The Human

Thorax
The Thoracic Wall
Lectured by Bien Eli Nillos, MD
 Thorax a.k.a Chest
 Region of the body
between the neck
and the abdomen
 Flattened in front
and behind but
rounded at the
sides
Framework of the Chest
 Behind –
vertebral column
 Either sides –
ribs and
intercostal
spaces
 Front – sternum
and costal
cartilages
 Superior –
thoracic inlet
Cavity of the Thorax
Examination of the Anterior
Surface
 Suprasternal Notch – superior margin
of the manubrium sterni, easily felt
between the prominent medial ends
of the clavicles in the midline. It lies
opposite the lower border of the
body of the Second Thoracic
Vertebrae
 Sternal Angle – the angle made
between the manubrium and body of
the sternum. At this level, the second
costal cartilage joins the lateral
margin of the sternum. It lies
opposite the intervetebral disc
between the fourth and fifth thoracic
 Xiphisternal joint – joint between the
xiphoid process of the sternum and
the body of the sternum. It lies
opposite the body of the ninth
vertebra.
 Subcostal angle – situated inferior
end of the sternum, between the
sternal attachments of the seventh
costal cartilages.
 Costal Margin – lower boundary of
the thorax and is formed by the
cartilages of the 7th, 8th and 10th ribs
and the ends of the 11th and 12th
cartilages.

The lowest part of the costal margin

is formed by the 10th rib and lies at
the level of the 3rd lumbar vertebra.
 Clavicle – easily palpated. It articulates at
its lateral extremity with the acromion
process of the scapula.
 Ribs – first rib lies deep to the clavicle.
Lateral surfaces of the remaining ribs can
be felt by pressing the fingers upward into
the axilla and drawing them downward
over the lateral surface of the chest wall.

The 12th rib may be difficult to palpate.

 Nipple – it usually lies in the 4th
intercostal space about 4 inches from
the midline.
 Apex Beat – is due to the apex of the
heart being thrust forward against
the thoracic wall as the heart pumps

It can be felt by placing the flat of the

hand on the chest wall over the
heart.
It is normally found in the 5th Left
Intercostal space 9 cms from the
midline.
 Axillary Folds –
 ANTERIOR FOLD - lower border of the
pectoralis major muscles
 POSTERIOR FOLD – tendon of the
latissimus dorsi muscle
Examination of the
Posterior Surface
 Spinous process of the thoracic
vertebrae – palpated in the midline
posteriorly. The first spinous process
to be felt is that of the 7th cervical
vertebra (C7), a.k.a. vertebra
prominens

The cervical spines of 1-6 are covered

by a large ligament, the ligamentum
nuchae.
 Scapula – located on the upper part
of the posterior surface of the thorax,
flat and triangular in shape.

Superior angle – lies opposite the spine

of the 2nd thoracic vertebra (T2)
Inferior angle – lies on the level with
the spine of T7
Spinous process of the scapula – the
root of the spine lies on a level with
the spine of T3
Lines of Orientation
 Bones of the Thorax
 Rib – 12 pairs, “true”, “false” and
“floating”
 Head – postero-medial end of the rib
 Neck – constricted region lateral to the
head
 Tubercle – a projection located postero-
inferior and lateral to the neck of the rib
 Body – shaft

 Angle – marked angulation located

lateral to tubercle

 Sternum – broad, flat bone at the
anterior of the chest
 Manubrium – superior part of the
sternum
 Sternal angle – junction between the
manubrium and body of sternum
 Body – middle part of the sternum

 Xiphoid Process – inferior part of the

sternum
 Clavicle – “S” shaped situated
between the scapula and the
sternum
 Sternal end – thickened proximal end of
the clavicle
 Acromial end – the flattened lateral end
of the clavicle
 Scapula – bone of the shoulder, very
hard to fracture and articulates with
only one bone: the clavicle.
 Superior border – superior edge of the
scapula
 Medial border – border which runs from
the superior angle to inferior angle
 Superior angle – angle formed by the
union of the superior and medial borders
 Lateral border – runs inferiormedially
from the infraglenoid tubercle to the
inferior angle
 Inferior angle – angle formed by the
union of the medial and lateral borders
 Glenoid cavity – articular surface located
at the junction of the superior and
lateral borders of the scapula
 Supraglenoid tubercle – projection
located superior to the glenoid cavity
 Infraglenoid tubercle – projection
located inferior to the glenoid cavity
 Spine – a heavy ridge that runs from
medial border of the scapula to the
acromion process
 Scapular notch – notch on the superior
border located medial to the attachment
of the coracoid process
 Coracoid process – beak-like process
projects anteriorly from the lateral end of
the superior border
 Acromion – broad flat process located at
the lateral end of the spine
 Supraspinatus Fossa – depression located
superior to the spine of the scapula
(versus Infraspinatus fossa)
Muscles of the Thorax
 Pectoralis Major
 Origin – medial ½ of the clavicle,
manubrium, body of sternum, costal
cartilages of ribs 2-6
 Insertion – crest of the tubercle of
the humerus
 Action – flexes and adducts the arm,
medially rotates the arms
 Blood supply – pectoral branch of the
thoracoacromial trunk
 Innervation – medial and lateral
 Pectoralis Minor
 Origin – ribs 3,4 and 5
 Insertion – coracoid process of the
scapula
 Action – draws the scapula forward,
medialward and downward
 Blood supply – pectoral branch of the
thoracoacromial trunk
 Innervation – medial pectoral nerve
 Diaphragm
 Origin: xiphoid process, costal
margin, lateral and medial arcuate
ligaments, vertebral bodies of L1-L3
 Insertion: central tendon
 Action: pushes the abdominal organs
inferiorly
 Blood supply: musculophrenic,
superior phrenic, inferior phrenic
 Innervation: phrenic nerve (C3-C5)
 External Intercostals
 Origin: lower border of a rib within an
intercostal space
 Insertion: upper border of rib below,
coursing downward and medially
 Action: keeps intercostal space from
blowing out or sucking in
 Blood supply: intercostal artery
 Innervation: intercostal nerves
 Internal Intercostals
 Origin: upper border of a rib
 Insertion: lower border of rib above,
coursing upward and medially
 Levatores Costarum
 Origin: transverse process of C7-T11
 Insertion: rib below its origin, medial
to the angle
 Action: elevates the rib
 Blood supply: deep cervical artery,
intercostal arteries
 Innervation: dorsal primary rami of
spinal nerves C7-T11
 Subcostalis
 Origin: angle of ribs
 Insertion: angle of a rib 2-3 ribs
above origin
 Action: compresses the intercostal
space
 Blood supply: intercostal artery
 Innervation: intercostal nerves
 Transversus Thoracis
 Origin: posterior surface of the
sternum
 Insertion: inner surface of costal
cartilages 2-6
 Action: compresses the thorax for
forced expiration
 Blood supply: internal thoracic artery
 Innervation: intercostal nerves 2-6