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Dr. Ahmed Fathalla Ibrahim Associate Professor of Anatomy College of Medicine King Saud University

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Presentation on theme: "Dr. Ahmed Fathalla Ibrahim Associate Professor of Anatomy College of Medicine King Saud University"— Presentation transcript:

1 Dr. Ahmed Fathalla Ibrahim Associate Professor of Anatomy College of Medicine King Saud University

2 OBJECTIVES At the end of the lecture, students should:  Describe the components of the thoracic cage and their articulations.  Describe in brief the respiratory movements.  List the muscles involved in inspiration and in expiration.  Describe the attachments of each muscle to the thoracic cage and its nerve supply.  Describe the origin, insertion, nerve supply of diaphragm.

3 THORACIC CAGE Rib Vertebra التفاصيل الشريحه القادمه

4 THORACIC THORACIC cage القفص الصدري مكون من : 1- sternum 2- rib 3- costal cartilage : يربط رقم 1 برقم 2 4- vertebra تظهر بالاسهم الحمراء بالرسمه السابقه فتحات القفص الصدري الاسهم الصفراء : تشرح لاحقا

5 THORACIC CAGE  Conical  Conical قمعي in shape  Has 2 apertures (openings): 1.Superior (thoracic outlet): 1.Superior علوي (thoracic outlet): narrow, open, continuous with neck 2.Inferior : 2.Inferior سفلي : wide, closed by diaphragm  Formed of: 1.Sternum & costal cartilages 1.Sternum & costal cartilages: anteriorly امامي 2.Twelve 12 pairs of ribs: 2.Twelve 12 pairs of ribs: laterally جانبي 3.Twelve thoracic vertebrae: 3.Twelve thoracic vertebrae: posteriorly خلفي

6 ARTICULATIONS المفاصل Sternocostal Costochondral Costovertebral بين عظمه القص والاضلاع بين الاضلاع والغضاريف بين الاضلاع والعمود الفقري

7 ARTICULATIONS Sternocostal Costochondral Costovertebral سيم

8 هذا اسم موقع مفيد اللي فاضي يدخله

9 RESPIRATORY MOVEMENTS A- MOVEMENTS OF DIAPHRAGM Contraction (descent) of diaphragm vertical diameter Increase of vertical diameter of thoracic cavity Inspiration Expiration Relaxation (ascent) of diaphragm)

10 RESPIRATORY MOVEMENTS B- MOVEMENTS OF RIBS PUMP HANDLE MOVEMENT Elevation of ribs Increase in antero-posterior diameter of thoracic cavity BUCKET HANDLE MOVEMENT Elevation of ribs Increase in lateral diameter of thoracic cavity

11 الهدف من الحركات السابقه هو زياده حجم القفص الصدري فيزداد الحجم فيقل الضغط ويحدث الشهيق

12 INSPIRATORY MUSCLES  Diaphragm (most important muscle)  Rib elevators: external intercostal muscles  Accessory muscles (only during forced inspiration): : انواعها 1.Muscles attaching cervical vertebrae to first & second rib: scalene muscles 2.Muscles attaching thoracic cage to upper limb:pectoralis major 2.Muscles attaching thoracic cage to upper limb: pectoralis major

13 ORIGIN OF DIAPHRAGM 1)Costal: 1) Costal: lower 6 costal cartilages 3) Sternal: 3) Sternal: xiphoid process of sternum 2) Vertebral: 2) Vertebral: upper 3 lumbar vertebrae (right & left crus + arcuate ligaments) B. Posterior view Lateral arcuate ligament Posterior view Medial arcuate ligamentLateral arcuate ligament Medial arcuate ligament اهم اوريجن للحجاب الحاجز لانه ثابت ولا يتحرك ويحقق الهدف من الاورجن 1-L-R crus : اهم جزئين واليمنى اكبر من اليسري لان لها وظيفه واخرى وهي دعم الكبد 2-Arcuate ligaments : وظيفتها الربط

14 INSERTION OF DIAPHRAGM (CENTRAL TENDON واحد فقط )

15 DIAPHRAGM A musculotendinous partition A musculotendinous partition between thoracic & abdominal cavity Convexconcave Convex toward thoracic & concave toward abdominal cavity Attached to: Attached to: sternum, costal cartilages,12 th rib & lumbar vertebrae central tendon Fibers converge تميل الى to join the central tendon Nerve supply: phrenic nerve (C3,4,5), Nerve supply: phrenic nerve (C3,4,5), penetrates diaphragm & innervates it from abdominal surface Action: (essential for normal breathing) Action: contraction (descent نزول ) of diaphragm increase vertical diameter of thoracic cavity (essential for normal breathing)

16 EXTERNAL INTERCOSTAL  Attachments:from lower border of rib above to upper border of rib below  Attachments: from lower border of rib above to upper border of rib below  Direction of fibers: downward & medially  Nerve supply: intercostal nerves  Action: rib elevators (inspiratory)

17 SCALENE MUSCLES  Origin:  Origin: cervical vertebrae  Insertion: 1 st & 2 nd ribs (inspiratory)  Action: elevates 1 st & 2 nd ribs (inspiratory) 5- Scalenus anterior 6. Scalenus medius 7. Scalenus posterior 1 st rib 2 nd rib Cervical vertebrae

18 PECTORALIS MAJOR  Origin:  Origin: sternum + costal cartilages  Insertion:  Insertion: humerus  Action:antero- posterior diameter (inspiratory)  Action: increases antero- posterior diameter of thoracic cavity, when arm is fixed (inspiratory)

19 EXPIRATORY MUSCLES لا تعمل الا عند الجهد فقط  Act only during forced expiration Rib depressors: Rib depressors: 1. Internal intercostal 2.Innermost intercostal 3.Subcostals 4.Transversus thoracis Anterior abdominal wall muscles: Anterior abdominal wall muscles: 1.External oblique 2.Internal oblique 3.Transversus abdominis 4.Rectus abdominis

20 RIB DEPRESSORS: REST OF INTERCOSTAL MUSCLES 1. Internal intercostal 2. Innermost intercostal Direction: Direction: upward & medially 3. Subcostal 4. Transversus thoracis Nerve supply: Nerve supply: intercostal nerves (ventral rami of T1-T11)

21 ANTERIOR ABDOMINAL WALL External oblique (outer layer)  Direction:  Direction: downward & medially Internal oblique (middle layer)  Direction:  Direction: upward & medially Linea alba بسبب عدم وجود عظمه ترتبط بها العضلات البطنيه تقوم هذه العضلات بالاتصال مع بعض لتكون لينيا البا التي تقوم مقام العظم

22 ANTERIOR ABDOMINAL WALL Transversus abdominis (inner layer)  Direction:  Direction: transverse Rectus abdominis  Direction:  Direction: vertical Rectus abdominis Transversus abdominis

23 Anterior abdominal wall 3 layers of muscles of fibers running in different directions  Is formed of 3 layers of muscles of fibers running in different directions (to increase strength of anterior abdominal wall) form a sheath in which a fourth muscles lies (rectus abdominis)  The 3 muscles form a sheath in which a fourth muscles lies (rectus abdominis) sternum, costal cartilages and ribs  Muscles are attached to: sternum, costal cartilages and ribs + hip bones linea alba  The aponeurosis of the 3 muscles on both sides fuse in the midline to form linea alba  Action (during forced expiration):  Action (during forced expiration): Compression of abdominal viscera to help in ascent of diaphragm (during forced expiration)  Nerve supply:  Nerve supply: lower intercostal nerves (T7 – T11), subcostal nerve (T12) and first lumbar nerve.

24 SUMMARY OF RESPIRATORY MOVEMENTS Inspiration  Quiet Inspiration (active) Expiration  Quiet Expiration (passive) 1.Elastic recoil of lung 2.Relaxation of diaphragm & external intercostal  Forced Expiration (active): Contraction of anterior Depression of ribs abdominal wall muscles abdominal wall muscles (rest of intercostal muscles) Compression of abdominal viscera Ascent of diaphragm Contraction (Descent) Elevation of ribs of diaphragm of diaphragm (external intercostal) vertical Increase in vertical Increase in: anteroposterior diameter - anteroposterior diameter lateral - lateral diameter Forced Inspiration (active)  Forced Inspiration (active) Accessory muscles of inspiration: 1.Pectoralis major 2.Scalene muscles لاحظ عند السكون لا تعمل العضلات

25 QUESTIONS Are the following muscles have a respiratory role? If yes, what is it? Are the following muscles have a respiratory role? If yes, what is it? 1.Levatores costarum. 2.Serratus posterior superior. 3.Serratus posterior inferior. 4.Pectoralis minor. 5.Serratus anterior. 6.Latissimus dorsi. 7.Quadratus lumborum. Why diaphragm is supplied by cervical nerves? Why diaphragm is supplied by cervical nerves? Why right crus of diaphragm is larger than left crus? الجواب ذكرته من قبل وجبته من دكتور العملي Why right crus of diaphragm is larger than left crus? الجواب ذكرته من قبل وجبته من دكتور العملي هذي اسئله قال الدكتور ابحثوا عنها

26 THANK YOU


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