Applied aspects: Mediastinitis, mediastinoscopy SUPERIOR AND POSTERIOR MEDIASTINA Boundaries and contents: Trachea, Oesophagus, Aorta, Azygos system, Thoracic duct Level 2: Superior mediastinal Syndrome, Course, relation and branches / area of drainage Level 3: Applied aspects: Coarctation of aorta, aneurysm, developmental anomalies PLEURA Pleural reflections, recesses, innervation Level 2: Functional importance of recesses Level 3: Pleuritis, pleural effusion, pleural tap, posterior approach to kidney (importance of pleural reflection) 41 LUNGS Gross description including lobes, fissures and bronchopulmonary -
Intervertebral Foramina - Wikipedia Visited on 06/06/2017
Intervertebral foramina - Wikipedia Visited on 06/06/2017 Not logged in Talk Contributions Create account Log in Article Talk Read Edit View history Intervertebral foramina From Wikipedia, the free encyclopedia Main page The intervertebral foramen (also called neural Contents Intervertebral foramina Featured content foramina, and often abbreviated as IV foramina Current events or IVF), is a foramen between two spinal Random article vertebrae. Cervical, thoracic, and lumbar Donate to Wikipedia vertebrae all have intervertebral foramina. Wikipedia store The foramina, or openings, are present between Interaction every pair of vertebrae in these areas. A number Help of structures pass through the foramen. These are About Wikipedia the root of each spinal nerve, dorsal root ganglion, Community portal the spinal artery of the segmental artery, Recent changes communicating veins between the internal and Contact page external plexuses, recurrent meningeal (sinu- Tools vertebral) nerves, and transforaminal ligaments. What links here When the spinal vertebrae are articulated with Related changes each other the bodies form a strong pillar for the Upload file support of the head and trunk, and the vertebral Special pages Permanent link foramen constitutes a canal for the protection of Page information the medulla spinalis (spinal cord). Peculiar thoracic vertebrae. Intervertebral foramina are indicated by arrows. Wikidata item The size of the foramina is variable due to Cite this page placement, pathology, spinal loading, and posture. Print/export Foramina can be occluded by arthritic Create a book degenerative changes and space-occupying Download as PDF lesions like tumors, metastases and spinal disc Printable version herniations. Languages Specifically the intervertebral foramen is bound by Deutsch the superior notch of the adjacent vertebra, the Español inferior notch of the vertebra, the vertebral body, and facet joints on the transverse process of the فارسی Français vertebra.