thoracic cage and wall surface landmarks. lines of orientation refer: refer: text:pp 91-92 (91)...
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THORACIC CAGETHORACIC CAGEand WALLand WALL
SURFACE LANDMARKSSURFACE LANDMARKS
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Lines of OrientationLines of Orientation
Refer:Refer:Text:Text: pp 91-92 (91)pp 91-92 (91)
Syllabus: p 44Syllabus: p 44Midsternal lineMidsternal lineMidclavicular lineMidclavicular lineAnterior axillary lineAnterior axillary linePosterior axillary linePosterior axillary line
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Lines of OrientationLines of Orientation
Midaxillary lineMidaxillary lineScapular lineScapular line
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Surface LandmarksSurface Landmarks
Jugular notchJugular notchSternal angle:Sternal angle:
Marks rib 2Marks rib 2
Lies at level of T4-5 IV discLies at level of T4-5 IV discApex heart beat:Apex heart beat:
Left IC space 5; midclavicular lineLeft IC space 5; midclavicular lineAortic valve:Aortic valve:
Right IC space 2Right IC space 2
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Surface LandmarksSurface Landmarks
Infrasternal angle:Infrasternal angle:Important in CPR.Important in CPR.
Depression between is the infrasternal Depression between is the infrasternal fossa.fossa.
Xiphisternal joint within the fossa is at the Xiphisternal joint within the fossa is at the level of the body of T9.level of the body of T9.
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Surface LandmarksSurface Landmarks
Pulmonary valvePulmonary valveLeft IC space 2Left IC space 2
Tricuspid valveTricuspid valveRight IC space 5Right IC space 5
Bicuspid valveBicuspid valveLeft IC space 5Left IC space 5
Bifurcation of tracheaBifurcation of tracheaVertebral level T4-5Vertebral level T4-5
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Surface LandmarksSurface Landmarks
Posterior thorax: scapula:Posterior thorax: scapula:Scapular spine is at level of 3Scapular spine is at level of 3rdrd rib and T2 rib and T2 vertebra.vertebra.
Inferior scapular angle is at the level of the Inferior scapular angle is at the level of the 77thth rib, the spine of T7 or the body of T9. rib, the spine of T7 or the body of T9.
Costal margin:Costal margin:Superior part is marked by the 7Superior part is marked by the 7 thth cartilage. cartilage.
Inferior part is marked by the 10Inferior part is marked by the 10 thth cartilage cartilage
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Cutaneous innervationCutaneous innervation
Clavicular and scapular regions:Clavicular and scapular regions:C3-4C3-4
Region of xiphoid process:Region of xiphoid process:T6T6
Anterior thorax:Anterior thorax:T1-T6T1-T6
Upper extremity:Upper extremity:C5-T1C5-T1
Lower thorax and anterior abdomen:Lower thorax and anterior abdomen:T7-T12T7-T12
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OSTEOLOGY OF THE OSTEOLOGY OF THE THORACIC CAGETHORACIC CAGE
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Structure of the Thoracic CageStructure of the Thoracic Cage
Twelve thoracic vertebraeTwelve thoracic vertebraeTwelve pairs of ribs and their costal Twelve pairs of ribs and their costal
cartilagescartilagesSternum Sternum Intercostal musclesIntercostal muscles
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Superior Boundary (outlet)Superior Boundary (outlet)
First thoracic vertebraFirst thoracic vertebraFirst pair of ribs and costal cartilagesFirst pair of ribs and costal cartilagesManubrium Manubrium Refer to Fig. 14, p. 53 in syllabusRefer to Fig. 14, p. 53 in syllabus
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Inferior Boundary (outlet)Inferior Boundary (outlet)
Twelfth thoracic vertebraTwelfth thoracic vertebraTwelfth pair of ribs and costal cartilagesTwelfth pair of ribs and costal cartilagesXiphisternal joint Xiphisternal joint Refer to Fig. 14, p. 53 in syllabusRefer to Fig. 14, p. 53 in syllabus
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Bones of the Thoracic CageBones of the Thoracic Cage
Manubrium Manubrium Body of sternum:Body of sternum:
Four sternebraeFour sternebraeXiphoid processXiphoid processManubriosternal joint:Manubriosternal joint:
Symphysis Symphysis
Synostosis after age 30 in someSynostosis after age 30 in some
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RibsRibs
Costa:Costa:= Rib bone + its cartilage= Rib bone + its cartilage
Vertebrosternal ribs:Vertebrosternal ribs:1-71-7
Vertebrochondral ribs:Vertebrochondral ribs:8-108-10
Vertebral ribs (floating):Vertebral ribs (floating):
11-1211-12
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Typical RibTypical Rib
Head:Head:Two articular facets for articulation with Two articular facets for articulation with
costal demifacets on adjacent thoracic costal demifacets on adjacent thoracic vertebrae.vertebrae.
Bony crest between facets for attachment Bony crest between facets for attachment to to intervertebral disc.intervertebral disc.
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Typical RibTypical Rib
Neck:Neck:Narrow portion between head and Narrow portion between head and
tubercle.tubercle.Tubercle:Tubercle:
Articulates with transverse process of Articulates with transverse process of vertebra with same number.vertebra with same number.
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Typical RibTypical Rib
ShaftShaft
Sternal extremitySternal extremity
Angle Angle
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Typical RibTypical Rib
Costal groove:Costal groove:Contains superior to inferior:Contains superior to inferior:
Intercostal veinIntercostal vein
Intercostal arteryIntercostal artery
Intercostal nerveIntercostal nerve
Costal cartilageCostal cartilage
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First RibFirst Rib
Flattened in a horizontal (transverse) Flattened in a horizontal (transverse) plane.plane.
Scalene tubercle:Scalene tubercle:For insertion of scalenus anterior muscle.For insertion of scalenus anterior muscle.
Shallow groove for subclavian vein:Shallow groove for subclavian vein:Anterior to tubercleAnterior to tubercle
Shallow groove for subclavian artery:Shallow groove for subclavian artery:Posterior to tuberclePosterior to tubercle
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Thoracic VertebraThoracic Vertebra
Heart-shaped centrum (body)Heart-shaped centrum (body)Centrum notched on left side for Centrum notched on left side for
descending aortadescending aorta Intervertebral discs = ¼ of total length of Intervertebral discs = ¼ of total length of
thoracic vertebral regionthoracic vertebral regionSuperior and inferior costal demifacets:Superior and inferior costal demifacets:
(on typical vertebrae (T2 – T9)(on typical vertebrae (T2 – T9)
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Thoracic VertebraThoracic Vertebra
Vertebra prominens (C7):Vertebra prominens (C7):First spinous process to be palpated.First spinous process to be palpated.
T1 spinous process most prominentT1 spinous process most prominent
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Atypical Thoracic VertebraAtypical Thoracic Vertebra
T1:T1:Superior costal facet (not a demifacet).Superior costal facet (not a demifacet).
T10:T10:One pair of costal facets located partly on One pair of costal facets located partly on body and partly on pedicle.body and partly on pedicle.
T11 and T12:T11 and T12:One pair of costal facets located on One pair of costal facets located on
pedicles.pedicles.
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Typical Rib ArticulationTypical Rib Articulation
Head articulates with demifacets of its own Head articulates with demifacets of its own number vertebra and the vertebra above number vertebra and the vertebra above as well as the intervertebral disc between:as well as the intervertebral disc between:
Tubercle articulates with transverse Tubercle articulates with transverse process process of same number vertebra.of same number vertebra.