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THORACIC CAGE and WALL SURFACE LANDMARKS. Lines of Orientation Refer: Refer: Text:pp 91-92 (91) Syllabus: p 44 Midsternal line Midsternal line Midclavicular.

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Presentation on theme: "THORACIC CAGE and WALL SURFACE LANDMARKS. Lines of Orientation Refer: Refer: Text:pp 91-92 (91) Syllabus: p 44 Midsternal line Midsternal line Midclavicular."— Presentation transcript:

1 THORACIC CAGE and WALL SURFACE LANDMARKS

2 Lines of Orientation Refer: Refer: Text:pp (91) Syllabus: p 44 Midsternal line Midsternal line Midclavicular line Midclavicular line Anterior axillary line Anterior axillary line Posterior axillary line Posterior axillary line

3 Lines of Orientation Midaxillary line Midaxillary line Scapular line Scapular line

4 Surface Landmarks Jugular notch Jugular notch Sternal angle: Sternal angle: Marks rib 2 Lies at level of T4-5 IV disc Apex heart beat: Apex heart beat: Left IC space 5; midclavicular line Aortic valve: Aortic valve: Right IC space 2

5 Surface Landmarks Infrasternal angle: Infrasternal angle: Important in CPR. Depression between is the infrasternal fossa. Xiphisternal joint within the fossa is at the level of the body of T9.

6 Surface Landmarks Pulmonary valve Pulmonary valve Left IC space 2 Tricuspid valve Tricuspid valve Right IC space 5 Bicuspid valve Bicuspid valve Left IC space 5 Bifurcation of trachea Bifurcation of trachea Vertebral level T4-5

7 Surface Landmarks Posterior thorax: scapula: Posterior thorax: scapula: Scapular spine is at level of 3 rd rib and T2 vertebra. Inferior scapular angle is at the level of the 7 th rib, the spine of T7 or the body of T9. Costal margin: Costal margin: Superior part is marked by the 7 th cartilage. Inferior part is marked by the 10 th cartilage

8 Cutaneous innervation Clavicular and scapular regions: Clavicular and scapular regions:C3-4 Region of xiphoid process: Region of xiphoid process:T6 Anterior thorax: Anterior thorax:T1-T6 Upper extremity: Upper extremity:C5-T1 Lower thorax and anterior abdomen: Lower thorax and anterior abdomen:T7-T12

9 OSTEOLOGY OF THE THORACIC CAGE

10 Structure of the Thoracic Cage Twelve thoracic vertebrae Twelve thoracic vertebrae Twelve pairs of ribs and their costal cartilages Twelve pairs of ribs and their costal cartilages Sternum Sternum Intercostal muscles Intercostal muscles

11 Superior Boundary (outlet) First thoracic vertebra First thoracic vertebra First pair of ribs and costal cartilages First pair of ribs and costal cartilages Manubrium Manubrium Refer to Fig. 14, p. 53 in syllabus Refer to Fig. 14, p. 53 in syllabus

12 Inferior Boundary (outlet) Twelfth thoracic vertebra Twelfth thoracic vertebra Twelfth pair of ribs and costal cartilages Twelfth pair of ribs and costal cartilages Xiphisternal joint Xiphisternal joint Refer to Fig. 14, p. 53 in syllabus Refer to Fig. 14, p. 53 in syllabus

13 Bones of the Thoracic Cage Manubrium Manubrium Body of sternum: Body of sternum: Four sternebrae Xiphoid process Xiphoid process Manubriosternal joint: Manubriosternal joint:Symphysis Synostosis after age 30 in some

14 Ribs Costa: Costa: = Rib bone + its cartilage Vertebrosternal ribs: Vertebrosternal ribs:1-7 Vertebrochondral ribs: Vertebrochondral ribs:8-10 Vertebral ribs (floating): Vertebral ribs (floating):11-12

15 Typical Rib Head: Head: Two articular facets for articulation with costal demifacets on adjacent thoracic vertebrae. Bony crest between facets for attachment to intervertebral disc.

16 Typical Rib Neck: Neck: Narrow portion between head and tubercle. Tubercle: Tubercle: Articulates with transverse process of vertebra with same number.

17 Typical Rib Shaft Shaft Sternal extremity Sternal extremity Angle Angle

18 Typical Rib Costal groove: Costal groove: Contains superior to inferior: Intercostal vein Intercostal artery Intercostal nerve Costal cartilage Costal cartilage

19 First Rib Flattened in a horizontal (transverse) plane. Flattened in a horizontal (transverse) plane. Scalene tubercle: Scalene tubercle: For insertion of scalenus anterior muscle. Shallow groove for subclavian vein: Shallow groove for subclavian vein: Anterior to tubercle Shallow groove for subclavian artery: Shallow groove for subclavian artery: Posterior to tubercle

20 Thoracic Vertebra Heart-shaped centrum (body) Heart-shaped centrum (body) Centrum notched on left side for descending aorta Centrum notched on left side for descending aorta Intervertebral discs = ¼ of total length of thoracic vertebral region Intervertebral discs = ¼ of total length of thoracic vertebral region Superior and inferior costal demifacets: Superior and inferior costal demifacets: (on typical vertebrae (T2 – T9)

21 Thoracic Vertebra Vertebra prominens (C7): Vertebra prominens (C7): First spinous process to be palpated. T1 spinous process most prominent T1 spinous process most prominent

22 Atypical Thoracic Vertebra T1: T1: Superior costal facet (not a demifacet). T10: T10: One pair of costal facets located partly on body and partly on pedicle. T11 and T12: T11 and T12: One pair of costal facets located on pedicles.

23 Typical Rib Articulation Head articulates with demifacets of its own number vertebra and the vertebra above as well as the intervertebral disc between: Head articulates with demifacets of its own number vertebra and the vertebra above as well as the intervertebral disc between: Tubercle articulates with transverse process of same number vertebra.


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