Bony Thoracic Cage

Weeks 1 & 2
 Thoracic Wall

• Structure:
skin  fascia  muscle 
bone blood vessels &
nerves
• Functions:
1. protection of thoracic
viscera

2. provides the mechanical

function of breathing
 Thoracic Cage
The bony part of thoracic wall

- 12 pairs of ribs & CC

- 12 thoracic vertebrae
- Sternum
 Ribs
-Flat curved bones with high
resilience

- Form most of the thoracic

cage

-3 types:

1. True (1 st – 7th )

2. False (8 th – 10 t h )
 Features of Typical Ribs

1. Head: wedge-shaped with 2 articular facets

2. Neck: connects the head with the body

3. Tubercle: articular &

non-articular parts

4. Shaft (Body): angle &

costal groove
 Typical Ribs
3 rd – 9 th ribs
are
considered
typical
1. Articular facets
2.Crest of Head
3. Neck
4+ 5. Tubercle
6. Angle
7. Costal groove
8. shaft
 Atypical Ribs
• 1st rib
Flat, scalene tubercle & grooves for subclavian v.

• 2nd rib
rough tuberosity for serratus anterior m.

• 10th rib
one facet on the head

• 11th & 12th

one facet on the head & no neck or tubercle
 1st Rib
1. Flat rib

2.Scalene Tubercle

3. Grooves for
subclavian
vessels

4. One Facet on the

head
 Clinical: Cervical Rib

• Extra rib arise from C7 vertebra

• Present in 1% of people

• Complications:

Causes pressure on nerves & arteries supplying the

upper limb

Tingling & numbness  Partial paralysis

ischemic muscle pain (due to?)

Cervical Rib
 Rib Fractures

• Common chest injuries (middle ribs, 5-10)

• Mostly in weakest part (the angle)

• Present as a sever localized pain

• Complications: inj. to underlying structures

pneumothorax (air in pleural cavity)
 Structure of Vertebrae
Body

Vertebral
arch ( P &L)

7 processes
Distinguishing Features of Thoracic
Vertebrae
 Sternum

( G, Sternon: chest bone )

Flat, vertically elongated bone

that forms the middle anterior
part of the thoracic cage

3 parts:
Manubrium

Body

Xiphoid process
 Manubrium
Shaped

(L, Handle)

* Several notches:
Jugular  Clavicular 
Costal

*Manubriosternal Joint:
2o fibrocartilaginous
Sternal angle
 Sternal Angle
Angle of louis
Manubriosternal
joint

Easily palpated

Opposite to T4- T5
disc

2nd costal cartilage:

Counting the ribs & intercostal spaces
 Body T5 – T9, costal notches 3 rd – 7th
:
Xiphoid process: T10, hyaline
cartilage 
ossified
 Openings of Thoracic Wall
Boundaries of superior
thoracic opening:
T1,
1st rib,
manubrium

Boundaries of inferior
thoracic opening:
T12,
11 t h & 12 t h ribs,
7- 10 CC,
xiphisternal joint
 Thoracic Outlet Syndrome
• On the superior thoracic opening (anatomical inlet)
• Compression of subclavian art. between the clavicle & 1st rib
(Costoclavicular syndrome)
• Pale color & coldness on the skin of upper limb
• Diminished radial pulse
 Joints of Thoracic Cage
Posteriorly:

1. Intervertebral joints 1
( 2o cartilaginous)

2
2. Costovertebral joints
( synovial plane)

3. Costotransverse joints
3
( synovial plane)
 Joints of Thoracic Cage
Anteriorly:
1. Costochondral joints
( 1o cartilaginous)

2. Sternocostal joints
( synovial plane,
except 1 st CC )

3. Manubriosternal joint
( 2o cartilaginous)

4. Xiphisternal joint
( 1o
 Intercostal Muscles
3 layers of m. that cover intercostal spaces

From outside to inside:

1. External intercostal m.:

runs downward toward sternum (your ant.

pockets) replaced anteriorly by membrane

2. Internal intercostal m.:

runs downward toward VC (your post.

pockets) replaced posteriorly by membrane

3. Innermost intercostal &
Transversus Thoracic
IIm:
on lateral sides only

TTm:
4- 5 slips of muscles
From post. surface of sternum To 2 nd - 6th costal
cartilages

Bld. Vessels & nerves run between: Internal & innermost IMs
Structure of the Thoracic
Wall
 Outside skin and by muscles attaching
the shoulder girdle to the trunk.
 Inside  lined with parietal pleura.
 Framework 
Posteriorly :the thoracic part of the vertebral
column
Anteriorly : the sternum and costal
cartilages Laterally : the ribs and intercostal
spaces Superiorly : the suprapleural
Sternu
m
Applied
Notes
Sincethe sternum possesses red hematopoietic
marrow throughout life, it is a common site
for marrow biopsy.


 The sternum may also be split (median sternotomy)

at operation to allow the surgeon to gain easy access
to the heart, great vessels, and thymus.
Rib
s
 There are 12 pairs of ribs, all of which are attached
posteriorly to the thoracic vertebrae .The ribs are
divided into three categories:
 True ribs: The upper seven pairs are attached
anteriorly to the sternum by their costal cartilages.
False ribs: The 8th, 9th, and 10th pairs of ribs are
attached anteriorly to each other and to the 7th rib by
means of their costal cartilages and small synovial
joints.
 Floating ribs: The 11th and 12th pairs have no anterior
attachment.
Typical
Rib
Head

Neck

Tubercle

Shaft

Angle
Atypical
Rib
•The first rib

•Small and
flattened from
above
downward
Applied
Notes
 Cervical Rib :

A rib arising from the anterior tubercle of the

transverse process of the seventh cervical
vertebra
occurs in about 0.5% of humans
May be connected to the first rib by a fibrous band, or
may articulate with the first rib.
 Pressure  the lower trunk of the brachial plexus
the subclavian artery

Costal
Cartilages
 Costalcartilages are bars of cartilage connecting the
upper seven ribs to the lateral edge of the sternum
and the 8th, 9th, and 10th ribs to the cartilage
immediately above. The cartilages of the 11th and
12th ribs end in the abdominal musculature.
 The costal cartilages contribute significantly to the
elasticity and mobility of the thoracic walls.
 Inold age, the costal cartilages tend to lose some of
their flexibility as the result of superficial
calcification.
Thoracic
Vertebrae
The 1st and 12th are called atypical
and the rest are typical.

• body (1)
• superior and inferior demifacets (2,3)
• pedicle (4)
•superior and inferior articular processes
(5, 6)
•transverse process (with an articular
process) (7,10)
• lamina (8)
• spinous process (9)
• superior and inferior notches (13,12)
• vertebral canal(14)
•not a bone but an integral part of the
vertebral column is the
intervertebral disk (11)
Joints of the Chest
Wall
 Manubriosternal joint (cartilaginous)  Small angular movement.
 The xiphisternal joint (cartilaginous)  fuses at middle age.
 Joints of the Heads of the Ribs 
 The first rib and the three lowest ribs have a single synovial joint with
corresponding
their vertebral body.
 the second to the ninth ribs, a synovial joint with the corresponding vertebral
body and that of the vertebra above it.
 Joints of the Tubercles of the Ribs  a synovial joint with the
transverse process of the corresponding vertebra .
 Joints of the Ribs and Costal Cartilages  These joints are cartilaginous
joints.
No movement is possible.
 Joints of the Costal Cartilages with the Sternum 
The -7 synovial
th
2nd first costal (cartilaginous) No movement
 Muscles of
Thoracic Wall
the

•External layer 
external intercostal
•Internal layer 
internal intercostal
•Innermost layer 
Transversus thoracic
(anterior)
Innermost (lateral)
Subcostal
(posterior )
Muscles of
the Thoracic
Wall
•Transversus thoracis

•Subcostal

•The diaphragm closes the

thoracic outlet and
separates the thoracic
cavity from the abdominal
cavity.

•The diaphragm is the

most important muscle
of the thoracic wall.
During normal
respiration, this muscle
is the primary
component.
Arterial Blood Supply to the Thoracic
Wall
Three sources of blood supply:
•Axillary
• supreme thoracic (2)
• lateral thoracic (3)
•Subclavian
• superior intecostal
• internal thoracic (or mammary)
artery (1)
• anterior intercostal
branches
•Aorta
• intercostal arteries (4)
Arterial Blood Supply to the Thoracic
Wall
 Each intercostal space : 1 large single posterior
intercostal artery 2 small anterior intercostal arteries.
 The posterior intercostal arteries :the first two spaces
are branches from the superior intercostal artery. the
lower nine spaces are branches of the descending
thoracic aorta.
 The anterior intercostal arteries :the first six spaces
are branches of the internal thoracic artery. The
anterior intercostal arteries of the lower spaces are
branches of the musculophrenic artery.
Venous drainage of thoracic
wall

 Thecorresponding posterior intercostal veins drain

backward into the azygos or hemiazygos veins

 theanterior intercostal veins drain forward into the

internal thoracic and musculophrenic veins.
Nerves of the Thoracic
Wall
•The thoracic wall is supplied by
the intercostal nerves which are
the anterior primary rami of
spinal nerves.

•spinal cord (1)

•dorsal (sensory, afferent) root (3)
•ventral (motor, efferent) root (2)
•spinal nerve (4)
•dorsal primary ramus (mixed) (5)
•ventral primary ramus (mixed)
(6)
•white communicating ramus
(8)
•gray communicating ramus
(7)
Applied
Notes
Skin Innervation of the Chest Wall and Referred Pain

Above the level of the sternal angle  supraclavicular

nerves (C3 and 4).
Below the level of the sternal angle  the anterior
and lateral cutaneous branches of the intercostal
nerves
Posteriorly  the posterior rami of the spinal
nerves
the 7th to 11th intercostal nerves leave the thoracic
wall and enter the anterior abdominal wall : pleurisy
Suprapleural
Membrane
 It is a dense fascial layer

 Tent-shaped fibrous sheet

 Attached laterally to the medial border of the first rib
and costal cartilage.
At its apex to the tip of the transverse process of the
seventh cervical vertebra.
Medially to the fascia investing the structures passing
from the thorax into the neck. It
 Protectsthe underlying cervical pleura and resists the
changes in intrathoracic pressure occurring during
Applied
Notes
 During Neck surgery (e.g Neck dissection) injury of
the suprapleural membrane may happen leading to
pneumothorax

wound at the root of the neck 

 Stab
pneumothorax
Endothoracic
Fascia
 Thin layer of loose connective tissue that separates
the parietal pleura from the thoracic wall.

 The suprapleural membrane is a thickening of this

fascia.
Thank
You
Grouped into 3
parts
 Costal
Sternalpart
part
 Lumbar part
 Medial lumbocostal
arch
 Lateral lumbocostal
arch
 Right crus
 Left crus
Sternal part
Arises by 2 fleshy slips from the back of
the
xiphoid process.
Costal part
 Arises from inner surfaces of the
cartilages
 Adjacent parts of the lower 6th ribs on
each side
 Interdigitating with transversus
abdominis
Lumbar
part:-
a) Medial lumbocostal arch

 Tendinous arch in fascia covering psoas

major
 Medially, attach to the side of the body
of vertebra L1.
 Laterally, attach to the front of
transverse process of vertebra L1
b) Lateral lumbocostal
arch
 Tendinous arch in fascia covering upper part

of quadratus lumborum.
 Medially, attach to front of the transverse

process of vertebra L1
 Laterally, attach to lower border of 12th rib
c) Right
crus
Arises from anterolateral surfaces of the bodies of the upper
three lumbar vertebrae and the intervening intervertebral
disc.

d) Left crus
 Arises from the corresponding parts of the upper two
lumbar vertebrae.
 Medial margin of two crura form tendinous arc across the
front of the aorta; median arcuate ligament.
 Insert into central
tendon
 Trilobarof
in shape; three leaflets
diaphragm
▪ Middle leaflet:
▪Triangular in shape with its apex directed towards xiphoid process
▪ Right and left leaflets
▪Tongue shaped, curve laterally
and backwards
▪Left is narrower than right
▪ Central point:
▪Four well-marked diagonal bands comes out from central point of
decussation (intersections); located in front of esophagus opening.
Motor
 Phrenic nerves

Sensory
 Phrenic nerves; central part of diaphragm
 Lower six thoracic nerves; peripheral part of
the diaphragm
Contraction of diaphragm
 Flatten the diaphragm
 Vertical diameter for thorax increase
 Happens in inspiration
 Quiet breathing: 1.5 cm

 Deep breathing: 6 to 10 cm
 Expulsive act: sneezing, coughing, laughing, crying,
vomiting, defecation, parturition, micturation, deep
inspiration (closure of glottis & powerful contraction of
Relaxation of diaphragm
 Concave of the diaphragm
Vertical diameter for thorax decrease
Main factors affecting position of
diaphragm
 Elastic recoil of lung tissue

 Lying down, abdominal viscera

pushes diaphragm upwards

 Lumbocostal triangle or Bochdalek's
foramen

 Diaphragmatic hernia

 Diaphragmatic paralysis

 Congenital eventration of diaphragm

 Hiccup
Why diaphragm is important to us?

 Main muscle in respiration

(75% in normal inspiration); by

contracting

 Separating thorax and abdomen

 Chaurasia, B. (2013). Human anatomy regional and applied
dissection and clinical. (6 ed., Vol. 2, pp. 331-335). New
Delhi, India: CBS Publishers & Distributors.

 digitallab3d. (n.d.). 3d model of human diaphragm.

Retrieved from
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Diaphragm/prod_28281.html
THANK
YOU