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Anatomy for physical Therapy and Respiratory Care under graduate students
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Prepared by: Dr. Kamal Motawei
THORAX
Thoracic Wall College of Medicine
Anatomy Dept.
2013-2014
The thoracic wall is formed by: Posteriorly: thoracic
vertebrae Laterally: ribs and
intercostal spaces Anteriorly: sternum
& costal cartilages. Superiorly: thoracic
outlet and suprapleural membranes
Inferiorly: diaphragm
Def.: spaces between the ribs (also, between the costal cartilages anteriorly).
So, they are 11 in number.
Each space contains: Intercostal muscles:
external, internal and innermost.
Intercostal vein, artery and nerve (VAN) in the neurovascular plane; between the internal intercostal and the innermost intercostal muscles.
Superficial layer; its
fibers are directed downward and forward from the inferior border of the rib above to the upper border of the rib below.
It extends from the rib tubercle behind to the costochondral junction in front, where it is replaced by the anterior intercostal membrane.
Intermediate layer; its
fibers are directed downward and backward from the subcostal groove of the rib above to the upper border of the rib below.
It extends from the sternum in front to the angles of the ribs behind, where it is replaced by the posterior intercostal membrane.
deepest layer; it is incomplete layer.
It is represented by three patches; anterior, lateral and posterior.
It crosses more than one intercostal space.
Action 1) narrow the intercostal spaces. So, they either raise or lower
ribs according to which rib is more stable, the 1st or the 12th
This means they are responsible for inspiration and forced expiration.
2) Their tone prevents sucking and bulging of the intercostal spaces during inspiration and expiration.
Nerve supply: Intercostal nerves and their
collateral branches
Posterior Intercostal Arteries: Upper 2: br. from the
superior intercostal a. of the costocervical trunk of the subclavian a.
Lower 9: from the descending aorta
Anterior intercostal arteries: (2 in each space)
Upper 6: from the internal thoracic a.
Lower 5: from the musculophrenic a.
Posterior Intercostal veins: Rt. side: into azygos vein
Lt. side: hemiazygos veins
Anterior intercostal veins: Drain into the internal
thoracic vein & the musculophrenic v.
Internal thoracic artery: Origin: 1st part of the subclavian
artery Course: deep to the costal
cartilages a finger breadth lateral to the edge of the sternum
Ends in the 6th intercostal space by dividing into 2 branches.
Branches: Anterior intercostal arteries Perforating arteries Mediastinal a. Pericardiacophrenic artery Superior epigastric a Musculophrenic a
Anterior primary rami of the upper 11 thoracic nerves.
Branches: White and gray rami
communicants
Collateral br.
Lateral cutaneous br.
Anterior cutaneous br.
Muscular br.
Pleural sensory branches
Peritoneal sensory branches (7th -11th)
The 1st intercostal nerve has no cutaneous branches. Also, most of the primary ramus share in the brachial plexus
The lateral cutaneous br. of the 2nd intercostal nerve is called intercostobrachial nerve as it communicates with medial cutaneous nerve of the arm
The 7th to the 11th nerves supply the anterior abdominal wall.
Needle thoracostomy
Tube thoracostomy
Thoracotomy
Intercostal nerve block
Intercostal muscles
Diaphragm
Levator costarum
Serratous posterior superior
Serratous posterior inferior