2 Lines of Orientation Refer: Midsternal line Midclavicular line Text: pp (91)Syllabus: p 44Midsternal lineMidclavicular lineAnterior axillary linePosterior axillary line
3 Lines of OrientationMidaxillary lineScapular line
4 Surface Landmarks Jugular notch Sternal angle: Apex heart beat: Marks rib 2Lies at level of T4-5 IV discApex heart beat:Left IC space 5; midclavicular lineAortic valve:Right IC space 2
5 Surface Landmarks 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 Tricuspid valve Bicuspid valve Left IC space 2Tricuspid valveRight IC space 5Bicuspid valveLeft IC space 5Bifurcation of tracheaVertebral level T4-5
7 Surface Landmarks Posterior thorax: scapula: Costal margin: Scapular spine is at level of 3rd rib and T2 vertebra.Inferior scapular angle is at the level of the 7th rib, the spine of T7 or the body of T9.Costal margin:Superior part is marked by the 7th cartilage.Inferior part is marked by the 10th cartilage
8 Cutaneous innervation Clavicular and scapular regions:C3-4Region of xiphoid process:T6Anterior thorax:T1-T6Upper extremity:C5-T1Lower thorax and anterior abdomen:T7-T12
18 Typical Rib Costal groove: Costal cartilage Contains superior to inferior:Intercostal veinIntercostal arteryIntercostal nerveCostal cartilage
19 First Rib Flattened in a horizontal (transverse) plane. Scalene tubercle:For insertion of scalenus anterior muscle.Shallow groove for subclavian vein:Anterior to tubercleShallow groove for subclavian artery:Posterior to tubercle
20 Thoracic Vertebra Heart-shaped centrum (body) Centrum notched on left side for descending aortaIntervertebral discs = ¼ of total length of thoracic vertebral regionSuperior and inferior costal demifacets:(on typical vertebrae (T2 – T9)
21 Thoracic Vertebra Vertebra prominens (C7): First spinous process to be palpated.T1 spinous process most prominent
22 Atypical Thoracic Vertebra Superior costal facet (not a demifacet).T10:One pair of costal facets located partly on body and partly on pedicle.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:Tubercle articulates with transverse process of same number vertebra.