Anatomy of thorax

INTRO
General functions of the thoracic wall and diaphragm

Contain and protect the thoracic contents, protect upper abdominal contents.
Along with the diaphragm it provides the ventilation apparatus for the respiratory
system. Provides attachment for the upper limb and other muscles. Force transfer
through the trunk.

General structure of the thoracic wall

thorax is shaped like a truncated cone which is flattened anterior-posteriorly

is composed of the thoracic vertebrae (12), ribs (12 pairs) and the sternum
ribs overall slope downwards both anteriorly and laterally
between the ribs are the intercostal spaces with the intercostal muscles
outer layer of skin and subcutaneous tissue which also contains the mammary
glands
inlet (or superior thoracic aperture: opening at the top of the thoracic cavity) is small
and slopes downwards and forwards. It communicates with neck region which
contains part of the upper airway
outlet (at costal margin, lower opening of the thoracic cavity) is larger and slopes
upwards and forwards. It is enclosed by the diaphragm
thoracic wall contains many joints most of which allow only a small amount of
movement. However when combined they allow sufficient movement of the thorax
as a whole for ventilation and for trunk movement.
increase the anterior-posterior and lateral diameters of the thoracic cavity in
ventilation = contractility of its muscles & many joints & rigidity of the ribs &
the downward sloping of the ribs both antero- posteriorly and laterally. This
increase in thoracic cavity dimensions is transferred to the lungs via the
pleura.
contents:
Lungs and pleura, diaphragm
Mediastinum: heart and pericardium, great vessels, trachea, oesophagus,
phrenic/cardiac nerves, thoracic duct (largest lymph vessel), thymus and
lymph nodes

BONES AND JOINTS

Thoracic Vertebral Column

typical vertebra has a body with upper and lower articular surfaces, pedicle, lamina,
transverse process, spine, superior and inferior articular processes and surfaces,
vertebral foramen, superior and inferior vertebral notches.
vertebral foramina collectively form the vertebral canal which contains the
spinal cord
vertebral notches form the intervertebral foramina through which the spinal
nerves pass
12 vertebra in thoracic region: medium sized body, a long downward directed spine
and additional articular surfaces on body and transverse processes for the ribs
Overall the thoracic vertebral column is curved, concave forwards, a kyphosis.
note: normal adult there are four curvatures in the vertebral column to align
head with sacrum
thoracic and sacral regions = kyphosis (concave [hole] anterior)
primary curvature (same in child and adult)
lumbar and cervical regions = lordosis (convex [bump] anterior)
secondary curvature (different between child and adult)
 Joints:
Intervertebral Disc Joints - between the bodies of the vertebrae, symphysis
(fibrocartilaginous)
Zygapophyseal Joints - plane joints between the articular processes, synovial
ex: between inferior articular facet of T8 (inferior articular process) and
superior articular facet of T9 (superior articular process)
sliding, anterior-posterior orientation allows mainly rotation in the
thoracic region.

Sternum:

Three parts: manubrium, body, xiphoid process (see image above)

Located anteriorly, at vertebral levels TV3 to TV8
Joints:
Manubrosternal Joint - between the manubrium and the body of the sternum
fibrocartilagenous (=symphysis) [bone - hyaline - fibrocartilage -
hyaline - bone]
forms the manubrosternal angle through which passes the
manubrosternal plane.
Xiphisternal Joint - between the body of the sternum and the xiphisternum
fibrocartilagenous
xiphisternal plane
Ribs: 12 pairs

R1-2: short, flat, c-shaped

R3-7: typical, become longer and less c-shaped as they progress downward
R1 —> 7 = true ribs: attach anteriorly to the sternum via costal cartilage
(hyaline)
R8-12: false ribs are not directly attached to sternum, become shorter
R11-12: no articular tubercle, no chondral end or anterior articulation, also
called floating ribs - very short
note: R1-4 are slanted anteriorly (expand superiorly)
R5-9 are straight (expand latero-superiorly)
R10-12 are slanted posteriorly (expand latero-superiorly)
see ventilation further down
A typical bony part of a rib has a head, neck, angle, shaft, tubercle (articular, non
articular parts), costal groove and a chondral end.
Joints:
Costocorporal: R1-12, head of rib with vertebral body - synovial
Costotransverse: R1-10, articular tubercle of rib with transverse process of
vertebra - synovial
Costochondral: R1-10, chondral end of rib with costal cartilage -
cartilagenous (hyaline)
Sternocostal: R1-7, costal cartilage directly with sternum, true ribs - synovial
(except for R1 which is fibrous)
Interchondral: R8, 9, 10 costal cartilage with the costal cartilage of R 7, false
ribs - synovial
Mouvements:
Upward movement of the ribs along an axis between the
costocorporal and costotransverse joints elevates the anterior end of
the rib
upward movement of the ribs along an axis between the posterior and
anterior joints elevates the lateral side of the rib
MUSCLES

Intercostal muscles: located between ribs - 11 paired sets.

May be incomplete and replaced by a membrane
External intercostal muscles: origins are along the inferior borders of the first
11 ribs and their insertions are along the superior borders of the rib below
fibres run obliquely downward and forward/inferior and anterior
aid in quit and forced inhalation
elevate ribs, bend them more open, expanding cavity diameter laterally
and superiorly
Internal intercostal muscles: origins form along the superior border of the
second through twelfth ribs and their insertions form along the inferior
borders of the rib above
fibres run obliquely upward and backward/superior and posterior (at
right angle of external muscles)
aid in forced expiration
depress the ribs and bend them inward, decreasing diameter of cavity
laterally and superiorly
Costal groove: intercostal Vein, Artery, Nerve (in that order top to bottom)
Innermost intercostal muscles:
fibres run obliquely upward and backwards/superior and posterior (at
right angle of external muscles)
 function same as above (thorax depression)
Muscles are innervated segmentally by intercostal nerves (11 pairs) which form as a
direct continuation of the anterior primary/ventral rami of thoracic spinal nerve
without an associated plexus.

Layer summary: Skin, subcutaneous, rib or intercostal muscles and intercostal space
(containing VAN), endothoracic fascia (loose CT), parietal pleura, pleural space
(potential)/fluid, visceral pleura, lung.

Diaphragm: separates thoracic (@inferior outlet) and abdominal contents & ventilation by
altering intra- abdominal pressure.

Skeletal muscle, large, flat, thin, curved antero-posterior and laterally, encloses the
thoracic outlet.
Contact points: Xiphoid process; the inner surface of the 7th-12th ribs; the anterior
surfaces of the L1-L3 vertebrae; the fascia over the quadratus lumborum; the psoas
major muscles via the medial and lateral arcuate ligaments.
Attachements: xiphisternal, costal, vertebral
Central tendon:
 contains the caval opening
fibrous pericardium fuses with the central tendon of the diaphragm via the
pericardiacophrenic ligament.
Arcuate ligaments:
Median (1): attaches to the lumbar vertebrae
the aorta passes beneath/behind it at the TV12 level
Medial (2): attaches from the lumbar vertebra to the transverse process of
LV1
the psoas major muscle passes beneath it.
Lateral (2): attaches from the transverse process of LV1 to R12
the quadratus lumborum muscle passes beneath it.

Openings:
Caval: TV8 level in the central tendon on the right
contains the inferior vena cava and the right phrenic nerve (left pierces
diaphragm independently)
Oesophageal: in the muscle, surrounded by the right crus, TV10 level on the
left
contains the oesophagus and the L&R vagus nerves
Motor innervation through phrenic nerve originating from C345 (cervical and
brachial plexuses)
Blood supply through superior&inferior phrenic & musculophrenic artery
Surrounding structures:
Above: Lungs and pleura laterally, heart and pericardium centrally
Bellow:
Right: Liver right lobe (not shown), kidney (+adrenal)
Left: Liver left lobe, kidney (+adrenal), stomach, spleen
Ventilation: contraction of the diaphragm increases the superior inferior dimension
of the thoracic cavity.
Several properties which make this possible are
its contractility (it can change shape)
 its curvatures (convex upwards)
the fixation of its margins (so the central tendon moves and not the
margins)
At rest the central tendon is higher than the margins
When it contracts the central part descends increasing the
superiori-inferior diameter of the thoracic cavity
This arrangement causes the central tendon to descend when the muscle
contracts. This increase in dimension, as with the chest wall, is transferred to
the lungs via the pleura.

Movements of the thorax and diaphragm during ventilation

Ventilation: mechanism by which air is moved in and out of the lungs.

Involves structures such as the chest wall, diaphragm, pleura and various
central and peripheral nerve structures.
parietal pleura is adhered to the chest wall and diaphragm laterally and
the visceral pleura of lung medially
medially, the two layers of pleura are held to-gether by the
surface tension of the small amount of fluid between them
as the walls and diaphragm move the lungs are expanded
because they are elastic
this increase in volume lowers the intra-alveolar pressure and
creates a pressure gradient with the external environment and
air enters the airways and alveoli via the conducting system.
see respiration notes
A two way pump with a subatmospheric (inspiration) and a above
atmospheric (expiration) component.
Quiet inspiration: involves altering the three dimensions of the thorax
superior- inferior by the curved diaphragm
antero-posterior & lateral by the movement of the ribs by the external
intercostal muscles (and the movement of the joints along the 2 planes (see
above)
Quiet expiration: The muscles relax, elastic recoil of the wall and lungs forces air out
of the lungs.
Forced inspiration: The diaphragm undergoes maximum descent, external
intercostal muscles act maximally, accessory muscles fix the ribs (particularly ribs
1, 2 eg scalenus muscles; sternocleidomastoid muscles in neck & 12 eg quadratus
lumborum) or move the ribs (eg pectoralis major)
Forced expiration: Elevation of the diaphragm is assisted by raising intra-abdominal
pressure through anterior abdominal wall muscle contraction
internal intercostal ribs contract
some accessory muscles (eg latissimus dorsi) are also used to move the ribs.
Conflicting modification on 26-Jul-16 2:35:15 PM
INTRO
General functions of the thoracic wall and diaphragm

Contain and protect the thoracic contents, protect upper abdominal contents.
Along with the diaphragm it provides the ventilation apparatus for the respiratory
system. Provides attachment for the upper limb and other muscles. Force transfer
through the trunk.

General structure of the thoracic wall

thorax is shaped like a truncated cone which is flattened anterior-posteriorly

is composed of the thoracic vertebrae (12), ribs (12 pairs) and the sternum
ribs overall slope downwards both anteriorly and laterally
between the ribs are the intercostal spaces with the intercostal muscles
outer layer of skin and subcutaneous tissue which also contains the mammary
glands
inlet (or superior thoracic aperture: opening at the top of the thoracic cavity) is small
and slopes downwards and forwards. It communicates with neck region which
contains part of the upper airway
outlet (lower opening of the thoracic cavity) is larger and slopes upwards and
forwards. It is enclosed by the diaphragm
thoracic wall contains many joints most of which allow only a small amount of
movement. However when combined they allow sufficient movement of the thorax
as a whole for ventilation and for trunk movement.
increase the anterior-posterior and lateral diameters of the thoracic cavity in
ventilation = contractility of its muscles & many joints & rigidity of the ribs &
the downward sloping of the ribs both antero- posteriorly and laterally. This
increase in thoracic cavity dimensions is transferred to the lungs via the
pleura.
 contents:
Lungs and pleura, diaphragm
Mediastinum: heart and pericardium, great vessels, trachea, oesophagus,
phrenic/cardiac nerves, thoracic duct (largest lymph vessel), thymus and
lymph nodes

BONES AND JOINTS

Thoracic Vertebral Column

typical vertebra has a body with upper and lower articular surfaces, pedicle, lamina,
transverse process, spine, superior and inferior articular processes and surfaces,
vertebral foramen, superior and inferior vertebral notches.
vertebral foramina collectively form the vertebral canal which contains the
spinal cord
vertebral notches form the intervertebral foramina through which the spinal
nerves pass
12 vertebra in thoracic region: medium sized body, a long downward directed spine
and additional articular surfaces on body and transverse processes for the ribs
Overall the thoracic vertebral column is curved, concave forwards, a kyphosis.
note: normal adult there are four curvatures in the vertebral column to align
head with sacrum
thoracic and sacral regions = kyphosis (concave [hole] anterior)
primary curvature (same in child and adult)
lumbar and cervical regions = lordosis (convex [bump] anterior)
secondary curvature (different between child and adult)
 Joints:
Intervertebral Disc Joints - between the bodies of the vertebrae, symphysis
Zygopophyseal Joints - between the articular processes, synovial
ex: between inferior articular facet of T8 (inferior articular process) and
superior articular facet of T9 (superior articular process)
sliding, anterior-posterior orientation allows mainly rotation in the
thoracic region.

Sternum:

Three parts: manubrium, body, xiphoid process (see image above)

Located anteriorly, at vertebral levels TV3 to TV8
Joints:
Manubrosternal Joint - between the manubrium and the body of the sternum
fibrocartilagenous
forms the manubrosternal angle through which passes the
manubrosternal plane.
Xiphisternal Joint - between the body of the sternum and the xiphisternum
fibrocartilagenous
xiphisternal plane
Ribs: 12 pairs

R1-2: short, flat, c-shaped

R3-7: typical, become longer and less c-shaped as they progress downward
R1 —> 7 = true ribs: attach anteriorly to the sternum via costal cartilage
(hyaline)
R8-12: false ribs are not directly attached to sternum, become shorter
R11-12: no articular tubercle, no chondral end or anterior articulation, also
called floating ribs - very short
note: R1-4 are slanted anteriorly (expand superiorly)
R5-9 are straight (expand latero-superiorly)
R10-12 are slanted posteriorly (expand latero-inferiorly)
see ventilation further down
A typical bony part of a rib has a head, neck, angle, shaft, tubercle (articular, non
articular parts), costal groove and a chondral end.
Joints:
Costocorporal: R1-12, head of rib with vertebral body - synovial
Costotransverse: R1-10, articular tubercle of rib with transverse process of
vertebra - synovial
Costochondral: R1-10, chondral end of rib with costal cartilage -
cartilagenous (hyaline)
Sternocostal: R1-7, costal cartilage directly with sternum, true ribs - synovial
(except for R1 which is fibrous)
Interchondral: R8, 9, 10 costal cartilage with the costal cartilage of R 7, false
ribs - synovial
Mouvements:
Upward movement of the ribs along an axis between the
costocorporal and costotransverse joints elevates the anterior end of
the rib
upward movement of the ribs along an axis between the posterior and
anterior joints elevates the lateral side of the rib
MUSCLES

Intercostal muscles: located between ribs - 11 paired sets.

May be incomplete and replaced by a membrane
External intercostal muscles: origins are along the inferior borders of the first
11 ribs and their insertions are along the superior borders of the rib below
fibres run obliquely downward and forward/inferior and anterior
aid in quit and forced inhalation
elevate ribs, bend them more open, expanding cavity diameter laterally
and superiorly
Internal intercostal muscles: origins form along the superior border of the
second through twelfth ribs and their insertions form along the inferior
borders of the rib above
fibres run obliquely upward and backward/superior and posterior (at
right angle of external muscles)
aid in forced expiration
depress the ribs and bend them inward, decreasing diameter of cavity
laterally and superiorly
Costal groove: intercostal Nerve, Artery, Nerve (in that order top to bottom)
Innermost intercostal muscles:
fibres run obliquely upward and backwards/superior and posterior (at
right angle of external muscles)
function same as above (thorax depression)
Muscles are innervated segmentally by intercostal nerves (11 pairs) which form as a
direct continuation of the anterior primary/ventral rami of thoracic spinal nerve
without an associated plexus.

Layer summary: Skin, subcutaneous, rib or intercostal muscles and intercostal space
(containing VAN), endothoracic fascia (loose CT), parietal pleura, pleural space
(potential)/fluid, visceral pleura, lung.
Diaphragm: separates thoracic (@inferior outlet) and abdominal contents & ventilation by
altering intra- abdominal pressure.

Skeletal muscle, large, flat, thin, curved antero-posterior and laterally, encloses the
thoracic outlet.
Contact points: Xiphoid process; the inner surface of the 7th-12th ribs; the anterior
surfaces of the L1-L3 vertebrae; the fascia over the quadratus lumborum; the psoas
major muscles via the medial and lateral arcuate ligaments.
Attachements: xiphisternal, costal, vertebral
Central tendon:
contains the caval opening
fibrous pericardium fuses with the central tendon of the diaphragm via the
pericardiacophrenic ligament.
Arcuate ligaments:
Median (1): attaches to the lumbar vertebrae
the aorta passes beneath/behind it at the TV12 level
Medial (2): attaches from the lumbar vertebra to the transverse process of
LV1
the psoas major muscle passes beneath it.
Lateral (2): attaches from the transverse process of LV1 to R12
the quadratus lumborum muscle passes beneath it.
Openings:
Caval: TV8 level in the central tendon on the right
contains the inferior vena cava and the right phrenic nerve
Oesophageal: in the muscle, surrounded by the right crus, TV10 level on the
left
contains the oesophagus and the vagus nerves
Motor innervation through phrenic nerve originating from C345 (cervical and
brachial plexuses)
Blood supply through superior&inferior phrenic & musculophrenic artery
Surrounding structures:
Above: Lungs and pleura laterally, heart and pericardium centrally
Bellow:
Right: Liver right lobe (not shown), kidney (+adrenal)
Left: Liver left lobe, kidney (+adrenal), stomach, spleen
 Ventilation: contraction of the diaphragm increases the superior inferior dimension
of the thoracic cavity.
Several properties which make this possible are
its contractility (it can change shape)
its curvatures (convex upwards)
the fixation of its margins (so the central tendon moves and not the
margins)
At rest the central tendon is higher than the margins
When it contracts the central part descends increasing the
superiori-inferior diameter of the thoracic cavity
This arrangement causes the central tendon to descend when the muscle
contracts. This increase in dimension, as with the chest wall, is transferred to
the lungs via the pleura.

Movements of the thorax and diaphragm during ventilation

Ventilation: mechanism by which air is moved in and out of the lungs.

Involves structures such as the chest wall, diaphragm, pleura and various
central and peripheral nerve structures.
parietal pleura is adhered to the chest wall and diaphragm laterally and
the visceral pleura of lung medially
medially, the two layers of pleura are held to-gether by the
 surface tension of the small amount of fluid between them
as the walls and diaphragm move the lungs are expanded
because they are elastic
this increase in volume lowers the intra-alveolar pressure and
creates a pressure gradient with the external environment and
air enters the airways and alveoli via the conducting system.
see respiration notes
A two way pump with a subatmospheric (inspiration) and a above
atmospheric (expiration) component.
Quiet inspiration: involves altering the three dimensions of the thorax
superior- inferior by the curved diaphragm
antero-posterior & lateral by the movement of the ribs by the external
intercostal muscles (and the movement of the joints along the 2 planes (see
above)
Quiet expiration: The muscles relax, elastic recoil of the wall and lungs forces air out
of the lungs.
Forced inspiration: The diaphragm undergoes maximum descent, external
intercostal muscles act maximally, accessory muscles fix the ribs (particularly ribs
1, 2 eg scalenus muscles and 12 eg quadratus lumborum) or move the ribs (eg
pectoralis major)
Forced expiration: Elevation of the diaphragm is assisted by raising intra-abdominal
pressure through anterior abdominal wall muscle contraction
internal intercostal ribs contract
some accessory muscles (eg latissimus dorsi) are also used to move the ribs.