Thoracic Cage

and Wall

dr. Afdal, SpA, M. Biomed

Fakultas Kedokteran Universitas Andalas
 Functions
• Protects vital organs within the thorax
• Supports thorax during respiration,
• Supports shoulder girdles and upper limbs
• Provides attachment points for back, chest
and shoulder muscles.
Thoracic cage
Thoracic inlet
Mediastinum
 Thoracic Cage
- The thoracic cage consists of the sternum, the ribs,
and the thoracic vertebrae.
- It has a narrow inlet and a wide outlet.

I. Thoracic inlet: (the upper opening of the thoracic

cage)
Boundaries:
a. Anterior -------------- Supra-sternal notch of the
manubrium sterni.
b. On each side --------- First rib.
c. Posterior -------------- First thoracic vertebra.
 II. Thoracic outlet
It is the lower opening of the thoracic cage.
Boundaries:
a. Anterior -------------- Xiphoid process.
b. On each side --------- Lower six costal
cartilages + Last two ribs.
c. Posterior -------------- Last thoracic
vertebra.
- It is closed by the diaphragm which
separates it from the abdominal cavity.
 Parts
• Composed of thoracic vertebrae (dorsal)
• Ribs (laterally)
• Sternum with costal cartilages (anteriorly).
 Sternum
• Divided into three parts, manubrium,
body and xiphoid process.
• A flat bone approximately 6 inches long.
• Manubrium (superior) is shaped like a
knot in a necktie.
• Articulates with clavicle at clavicular
notches.
Sternum
 Manubrium
– The superior portion of sternum
– Broad, triangular shape
– Articulates with clavicles (collarbones)
– Articulates with cartilages of first rib pair
– Has a jugular notch, a shallow indentation
between clavicular articulations
 Body
• Forms the bulk of the sternum (tongue
shapes)
• Sides are notched where it articulates with
cartilages of the second to seventh ribs.
Body
 Xiphoid process
• Forms inferior end of sternum.
• Is hyaline cartilage in youth, but ossifies in
adults.
• Articulates only with sternal body and
serves as attachment point for diaphragm
and some abdominal muscles (m. rectus
abdominis).
 Sternal landmarks
• Jugular notch
• Sternal angle
• Xiphisternal joint
 Jugular notch
• Visible as a central indentation in the
upper border of manubrium.
• Is generally in line with the disc between
T-2 and T-3.
• Is also in line with the point where the left
common carotid artery issues from the
aorta.
 Sternal angle
• Found where the manubrium joins the
sternal body.
• Sternum is slightly angled at this point.
• Can be felt as a horizontal ridge across
across front of sternum.
• Landmark position for 2nd rib and the disc
between T-4 and T-5.
 Xiphisternal angle
• Where sternal body and xiphoid process
fuse.
• Lies opposite ninth thoracic vertebrae.
 Rib Cage
• Ribs
– Are mobile
– Can absorb shock
– Functions of ribs
• Rib movements (breathing):
– affect width and depth of thoracic cage
– changing its volume

Copyright © 2009 Pearson

Education, Inc., publishing as
Pearson Benjamin Cummings
Rib Cage
The Rib Cage
 The Rib Cage
• Ribs (costae)
– Are 12 pairs of long, curved, flat bones

– Extending from the thoracic vertebrae

– Ribs are divided into two types

• True ribs

• False ribs
Copyright © 2009 Pearson
Education, Inc., publishing as
Pearson Benjamin Cummings
• Ribs 1–7 (true ribs)
– Vertebrosternal ribs
– Connected to the sternum by costal cartilages
• Ribs 8–12 (false ribs)
– Do not attach directly to the sternum
– Vertebrochondral ribs (ribs 8–10)
• Fuse together
• Merge with cartilage before reaching the sternum
– Floating or vertebral ribs (ribs 11–12)
• Connect only to the vertebrae and back muscles
• Have no connection with the sternum
Copyright © 2009 Pearson
Education, Inc., publishing as
Pearson Benjamin Cummings
 Thoracic vertebrae
Classification of thoracic vertebrae:
- There are twelve thoracic vertebrae
classified as:
A: Typical ------ 2nd – 8th vertebrae.
B: Atypical ----- 1st, 9th, 10th, 11th, and 12th
vertebrae (first one and last 4
vertebrae).
 Typical thoracic vertebra
Lateral
surface

Superior
surface
Articulation between Thoracic
vertebrae and the ribs
 The muscles of the thorax

• They are all concerned in the movements

of the ribs and hence with respiration
• The intercostales
• Transversus thoracis
• Levatores costarum
• Pectorales
 • Intercostal Spaces
• There are 9 anterior and
11 posterior
• Each space contains:
• 1- Intercostal muscles:
(External, Internal and
transversus thoracicus)
• 2- An Intercostal nerve.
• 3- Intercostal vessels:
• a. Intercostal arteries
(Anterior & Posterior)
• b. Intercostal veins
(Anterior & Posterior).
• EXTERNAL INTERCOSTAL
• Origin: From the lower border
of the rib above
• Insertion: Into outer lip of
upper border of rib below
• Fibers are directed from
above downward and
forwards
• Begins from post. end of
Intercostal space close to the
tubercle of the rib.
• Ends at the costochondral
junction where it is replaced
by external or anterior
Intercostal membrane.
• It elevates the rib during
inspiration
• INTERNAL INTERCOSTAL
• Origin: Floor of costal
groove
• Insertion: Inner lip of upper
border of rib below
• Fibers are directed from
above downwards &
backward
• Begins from anterior end of
space close to the sternum.
• Ends at the angle of the rib,
where it is replaced by post.
Or internal Intercostal
membrane.
• Action: Depresses the rib
downwards during
expiration
• Internal Intercostal
• is partly traversed by the
nerve & vessels, which
splits each muscle into 2
parts:
• Outer: Internal Intercostal
(proper)
• Inner: Innermost Intercostal
• (In the middle of the space)
• Transversus thoracicus
• The most inner layer of
thoracic wall
• It is formed of 3 muscles
• 1- Innermost Intercostal.
• 2- Sternocostalis.
• 3- Subcostalis
 Intercostal Nerves
• They are the anterior
primary rami of spinal
thoracic nerves fromT1 to
T11
• T3 toT6 are Typical
• T12 is called Subcostal
• The remaining nerves are
called atypical (non-typical)
• Each nerve runs in the
Intercostal space inferior to
the Intercostal vessels
 Azygos Vein S
• Connects IVC with SVC V
C
• Begins in abdomen from
back of IVC at level of L2
• Enters thorax through Aortic
opening of diaphragm on Rt.
side of thoracic duct & aorta.
• In post. Mediastinum it
passes behind Rt. Border of I
V
esophagus & root of rt. Lung C
• In sup. Mediastinum (L4) it
crosses above the root of rt.
lung
Enters the middle of the back
of the SVC.
Spatium Puncture of the pleural cavity
intercostale Punkce cavum pleurae
N. Phrenicus (C 4)
Inferior Phrenic nerve
phrenic artery
 Inspiration

• Elevation of ribs (external intercostal

muscles)
• Depression of the diaphragm
• In quiet inspiration the principal muscle is the diaphragm
• In forced inspiration additional muscles are called into
action (pectoral, scalenic)
 Expiration
• Relaxation of the diaphragm
• Contraction of the intercostales interni
 Surface Anatomy

Use the next 3 slides and follow the book to

palpate (feel) the features listed
 Anterior Surface of
Thorax
• Palpate the following
– Sternum (3 parts)
– Jugular notch
– Sternal Angle (= 2nd rib)
– Clavicle
– Costal margin
– Xiphosternal joint
• Midclavicular Line
• Midaxillary Line
 Posterior Surface of
Thorax
• Palpate the following
– Spinous Process of C7
– Scapula (ribs 2-7)
• Scapular spine
• Acromion Process
• Inferior Angle of Spine
• Inferior Border
 Locating Internal
Structures
• Pleural Cavities
– Inferior margin = adjacent to
T12 in Posterior Midline
– To Rib 10 at Midaxillary line
– To Rib 8 at Midclavicular line
– To Xiphosternal joint medially
– Lungs posterior border is 2
ribs superior to pleural cavity
(rib 8)
• Heart
– Deep to xiphisternal angle