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THORAX
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THE THORACIC CAGE :- Boundaries: Behind: In front:
Bodies of twelve thoracic vertebra and their intervening discs Posterior parts of ribs In front: Sternum Anterior part of ribs and their costal cartilages
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On each side: Inlet of thorax: Outlet: Twelve ribs
It is reniform in shape Outlet: It is closed by the diaphragm
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Skeleton of thorax: Thoracic vertebra Ribs Sternum
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Thoracic vertebra: Classification: They are 12 in number
They are recognized by the presence of costal facets on sides of the bodies and transverse process Classification: Typical thoracic vertebra: Second to Eight Atypical thoracic vertebra: First, Nine to Twelve
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Features of typical thoracic vertebra:
Body , Vertebral foramen, Superior articular facets Transverse process & Spinous process
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Body: It is heart shape Presence of two two costal demifacets
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Vertebral foramen: Small and circular in shape Pedicles are short
Lamina are short, thick and broad
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The transverse process:
Tips bear oval costal facets
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Spinous process: Long and slopes downward
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Sternum: Consists of three parts Manubrium Body Xiphoid process
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Manubrium:
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Body:
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Xiphoid process:
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THE RIBS: Arranged in twelve pairs
Posteriorly it articulates with the thoracic vertebra Anteriorly joins with the sternum through their respective costal cartilages directly or indirectly
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True ribs: False ribs: Typical ribs: Atypical ribs:
Classification of ribs: True ribs: Upper seven pairs (Vertebrosternal ribs) False ribs: Lower five pairs (Vertebro-chondral ribs) Typical ribs: 3rd to 9th ribs Atypical ribs: 1st, 2nd, 10th 11th and 12th ribs
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Typical ribs: Sternal end Vertebral end Intervening shaft
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Sternal end: Lower than vertebral end and receives its own costal cartilage
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Vertebral end: It includes: - Head - Neck - Tubercle
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Shaft: It is thin flat and curved
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Applied anatomy: Fracture of ribs: Pneumothorax or Haemothorax
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INTERCOSTAL SPACE
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Intercostal space: Eleven in number on each side
Last two intercostal spaces are open in front
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Typical Intercostal space:
Those spaces intervening between typical ribs and traversed by vessels and nerves which are confined to the thoracic wall, are known as typical intercostal space As such 3rd , 4th, 5th and 6th intercostal space are typical
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Boundaries of typical intercostal space:
Above: Lower margin of upper rib and its cartilage Below: Upper margin of the lower rib and its cartilage In front: Lateral border of sternum between the costal notches Behind: Body of corresponding thoracic vertebra
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Contents of space: Muscles Vessels and Nerves
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Muscles: They are arranged in three sheets from outside to inside:
Intercostalis externus Intercostalis internus Intercostalis intimus
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Intercostalis externus:
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Intercostalis internus:
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Intercostalis intimus:
It occupies middle 2/4th of typical intercostal space Intercostal vessels and nerves passes between intercostalis internus and intimus muscle
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Arteries: Intercostal vessels:
In each space the arteries are arranged in two groups Anterior intercostal arteries Posterior intercostal arteries
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Anterior intercostal arteries:
Upper six spaces: Internal thoracic artery Lower three spaces: Musculo-phrenic artery
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Posterior intercostal arteries:
Upper two spaces: Superior intercostal artery Lower nine spaces: Descending thoracic aorta
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Anterior intercostal veins Internal thoracic vein
In each space the veins are arranged in two groups Anterior intercostal veins Upper six spaces Lower three spaces Internal thoracic vein Musculophrenic vein
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Posterior intercostal veins
On right side On left side Azygous vein Hemiazygous vein
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intercostal Nerve: They are eleven in number
Each nerve is ventral ramus of a thoracic nerve Ventral ramus of 1st thoracic nerve forms lower trunk of brachial plexus Lateral cutaneous branch of 2nd intercostal nerve remains as intercostobrachial nerve 3rd to 6th intercostal nerves are called as typical intercostal nerves 7th to 11th intercostal nerves appears in anterior abdominal wall
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Branches: Rami communicantes Collateral branch
Lateral cutaneous branch Muscular branches run to the intercostal muscles. Pleural sensory branches go to the parietal pleura. Peritoneal sensory branches (7th to 11th intercostal nerves only) run to the parietal peritoneum
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Applied anatomy: Intercostal neuralgia: Herpes zoster
It is a sharp burning pain in the area of skin supplied by thoracic spinal nerve produced by rib fracture Herpes zoster Caused by a virus called as varicella-zoster virus
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