Thoracic Anatomy and Shoulder Tuberculosis
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Questions and Answers

Which of the following is true about the types of ribs?

  • True ribs attach directly to the sternum. (correct)
  • False ribs have no connection to the sternum.
  • Floating ribs are the only type that are not connected to the vertebrae.
  • Floating ribs include the 7th and 8th ribs.

    • What anatomical structure separates the neck from the abdomen?

  • Sternal angle
  • Xiphoid process
  • Superior thoracic aperture (correct)
  • Inferior thoracic aperture

    • Which landmarks are associated with the thoracic anatomy?

  • Sternal angle and xiphoid process (correct)
  • Costal grooves and rib heads
  • Cervical vertebrae and inferior thoracic aperture
  • Nasal cavity and jugular notch

    • Which ribs are classified as atypical ribs?

    <p>1st and 2nd ribs</p> Signup and view all the answers

    What is the shape description of the thoracic cavity?

    <p>Truncated cone</p> Signup and view all the answers

    Which ribs articulate directly with the sternum?

    <p>1st - 7th ribs</p> Signup and view all the answers

    What is the primary role of the accessory respiratory muscles?

    <p>Facilitate rib elevation during inhalation</p> Signup and view all the answers

    What characterizes the costovertebral joints?

    <p>They involve the attachment of the ribs to the thoracic vertebrae.</p> Signup and view all the answers

    What joints are involved in connecting the xiphoid process to the sternum?

    <p>Manubriosternal and xiphisternal joints</p> Signup and view all the answers

    Which of the following muscles is considered a true muscle of the thoracic wall?

    <p>Serratus posterior inferior</p> Signup and view all the answers

    What direction do the external intercostals run?

    <p>Forward and downward</p> Signup and view all the answers

    Which type of intercostal nerves are confined to their respective intercostal spaces?

    <p>Typical intercostal nerves</p> Signup and view all the answers

    What is the primary viral cause of shingles?

    <p>Varicella-zoster virus</p> Signup and view all the answers

    What is the main purpose of an intercostal nerve block?

    <p>To relieve pain</p> Signup and view all the answers

    Which of the following correctly describes an atypical intercostal nerve?

    <p>Innervates the abdominal wall</p> Signup and view all the answers

    What type of pain is typically experienced with herpes zoster?

    <p>Sharp and burning</p> Signup and view all the answers

    Which intercostal nerves are typically considered 'atypical'?

    <p>1st - 2nd intercostal nerves</p> Signup and view all the answers

    How does a local anesthetic work in an intercostal nerve block?

    <p>It interrupts the transmission of pain impulses</p> Signup and view all the answers

    What anatomical structures are found within the mediastinum?

    <p>Heart and thoracic part of great vessels</p> Signup and view all the answers

    Which statement accurately describes the lobes of the left and right lungs?

    <p>The right lung has three lobes: superior, middle, and inferior.</p> Signup and view all the answers

    What is the role of the costodiaphragmatic recesses?

    <p>They accumulate pleural exudate.</p> Signup and view all the answers

    What is indicated by the deviation of the trachea from midline?

    <p>A pathological process</p> Signup and view all the answers

    Which arteries supply the left lung?

    <p>Left bronchial arteries from the aorta</p> Signup and view all the answers

    How are the anterior borders of the lungs positioned in relation to the parietal pleura?

    <p>They lie adjacent to the line of reflection of the pleura.</p> Signup and view all the answers

    What structures are associated with the right lung's bronchial blood supply?

    <p>Right bronchial artery from the aorta</p> Signup and view all the answers

    Which structures are involved in gas exchange in the lungs?

    <p>Alveoli and bronchioles</p> Signup and view all the answers

    Which ribs are classified as true ribs?

    <p>1st-7th ribs</p> Signup and view all the answers

    What anatomical division is found between the neck and the abdomen?

    <p>Thoracic cavity</p> Signup and view all the answers

    What distinguishes atypical ribs from typical ribs?

    <p>The number of facets and grooves</p> Signup and view all the answers

    How many pairs of ribs are present in the human body?

    <p>12 pairs</p> Signup and view all the answers

    Which of the following describes the shape of the thoracic cavity?

    <p>Truncated cone</p> Signup and view all the answers

    Which intercostal nerves are involved in supplying the abdominal wall?

    <p>7th to 11th intercostal nerves</p> Signup and view all the answers

    What is the primary site of a herpes zoster outbreak?

    <p>The thoracic spinal ganglia</p> Signup and view all the answers

    Which anatomical feature is common to the 3rd to 6th intercostal nerves?

    <p>They are confined to their own intercostal spaces.</p> Signup and view all the answers

    What happens to the skin area affected by the herpes zoster virus?

    <p>It develops a red rash and vesicular eruptions.</p> Signup and view all the answers

    What is the role of the intercostal nerve block?

    <p>To provide pain relief by blocking nerve signals.</p> Signup and view all the answers

    What direction do the internal intercostal muscles run?

    <p>Downward and posteriorly</p> Signup and view all the answers

    Which of the following describes the innervation provided by atypical intercostal nerves?

    <p>They have additional innervation to other regions.</p> Signup and view all the answers

    What is the anatomical relationship of the 11th and 12th ribs regarding costal elements?

    <p>They have no neck or tubercle and form caps at the ends.</p> Signup and view all the answers

    Which of the following describes the 1st rib's articulation?

    <p>Articulates only with T1 vertebra.</p> Signup and view all the answers

    Which structure forms the posterior boundary of the superior thoracic outlet?

    <p>T1 vertebra</p> Signup and view all the answers

    What type of joints connect the costal cartilages of ribs 7-10 to the sternum?

    <p>Sternocostal joints</p> Signup and view all the answers

    Which of the following muscles is included among the true muscles of the thoracic wall?

    <p>Serratus posterior inferior</p> Signup and view all the answers

    How many intercostal spaces are present in the thoracic cavity?

    <p>11</p> Signup and view all the answers

    What are bilateral costal demifacets?

    <p>Articulations on the body of vertebrae for rib attachment.</p> Signup and view all the answers

    Which structure forms the anterior boundary of the inferior thoracic outlet?

    <p>Xiphisternal joint</p> Signup and view all the answers

    Study Notes

    Shoulder Tuberculosis

    • Images included in lecture are from Professor Karanis' own collection

    Thorax

    • Located between the neck and abdomen
    • Shaped like a truncated cone
    • Contains:
      • Superior thoracic aperture (thoracic inlet)
      • Inferior thoracic aperture (thoracic outlet)
      • Two pleural cavities
      • Central mediastinum:
        • Superior
        • Inferior
        • Anterior
        • Middle
        • Posterior

    Thoracic Wall

    • Composed of:
      • Sternum
      • 12 pairs of ribs and associated costal cartilages
      • 12 thoracic vertebrae

    Ribs

    • True vertebro - sternal ribs: 1st-7th ribs
    • False (Vertebro - chondral) ribs: 8th, 9th, and usually 10th ribs
    • Floating (vertebral, free) ribs: 11th, 12th, and sometimes 10th ribs

    Typical Ribs (3rd – 9th):

    • Head: Contains 2 facets and a crest of the head
    • Neck
    • Tubercle: Contains articular and non-articular components
    • Body: Contains a costal angle and costal groove

    Atypical Ribs:

    • 1st Rib: Single facet, 2 grooves for subclavian vessels
    • 2nd Rib: 2 facets, tuberosity of serratus anterior muscle
    • 10th-12th Ribs: 1 facet, 11th-12th no neck or tubercle

    Costal Cartilages

    • 1st – 7th: Connect directly to the sternum
    • 8th – 10th: Articulate with the superior costal cartilage
    • 11th and 12th: Form caps at the ends of the ribs

    Intercostal Spaces

    • 11 intercostal spaces
    • 11 intercostal nerves
    • Subcostal space
    • Subcostal nerve

    Thoracic Vertebrae Articulations with Ribs:

    • Bilateral costal facets (demifacets) on vertebral bodies
      • 1st rib articulates only with T1
      • T10, T11, T12 only have one costal facet
    • Costal facets on transverse processes
    • Spinous processes

    Sternum

    • Composed of:
      • Manubrium
      • Body
      • Xiphoid process

    Thoracic Apertures

    • Superior Thoracic Outlet:

      • Posteriorly: T1 vertebra
      • Laterally: 1st pair of ribs and their costal cartilages
      • Anteriorly: Superior border of manubrium

    • Inferior Thoracic Outlet:

      • Posteriorly: 12th thoracic vertebra
      • Posterolateral: 11th and 12th pairs of ribs
      • Anterolateral: Joined cartilages of ribs 7-10 forming the costal margins
      • Anteriorly: Xiphosternal joint

    Thoracic Wall Joints

    • Intervertebral joints
    • Sternoclavicular joints
    • Costovertebral joints
    • Joints of head of ribs
    • Costotransverse
    • Costochondral
    • Interchondral
    • Sternocostal
    • Manubriosternal
    • Xiphisternal

    Thoracic Wall Muscles

    • True muscles of the thoracic wall:
      • Serratus posterior superior muscle
      • Serratus posterior inferior muscle
      • Levatores costarum muscle
      • Intercostal muscles
      • Subcostal muscle
      • Transversus thoracis muscle
    • Accessory respiratory muscles:
      • Pectoralis major muscle
      • Pectoralis minor muscle
      • Serratus anterior muscle

    Intercostal Muscles

    • External intercostals: Run forward and downward
    • Internal intercostals: Run downward and posteriorly at right angles to the externals
    • Innermost intercostals: Run in the same direction as the internal intercostals

    Thoracic Wall Nerves

    • Intercostal nerves (anterior rami of nerves T1-T11)
    • Subcostal nerve (anterior ramus of T12 nerve)
    • Posterior rami of thoracic spinal nerves

    Typical Intercostal Nerves (3rd-6th)

    • Confined to their very own intercostal spaces
    • Composed of: - Rami communicantes - Collateral branches - Lateral cutaneous branches (lateral thoracic wall) - Anterior cutaneous branches (anterior thoracic wall) - Muscular branches

    Atypical Intercostal Nerves

    • Supply other areas in addition to intercostal spaces
    • First - Second (brachial plexus, medial side of arm)
    • ** Intercostobrachial nerve**
    • Seventh – Eleventh (abdominal wall)

    Herpes Zoster

    • Causes shingles, a painful dermatomally distributed skin lesion
    • Results from reactivation of the varicella–zoster virus (VZV) or chickenpox virus
    • Manifests as sharp burning pain in the dermatome of the involved nerve
    • Skin becomes red with vesicular eruptions
    • Pain may precede or follow eruptions
    • Weakness can occur in 0.5–5.0% of cases, especially in elderly cancer patients
    • Primarily a sensory neuropathy, but can also affect motor function

    Intercostal Nerve Block

    • Local anesthesia of an intercostal space achieved by injecting an anesthetic around the intercostal nerves
    • Used for rib fractures and sometimes thoracic surgery
    • Involves infiltration of the anesthetic around the intercostal nerve trunk and its collateral branches
    • Blocks nerve endings in the skin and transmission of pain impulses, preventing them from reaching the spinal cord and brain
    • Complete loss of sensation is unlikely due to overlapping of adjacent dermatomes

    Thoracic Cavity

    • Contains: - Right and left pulmonary cavities (lungs and pleurae) - Mediastinum (heart, great vessels, trachea, esophagus, thymus, and other structures)

    Lungs

    • Shapes are demonstrated during quiet respiration
    • Costodiaphragmatic recesses are where pleural exudate accumulates when standing
    • The horizontal fissure of the right lung parallels the 4th rib
    • Right Lung:
      • Right oblique and horizontal fissure
      • 3 lobes: superior, middle, inferior
    • Left Lung:
      • Left oblique fissure
      • 2 lobes: superior, inferior

    Trachea

    • fibrocartilagenous tube
    • Contains tracheal cartilages (incomplete)
    • Dimensions in adults: 2.5 cm in diameter
    • Location: C6 to T4-5 IV disc (sternal angle)
    • Right and left bronchi branch off
    • Deviation from midline indicates a pathological process
    • Brachiocephalic trunk is related to the right side of the trachea

    Pulmonary Circulation

    • Respiratory bronchioles, alveolar ducts, and alveoli are involved in gas exchange
    • Arteries:
      • Right and left pulmonary arteries (from pulmonary trunk at sternal angle)
      • Lobar arteries
        • Right & left superior lobar artery before entering hilum
        • Inferior lobar artery in left lung
        • Middle and inferior lobar artery in right lung
      • Tertiary segmental arteries
    • Veins:
      • Superior and inferior pulmonary veins
      • Middle lobe vein

    Bronchial Circulation

    • Arteries:
      • 2 left bronchial arteries (from the aorta)
      • Right bronchial artery (from the aorta or superior posterior intercostal artery, common trunk with left superior bronchial artery)
    • Veins: Bronchial veins

    Thoracic Apertures and Lung Position

    • Cervical pleurae and lung apices pass through the superior thoracic aperture deep to the supraclavicular fossae
    • Anterior borders of the lungs lie adjacent to the anterior line of reflection of the parietal pleura between the 2nd and 4th costal cartilages
    • The margin of the left pleural reflection moves laterally and then inferiorly at the cardiac notch to reach the 6th costal cartilage
    • The anterior border of the left lung is more deeply indented by its cardiac notch
    • On the right side, the pleural reflection continues inferiorly from the 4th to the 6th costal cartilage, paralleled closely by the anterior border of the right lung.

    Reminder

    • The information in these notes is a summary of the provided text and may not be exhaustive.
    • For further understanding, it is recommended to refer to relevant textbooks and resources.

    The Thorax

    • Conical shape, located between the neck and abdomen
    • Superior thoracic aperture (thoracic inlet) is the superior opening
    • Inferior thoracic aperture (thoracic outlet) is the inferior opening
    • Two pleural cavities contain the lungs
    • Mediastinum contains the heart, trachea, esophagus, and other structures in the thoracic cavity

    Thoracic Wall

    • Structures: Sternum, 12 pairs of ribs, 12 thoracic vertebrae
    • Ribs: True ribs (1st-7th), False ribs (8th-10th), Floating ribs (11th-12th)

    Ribs

    • Typical Ribs (3rd - 9th): Head, Neck, Tubercle, Body, Costal angle, Costal groove
    • Atypical Ribs: 1st Rib (single facet, 2 grooves), 2nd Rib (2 facets, tuberosity), 10th-12th Ribs (1 facet, no neck or tubercle)

    Costal Cartilages

    • Connect ribs to sternum
    • 1st-7th ribs directly connect to the sternum
    • 8th-10th ribs connect to superior rib
    • 11th and 12th ribs form caps at the ends of ribs

    Intercostal Spaces

    • 11 intercostal spaces
    • 11 intercostal nerves

    Sternum

    • Manubrium: Superior part
    • Body: Middle part
    • Xiphoid process: Inferior part

    Thoracic Outlet

    • Superior thoracic outlet: T1 vertebra, 1st pair of ribs
    • Inferior thoracic outlet: 12th thoracic vertebra, 11th and 12th pairs of ribs

    Thoracic Wall Joints

    • Intervertebral: Between vertebral bodies
    • Sternoclavicular: Between sternum and clavicle
    • Costovertebral: Between ribs and vertebrae
    • Joints of the head of ribs: Between rib head and vertebral bodies
    • Costotransverse: Between rib tubercle and transverse processes of vertebrae
    • Costochondral: Between rib and costal cartilage
    • Interchondral: Between costal cartilages
    • Sternocostal: Between ribs and sternum
    • Manubriosternal: Between manubrium and body of sternum
    • Xiphisternal: Between xiphoid process and body of sternum

    Muscles of the Thoracic Wall

    • True muscles: Serratus posterior superior, Serratus posterior inferior, Levatores costarum, Intercostals, Subcostal, Transversus thoracis
    • Accessory respiratory muscles: Pectoralis major, Pectoralis minor, Serratus anterior

    Intercostal Muscles

    • External intercostals: Run forward and downward
    • Internal intercostals: Run downward and posteriorly, perpendicular to externals
    • Innermost intercostals: Run in the same direction as internal intercostals

    Intercostal Nerves

    • Anterior rami of nerves T1-T11
    • Subcostal nerve: Anterior ramus of T12
    • Typical (3rd - 6th): Confined to their intercostal space
    • Atypical (1st-2nd, 7th-11th): Supply other areas

    Lungs

    • Right Lung: 3 lobes (superior, middle, inferior)
    • Left Lung: 2 lobes (superior, inferior)
    • Costodiaphragmatic recesses are potential spaces for fluid accumulation

    Trachea

    • Fibrocartilagenous tube
    • Tracheal cartilages are incomplete rings
    • 2.5 cm in diameter in adults
    • Extends from C6 to T4-5 IV disc (sternal angle)
    • Right and Left bronchi branch at the level of the sternal angle

    Pulmonary Vessels

    • Pulmonary arteries: Carry deoxygenated blood from the heart to the lungs
      • Right and Left pulmonary arteries branch off the pulmonary trunk at the level of the sternal angle
      • Lobar arteries: Supply lobes of each lung
      • Tertiary segmental arteries: Branch further within the lungs
    • Pulmonary veins: Carry oxygenated blood from the lungs to the heart
      • Superior and Inferior pulmonary veins
      • Middle lobe vein (right lung only)
    • Bronchial arteries: Supply the bronchi and lung tissue
      • 2 left bronchial arteries arise from the aorta
      • Right bronchial artery originates from the aorta or a common trunk with the left superior bronchial artery
    • Bronchial veins drain the lung tissue

    Superior Thoracic Aperture and Supraclavicular Fossae

    • Cervical pleurae and lung apexes pass through the superior thoracic aperture, deep to the supraclavicular fossae

    Anterior Borders of the Lungs

    • Anterior borders of the lungs lie adjacent to the anterior line of reflection of the parietal pleura between the 2nd and 4th costal cartilages
    • Left lung has a cardiac notch
    • Right lung continues inferiorly from the 4th to the 6th costal cartilage

    Herpes Zoster and Intercostal Nerve Block

    • Herpes zoster: Reactivated chickenpox virus (VZV) that causes shingles
    • Intercostal nerve block: Procedure to provide local anesthesia to an intercostal space by injecting anesthetic around the intercostal nerves
    • Nerve block interrupts pain sensation transmission.

    Mediastinum

    • Contains: Heart, thoracic part of great vessels, thoracic part of trachea, esophagus, thymus, lymph nodes, and other structures

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