KINE1102- mideterm lecture 6
Typical features of the rib: POSTERIOR
head
tubercle
facets
neck
costal angle- initial curvature of the rib
Typical features of the rib: INFERIOR
Costal groove- important for neuro vascular structures that travel within this groove
Body of the Rib
Typical features of the rib: ANTERIOR
costal cartilage
Three Articular surfaces
Costal cartilage: anterior, sternum
Tubercle: posterior, vertebrae
Head: posterior, vertebrae
The thoracic spine
SP- spinous processes
TP- transverse processes (facets on this attatch to the tubercle of rib)
Vertebre foreamen (gap)
VB- vertebral body (facets on this attatch t the head of rib)
Costotransverse joint
Tubercle of the rib articulates with facet on TP at it's own level
Costovertebral joint
Head of the rib articulates with VB at it's own level AND the level above
Atypical ribs of the thoracic cage
XI/XII (11/12)- floating nature
I/II(1/2)- short, flat and horizontally oriented
X/XI/XII(10,11,12)- only articulate with vertebral bone at OWN level
Diaphragm
L&R dome
connected by central tendon
seperates thorax and abdomen
At rest: curved
Inhalation: flattens
Exhalation: returns bacl to shape through passive recoil
Located at ribV(5)
R dome sits higher because of the liver
Mechanics of respiration: bucket handle movement
Done by the costotransverse and vertebral joint
ribs VII-X (6-9)
Changes volume laterally (side to side)
Mechanics of respiration: Pump handle movement
Done by the costotransverse and veretebral joint of rib I-VI (1-6)
Changes volume posterior-anterior (F-B)
Muscles of Thoracic Wall: External Intercostal muscle
Outermost layer
Origin: rib above, extends to the rib below
FD: anterior, inferior
Elevates rib
Forceful inspiration
Bucket-handle movement
Muscle of Thoracic wall: Internal & innermost intercostal muscle
O: rib below and extends to rib above (insertion)
FD: Anterior, superior
Depresses rib
forceful expiratopm
decreases volume of thoracic cage (pushing air out)
Transverse Thoracis
NOT A INTERCOSTAL MUSCLE BECAUSE NOT INBETWEEN RIB
Depression, forceful expiration
extends from sternum and towards ribs II-VI (2-6)
Neurovascular supply to thoracic wall
SUPERIOR TO INFERIOR
VAN: 1) vein
2) arteries
3) nerve
Sits between intercostal and innermost
** CHEST TUBES ALWAYS PLACED ON SUPERIOR BORDER**
Neurovascular supply: Spinal nerves from spinal cord
Immediatley split into to two branches
1) Dorsal ramus: goes posterior
2) Ventral Ramus: goes anterior travels within intercostal spaces and becomes intercostal nerves
Branches of Ventral ramus
1) Lateral Cutaneous nerve
2) Anterior cutaneous nerve
**VENTRAL RAMUS PROVIDES MOTOR TO MUSCLE AND SENSORY TO SKIN**
Dermatome & clinical landmarks
area/region of skin that is innervated by single spinal nerve
CLINICAL LANDMARKS
1) T4- nipple
2) T6- skin over xiphoid process
3) T10- Umbilicus
Pleura
Continous serous membrane forming closed sac on outer surface of lung and lining thoracic cavity
Parietal Pleura VS Visceral Pleura
PP: chest wall
VP: surface of lungs
Pleural Cavity
Space between PP& VP small amount of fluid (8-10mL)
-ve pressure, takes surface of lung and keeps it open
Hilum (root) of lung
Where pulmonary V and A stretch from heat over to lungslower airway route
Mechanics of Respiration
Hemothorax- excess blood
Pneumothorax- excess air
Sensory innervation of pleura
Visceral- insensitive to pain- by ANS
Parietal- 1) phrenic nerve ( neck, shoulders)
2) Intercostal nerve: lateral thoracic and abdominal wall
Lungs- Lobes& Fissures
Left Lung: 1) Superior Lobe
2) Inferior Lobe
**SEPERATED BY OBLIQUE FISSURE**
Right Lung: 1) Superior Lobe
2) Middle Lobe
3) Inferior lobe
*** SL& IL, ML&IL SEPERATED BY OF***
** SL&ML SPEREATED BY HF**
Horizontal Fissure
Located at midclavicular and rib 4 (right side)
To listen to SL, must be above rib 4
Oblique Fissure
Starts high in the back and anteriorly at its lowest point lines up with rib 6 and midclavicular line
Costodiaphragmatic Recess
Potential space when at resting time and we inspire, lung expands to this space
Asucultation of lung sounds: ANTERIOR
RUL-> between ribs II-III
Apex of right lung-> right above clavicle
RML-> below rib IV (4) *only seen at the front*
RLL-> Below rib VI (6)
Asucultation of lungs: POSTERIOR
OF: begins at TIV(4)
Inferior border of lung: TX, rib X (10)