Thoracic Cage and Wall

Nur Afrainin Syah

Functions

Protects vital organs within the thorax

Supports thorax during respiration,
Supports shoulder girdles and upper limbs
Provides attachment points for back, chest
and shoulder muscles.

Thoracic
cage

Thoracic inlet

Suprapleural membrane
Dense fascia closes the
lateral part of the thoracic
inlet.
Triangular in shape
Apex: attached to transverse
process of C7
Base: Attached to medial
border of the first rib
Superiorly: Related to
subclavian vessels
Inferiorly: Apex of lung &
cervical pleura

Mediastinum

Thoracic Cage
- The thoracic cage consists of the sternum, the ribs, and
the thoracic vertebrae.
- It has a narrow inlet and a wide outlet.
I. Thoracic inlet: (the upper opening of the thoracic cage)
Boundaries:
a. Anterior -------------- Supra-sternal notch of the
manubrium sterni.
b. On each side --------- First rib.
c. Posterior -------------- First thoracic vertebra.

II. Thoracic outlet

It is the lower opening of the thoracic cage.
Boundaries:
a. Anterior -------------- Xiphoid process.
b. On each side --------- Lower six costal
cartilages + Last two ribs.
c. Posterior -------------- Last thoracic vertebra.
- It is closed by the diaphragm which separates it
from the abdominal cavity.

Parts

Composed of thoracic vertebrae (dorsal)

Ribs (laterally)
Sternum with costal cartilages (anteriorly).

Sternum

Divided into three parts, manubrium, body

and xiphoid process.
A flat bone approximately 6 inches long.
Manubrium (superior) is shaped like a
knot in a necktie.
Articulates with clavicle at clavicular
notches.

Sternum

Manubrium

The superior portion of sternum

Broad, triangular shape

Articulates with clavicles (collarbones)

Articulates with cartilages of first rib pair

Has a jugular notch, a shallow indentation

between clavicular articulations

Body

Forms the bulk of the sternum (tongue

shapes)
Sides are notched where it articulates with
cartilages of the second to seventh ribs.

Body

Xiphoid process

Forms inferior end of sternum.

Is hyaline cartilage in youth, but ossifies in
adults.
Articulates only with sternal body and
serves as attachment point for diaphragm
and some abdominal muscles (m. rectus
abdominis).

Sternal landmarks

Jugular notch
Sternal angle
Xiphisternal joint

Jugular notch

Visible as a central indentation in the upper

border of manubrium.
Is generally in line with the disc between
T-2 and T-3.
Is also in line with the point where the left
common carotid artery issues from the
aorta.

Sternal angle

Found where the manubrium joins the

sternal body.
Sternum is slightly angled at this point.
Can be felt as a horizontal ridge across
across front of sternum.
Landmark position for 2nd rib and the disc
between T-4 and T-5.

Xiphisternal angle

Where sternal body and xiphoid process

fuse.
Lies opposite ninth thoracic vertebrae.

Development of the Sternum

The developing sternal body

Consists of four unfused bones

Completes fusion about age 25

Leaving transverse lines

The xiphoid process

Is the last part of sternum to fuse

Can easily be broken away

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publishing as Pearson Benjamin Cummings

Rib Cage

Ribs

Are mobile

Can absorb shock

Functions of ribs

Rib movements (breathing):

affect width and depth of thoracic cage

changing its volume

Copyright 2009 Pearson Education, Inc.,

publishing as Pearson Benjamin Cummings

Rib Cage

The Rib Cage

Copyright 2009 Pearson Education, Inc.,

publishing as Pearson Benjamin Cummings

The Rib Cage

Ribs (costae)

Are 12 pairs of long, curved, flat bones

Extending from the thoracic vertebrae

Ribs are divided into two types

True ribs

False ribs

Copyright 2009 Pearson Education, Inc.,

publishing as Pearson Benjamin Cummings

Ribs 17 (true ribs)

Vertebrosternal ribs
Connected to the sternum by costal cartilages

Ribs 812 (false ribs)

Do not attach directly to the sternum

Vertebrochondral ribs (ribs 810)

Fuse together
Merge with cartilage before reaching the sternum

Floating or vertebral ribs (ribs 1112)

Connect only to the vertebrae and back muscles

Have no connection with the sternum

Copyright 2009 Pearson Education, Inc.,

publishing as Pearson Benjamin Cummings

Copyright 2009 Pearson Education, Inc.,

publishing as Pearson Benjamin Cummings

Copyright 2009 Pearson Education, Inc.,

publishing as Pearson Benjamin Cummings

Typical rib

Atypical ribs
First rib (general features)

Second rib

Tenth rib
a. Single articular
facet on
the head.

Eleventh rib
a. Single articular
facet on the head.
b. No tubercle.

Twelveth rib

a. Single articular facet on the head.

b. No tubercle.
c. No neck.
d. No costal groove.
e. Large head.
f. Tapering anterior end.

Thoracic vertebrae
Classification of thoracic vertebrae:
- There are twelve thoracic vertebrae
classified as:
A: Typical ------ 2nd 8th vertebrae.
B: Atypical ----- 1st, 9th, 10th, 11th, and 12th
vertebrae (first one and last 4 vertebrae).

Characteristics of a typical thoracic

vertebra
1. The body is characterized by:
- Small in size and heart shaped.
- Its side contains two demifacets:
a. Large upper demifacet for articulation with the head of the rib of the
corresponding number.
b. Small lower demifacet for articulation with the head of the rib below
it.
2. The tip of the transverse process contains circular facet for articulation
with the
tubercle of the rib of the corresponding number.
3. The spine is long, tapering, and directed downwards and backwards.
4. The vertebral foramen is circular and small.
5. The superior articular process faces backwards, while the inferior
articular

Typical thoracic vertebra

Lateral
surface

Superior
surface

First thoracic vertebra

1. The body is small .

2. The vertebral foramen is wide and
triangular.
3. The body carries complete circular articular
facet for articulation with the head of the first
rib.

The ninth& tenth thoracic vertebrae

Ninth
vertebra

Tenth vertebra

The eleventh & twelveth thoracic

vertebrae

Eleventh vertebra

Twelveth
vertebra

Articulation between Thoracic

vertebrae and the ribs

The muscles of the thorax

They are all concerned in the movements

of the ribs and hence with respiration
The intercostales
Transversus thoracis
Levatores costarum
Pectorales

Mm. pectorales
Sulcus
deltoideopectoralis

Clavipectoral
triangle
Trigonum
clavipectorale
Anterior wall
of the axilla

M. Pectoralis
major
Origo :
Clavicula,
sternum
Vagina m.
rectorum
Insertio : crista
tuberculi
majoris

Clavipectoral
fascia

Relations of the pectoralis minor to axillary vessels and brachial plexus

CLAVIPECTORAL FASCIA

M. serratus ant.
Origo : 1. 9. Rib
Insertio : medial
margin of the
scapula.
N. Thoracicus
longus

Intercostal Spaces
There are 9 anterior and 11
posterior
Each space contains:
1- Intercostal muscles:
(External, Internal and
transversus thoracicus)
2- An Intercostal nerve.
3- Intercostal vessels:
a. Intercostal arteries
(Anterior & Posterior)
b. Intercostal veins
(Anterior & Posterior).

EXTERNAL
INTERCOSTAL
Origin: From the lower border
of the rib above
Insertion: Into outer lip of
upper border of rib below
Fibers are directed from above
downward and forwards
Begins from post. end of
Intercostal space close to the
tubercle of the rib.
Ends at the costochondral
junction where it is replaced
by external or anterior
Intercostal membrane.
It elevates the rib during
inspiration

INTERNAL
INTERCOSTAL
Origin: Floor of costal groove
Insertion: Inner lip of upper
border of rib below
Fibers are directed from
above downwards &
backward
Begins from anterior end of
space close to the sternum.
Ends at the angle of the rib,
where it is replaced by post.
Or internal Intercostal
membrane.
Action: Depresses the rib
downwards during expiration

Internal Intercostal
is partly traversed by the

nerve & vessels, which splits

each muscle into 2 parts:
Outer: Internal Intercostal
(proper)
Inner: Innermost Intercostal
(In the middle of the space)
Transversus thoracicus
The most inner layer of
thoracic wall
It is formed of 3 muscles
1- Innermost Intercostal.
2- Sternocostalis.
3- Subcostalis

Sternocostalis

4 to 5 slips which arise from

inner surface of lower part of
body of sternum and costal
cartilages
Inserted into inner surface of
costal cartilages from 2 to 6.
Subcostalis muscle
Thin bands of muscle fibers.
Mainly in lower 6 spaces.
Only in post. part of spaces.
Origin: Inner surface & lower
border of rib above.
Insertion: Upper border of 2nd
or 3rd rib below.

Anterior Intercostal
arteries
2 small arteries in each
of the 9 spaces.
The upper 6 from
internal mammary artery
The lower 3 from
musculo-phrenic artery
NB. Internal mammary
or internal thoracic artery
is a branch from1st part
of subclavian artery

Posterior Intercostal
arteries
One in each of the 11
spaces
1st & 2nd arise from
superior Intercostal
artery of costocervical
trunk of 2nd part of
subclavian artery
The lower 9 arteries &
subcostal artery arise
from descending
thoracic aorta.

In each space the

posterior Intercostal
artery and its
collateral branch
anastomose with the
2 anterior Intercostal
arteries

Anterior Intercostal veins

2 in each space.
9th,8th & 7th join the venae
commitantes of musculophrenic artery
6th,5th & 4th join venae
commitantes of internal
mammary artery
3rd,2nd &1st join internal
mammary vein
Internal mammary vein
drains into innominate
(Brachiocephalic vein)

Posterior Intercostal veins

One in each of the 11 spaces.
On the right:
1st drains into Rt. Innominate v.
2nd,3rd & sometimes the 4th unite to form
Rt. Superior Intercostal vein (B) which
drains into azygos vein.
From 5th to 11th & subcostal veins drain
into azygos vein .
On the Left:
1st drains into Lt. innominate V.
2nd,3rd& sometimes the 4th join to form
Lt. Superior Intercostal vein which
drains into Lt innominate vein.
5th,6th,7th, & 8th form superior
hemiazygos vein to azygos vein
9th,10th.11th &Subcostal form inferior
hemiazygos vein to azygos vein.

Intercostal Nerves
They are the anterior
primary rami of spinal
thoracic nerves fromT1
to T11
T3 toT6 are Typical
T12 is called Subcostal
The remaining nerves
are called atypical
(non-typical)
Each nerve runs in the
Intercostal space
inferior to the
Intercostal vessels

Typical Intercostal nerve

From T3 to T6
Leaves the intervertebral
foramen to reach the
Intercostal space.
Runs between pleura & post.
Intercostal membrane
Pierces Internal Intercostal
muscle splitting it into Internal
Intercostal (proper) and
innermost Intercostal.
Runs between Internal
Intercostal muscle & Pleura.
Pierces Internal Intercostal
muscle, anterior Intercostal
membrane, pectoralis major,
and deep fascia to become
anterior cutaenous nerve

Branches:
White & grey rami (I)
communicans with
sympathetic ganglion
Collateral branch to
Intercostals (2)
Lateral cutaenous
branch to skin (3)
Anterior cutaenous (4)
Muscular branches
Pleural sensory branches
peritoneal branches (5)
Articular branches.

1st Intercostal nerve:

Joined to Brachial plexus, by a branch that is equivalent
to lateral cutaenous branch.
2nd Intercostal nerve:
Joined to the medial cutaenous nerve of the arm, by a
branch called Intercostobrachial nerve
( corresponds to lateral cutaenous branch)
In Angina pectoris & myocardial infarction pain
referred to medial side of arm along this nerve.
So, with previous exception the upper 6 Intercostal
nerves supply skin & parietal pleura and Intercostal
muscles in each space

Azygos Vein
Connects IVC with SVC
Begins in abdomen from
back of IVC at level of
L2
Enters thorax through Aortic
opening of diaphragm on Rt.
side of thoracic duct & aorta.
In post. Mediastinum it passes
behind Rt. Border of esophagus
& root of rt. Lung
In sup. Mediastinum (L4) it
crosses above the root of rt. lung
Enters the middle of the back of
the SVC.

S
V
C

I
V
C

Mm.
Intercostales
interni (11)
Internal
intercostal
membrane
(depression of
the ribs)

Exspiratory
muscles

From posterior
costal angles to
the sternum

Mm.intercostales
externi (11)
Inspiratory muscles
(elevation of ribs)
From the tubercles of
the ribs to the cartilage
of the ribs in front

Intercostal Muscles

External Intercostals

Internal Intercostals

O: Inferior border of rib above I: Superior border of rib below

Fibers run OBLIQUE (down and forward)
Aid in Inspiration (lift ribcage, increase dimensions)
O: Superior border of rib below I: Inferior border of rib above
Fibers run at RIGHT ANGLES to external intercostals
Aid in forced expiration (depress ribcage, decrease dimensions)

Innermost Intercostals, Subcostals, Transversus thoracis

Attachments similar to Internal Intercostals, Attach ribs

Small, variable, function unclear

Neurovascular Bundle
of Intercostal Muscles

VAN (vein, artery, nerve)

Intercostal vein
Intercostal artery
Intercostal nerve

Sit in Subcostal Groove

Between Internal Intercostal and Innermost
intercostal layer

Pg 128

Mm. Intercostales
externi
External intercostal
membrane

Spatium intercostale
Intercostal space and layers of thoracic wall

The intercostales intimi

Poorly developed in upper spaces,
More extensive in lower spaces
Separate intyercostal vessels and
nerve from the pleura

Action : like the intercostales interni

Spatium
intercostale

Puncture of the pleural cavity

Punkce cavum pleurae

DIAPHRAGMA
THE DIAPHRAGM
A dome- shaped muscle which separates the thoracic from the
abdominal cavity.
Its periphery consists of muscular fibres attached to the central
tendon (aponeurotic).
LUMBAR PART
COSTAL PART

STERNAL PART

The diaphragmatic aperturtes :

Aortic
Oesophageal
Vena caval

Main inspiratory muscle

DIAPHRAGMA

Hranice mezi dutinou hrudn a bin

Diaphragma

Crus mediale L1
L3

Crus laterale L 1 L2

Lumbocostal
arches
Medial and lateral

N. Phrenicus (C 4)

Inferior phrenic
artery

Phrenic nerve

Diaphragmatic part of the pericard

Relations of the diaphragm

The upper surface is in relation with the pleura

(right and left diaphragmatic pleura) and with the
pericardium

Lower surface is covered by peritoneum

Right dome

Left dome

4th intercostal
space

5th
intercostal
space

Upper surface
and
diaphragmatic
apertures

Diaphragma - actions

Principal muscle of inspiration

During inspiration muscular fibres contract
and the central tendon and domes move
downwards (volume of the thoracic cavity
increases)

Inspiration

Elevation of ribs (external intercostal

muscles)
Depression of the diaphragm
In quiet inspiration the principal muscle is the diaphragm
In forced inspiration additional muscles are called into
action (pectoral, scalenic)

Expiration

Relaxation of the diaphragm

Contraction of the intercostales interni

Surface Anatomy
Use the next 3 slides and follow the book to
palpate (feel) the features listed

Anterior Surface of Thorax

Palpate the following

Sternum (3 parts)
Jugular notch
Sternal Angle (= 2nd rib)
Clavicle
Costal margin
Xiphosternal joint

Midclavicular Line
Midaxillary Line

Page 201

Posterior Surface of Thorax

Palpate the following

Spinous Process of C7
Scapula (ribs 2-7)
Scapular spine
Acromion Process
Inferior Angle of Spine
Inferior Border

Page 90

Locating Internal Structures

Pleural Cavities

Inferior margin = adjacent to

T12 in Posterior Midline
To Rib 10 at Midaxillary line
To Rib 8 at Midclavicular line
To Xiphosternal joint medially
Lungs posterior border is 2
ribs superior to pleural cavity
(rib 8)

Heart

Deep to xiphisternal angle

Page 206