Thoracic Cage Anatomy Quiz

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Questions and Answers

What type of joint is the manubriosternal joint?

  • Synovial joint
  • Primary cartilaginous joint (synchondrosis)
  • Fibrous joint
  • Secondary cartilaginous joint (symphysis) (correct)

Which ribs are considered typical ribs?

  • Ribs 4 and 7
  • Ribs 1, 2, 11, and 12
  • Ribs 5 and 6
  • Ribs 3 to 10 (correct)

What is the primary movement at the xiphisternal joint?

  • Angulation
  • No movement (correct)
  • Translation
  • Anteroposterior displacement

Which ligament is associated with the manubriosternal joint?

<p>Manubriosternal ligament (D)</p> Signup and view all the answers

What structures articulate with the superior margin of the xiphoid process?

<p>Articular disc (B), Inferior margin of sternal body (C)</p> Signup and view all the answers

How many articular facets does the first rib have?

<p>One (D)</p> Signup and view all the answers

Which of the following describes the 11th and 12th ribs?

<p>They do not have tubercles and do not attach to anything anteriorly. (D)</p> Signup and view all the answers

What is the blood supply to the intercostal nerves?

<p>Internal thoracic artery (D)</p> Signup and view all the answers

Which of the following bony structures is not part of the rib cage?

<p>Scapula (D)</p> Signup and view all the answers

What type of joint is the 1st sternocostal joint classified as?

<p>Primary cartilaginous joint (D)</p> Signup and view all the answers

What is the primary function of the true ribs?

<p>To attach to the sternum via costochondral joints (A)</p> Signup and view all the answers

Which ribs are considered floating ribs?

<p>Ribs 11-12 (C)</p> Signup and view all the answers

How are the false ribs attached in the anterior part of the body?

<p>Only via costochondral joints (D)</p> Signup and view all the answers

Which component is part of the mechanics of breathing?

<p>Control of breathing (A)</p> Signup and view all the answers

What structure does the costal cartilage of the first rib attach to?

<p>Manubrium (A)</p> Signup and view all the answers

What is a characteristic of the synovial joints found in the thoracic cage?

<p>They are freely mobile. (B)</p> Signup and view all the answers

What is the origin of the quadratus lumborum?

<p>Iliac crest, iliolumbar ligament (B)</p> Signup and view all the answers

Which nerve innervates the serratus anterior muscle?

<p>Long thoracic nerve (A)</p> Signup and view all the answers

What is a primary function of the quadratus lumborum?

<p>Lateral flexion of the trunk (D)</p> Signup and view all the answers

Which artery is primarily associated with the blood supply of the quadratus lumborum?

<p>Subcostal artery (D)</p> Signup and view all the answers

Which part of the serratus anterior inserts onto the scapula?

<p>All parts of the muscle (D)</p> Signup and view all the answers

Which of the following best describes the function of the serratus anterior muscle?

<p>Suspending the scapula on the thoracic wall (C)</p> Signup and view all the answers

What is the origin of the superior part of the serratus anterior?

<p>Ribs 1-2, Intercostal fascia (A)</p> Signup and view all the answers

What is a key mnemonic to remember the innervation of the serratus anterior?

<p>SALT (B)</p> Signup and view all the answers

What primarily facilitates the mechanics of breathing?

<p>Contraction of respiratory muscles (A)</p> Signup and view all the answers

During which type of breathing do the external intercostals and diaphragm contract?

<p>Quiet or tidal breathing (B)</p> Signup and view all the answers

What is the effect on thoracic pressure during inhalation?

<p>It decreases (D)</p> Signup and view all the answers

What type of movement do the lower ribs primarily engage in during quiet breathing?

<p>Bucket handle movement (A)</p> Signup and view all the answers

What happens to the diaphragm during passive expiration?

<p>It domes upwards (C)</p> Signup and view all the answers

Which muscles are primarily used during forced expiration?

<p>Abdominal muscles and internal intercostals (D)</p> Signup and view all the answers

What is true about the nature of breathing at rest?

<p>It is a passive process (C)</p> Signup and view all the answers

Which pressure gradient does air move down during inhalation?

<p>From high to low pressure (C)</p> Signup and view all the answers

What is the primary function of the suprapleural membrane?

<p>Prevents lung expansion in the upward direction (C)</p> Signup and view all the answers

What is the primary function of the descending part of the muscle described?

<p>Extension of the head and neck (A)</p> Signup and view all the answers

Which of the following conditions can lead to Thoracic Outlet Syndrome?

<p>Apical lung cancer (B)</p> Signup and view all the answers

What is the main blood supply to the superior thyroid artery?

<p>Ascending cervical branch of the inferior thyroid artery (A)</p> Signup and view all the answers

Which spinal nerves are involved in the motor/sensory supply of this muscle?

<p>C3-C4 (A)</p> Signup and view all the answers

What is one of the functions of the anterior scalene muscle?

<p>Elevation of rib 1 (D)</p> Signup and view all the answers

What action does unilateral contraction of this muscle perform at the cervical spine?

<p>Contralateral rotation (C)</p> Signup and view all the answers

Where does the posterior scalene muscle insert?

<p>Lateral surface of rib 2 (C)</p> Signup and view all the answers

Which joint is involved in the elevation of the clavicle?

<p>Sternoclavicular joint (C)</p> Signup and view all the answers

What is the function of the transverse part of the muscle?

<p>Draws scapula medially (D)</p> Signup and view all the answers

Which part of the trapezius muscle originates from the superior nuchal line?

<p>Descending part (D)</p> Signup and view all the answers

What is the innervation of the pectoralis major muscle?

<p>Medial and lateral pectoral nerves (A)</p> Signup and view all the answers

Which arteries provide blood supply to the descending part of the muscle?

<p>Occipital artery and transverse cervical artery (D)</p> Signup and view all the answers

What is the primary function of the scalene muscles?

<p>Neck lateral flexion and elevation of ribs (C)</p> Signup and view all the answers

What joint is responsible for lateral flexion of the head and neck?

<p>Atlanto-occipital joint (D)</p> Signup and view all the answers

Which structure passes through the thoracic outlet?

<p>Esophagus (A), Trachea (C)</p> Signup and view all the answers

Which action does NOT occur during bilateral contraction of the muscle?

<p>Flexion of the neck (A)</p> Signup and view all the answers

What is the origin of the pectoralis minor muscle?

<p>Costal cartilages of ribs 3-5 (D)</p> Signup and view all the answers

Which part of the muscle draws the scapula inferomedially?

<p>Ascending part (D)</p> Signup and view all the answers

What is a function of the scapulothoracic joint?

<p>Stabilizes the scapula on the thoracic wall (C)</p> Signup and view all the answers

Which skeletal feature is associated with the attachment of the anterior scalene muscle?

<p>Rib 1 (B)</p> Signup and view all the answers

What muscle primarily assists in head/neck extension when contracted bilaterally?

<p>Trapezius (A)</p> Signup and view all the answers

Which artery supplies blood to the trapezius muscle?

<p>Thoracoacromial artery (D)</p> Signup and view all the answers

What is the main action of the ascending part of the trapezius muscle?

<p>Depression of scapula (C)</p> Signup and view all the answers

Flashcards

Thoracic cage

The bony structure that forms the cage-like structure of the chest, protecting the vital organs inside.

True Ribs

The seven ribs that directly attach to the sternum (breastbone) via costal cartilage.

False Ribs

Ribs 8-10, they indirectly attach to the sternum via costal cartilage, but join to the rib above.

Floating ribs

Ribs 11-12, they do not attach to the sternum at all, only to the vertebral column.

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Sternal Angle

The point on the sternum where the manubrium (top part) meets the body of the sternum.

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Synovial Joints

Joints that allow for movement, such as between the ribs, costal cartilages, vertebrae, and sternum.

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Primary Cartilaginous Joints

These joints connect bones using hyaline cartilage, such as the connection of the first costal cartilage to the manubrium.

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Sternocostal joints

These joints link the costal cartilages to the sternum and allow for rib movement during breathing.

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Manubriosternal Joint

The junction between the manubrium and the body of the sternum.

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Manubriosternal Joint: Type

A secondary cartilaginous joint (symphysis) located between the manubrium and sternal body. It allows for slight angulation and anteroposterior displacement.

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Xiphisternal Joint

A fibrous joint located between the xiphoid process and the sternal body.

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Xiphisternal Joint: Type

The junction between the xiphoid process and the sternal body.

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Typical Ribs (Ribs 3-10)

These ribs are long and curved, and they have two articular facets on their heads and a tubercle.

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Atypical Ribs: First Rib

The first rib is short, strong, and highly curved. It has a single facet on its head and grooves for the subclavian vessels.

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Atypical Ribs: Second Rib

The second rib is long and has a tubercle for the scalenus posterior muscle.

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Atypical Ribs: Eleventh and Twelfth Ribs

The eleventh and twelfth ribs are short and do not have tubercles. They only have a single facet on their heads.

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Pectoralis Minor

A muscle that helps with breathing by elevating the clavicle and manubrium of the sternum, which expands the chest cavity.

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Unilateral contraction of the Pectoralis Minor

Contraction of the muscle on one side of the body causes flexion (bending) of the neck to that side and rotation of the head to the opposite side.

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Bilateral contraction of the Pectoralis Minor

Contraction of the muscle on both sides of the body acts to extend the head and neck.

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Superior fibers of the Pectoralis Minor

The superior fibers of the Pectoralis Minor draw the scapula upwards and inwards.

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Transverse fibers of the Pectoralis Minor

The middle fibers of the Pectoralis Minor pull the scapula towards the spine (medially).

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Inferior fibers of the Pectoralis Minor

The inferior fibers of the Pectoralis Minor pull the scapula downwards and inwards.

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Nerve supply of the Pectoralis Minor

The Pectoralis Minor muscle is supplied by nerves from the cervical plexus, which is a network of nerves in the neck.

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Stabilizing function of the Pectoralis Minor

The Pectoralis Minor muscle helps to stabilize the scapula (shoulder blade) against the chest wall, crucial for proper arm movement.

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Role of Pectoralis Minor in breathing

The Pectoralis Minor assists with breathing by elevating the ribs, expanding the chest cavity.

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Importance of Pectoralis Minor in shoulder girdle movement

The Pectoralis Minor plays a crucial role in the movement of the shoulder girdle, allowing for a wide range of arm motions.

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What is the function of the serratus anterior muscle?

The serratus anterior is a muscle that helps to stabilize the scapula and allows for its protraction and upward rotation. Its innervation is by the long thoracic nerve, which is responsible for its function.

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What is the function of the quadratus lumborum muscle?

The quadratus lumborum muscle is located in the posterior abdominal wall. It is responsible for various bodily functions, including lateral flexion and extension of the trunk, and supporting the lumbar spine.

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Where does the quadratus lumborum muscle originate and insert?

The quadratus lumborum originates from the iliac crest and iliolumbar ligament and inserts into the inferior border of rib 12 and the transverse processes of L1-L4 vertebrae.

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What innervates the serratus anterior muscle?

The serratus anterior is innervated by the Long Thoracic nerve (C5-C7). This nerve is essential for its function and can suffer damage leading to a condition called "winged scapula."

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What is the innervation of the quadratus lumborum?

The quadratus lumborum muscle is primarily innervated by the subcostal nerve (T12), as well as the anterior rami of L1-L4 spinal nerves. This nerve input allows for control over the muscle's actions, including lateral flexion and trunk extension.

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What is the primary role of the serratus anterior in scapular movements?

The serratus anterior muscle is involved in the abduction and upward rotation of the scapula. It also helps to stabilize the scapula against the chest wall, ensuring proper shoulder joint mechanics. These actions are crucial for movements like throwing, pushing, and pulling.

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What are the functions of the quadratus lumborum when contracted unilaterally and bilaterally?

The quadratus lumborum, on one side, aids in lateral flexion of the trunk towards that side. If both sides contract together, it helps fix the 12th rib during inspiration and assists with trunk extension.

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What is the blood supply for the serratus anterior?

The serratus anterior is supplied by the superior and lateral thoracic arteries, as well as branches from the thoracodorsal artery. These arteries are essential for providing blood supply to the muscle, allowing it to function correctly.

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Thoracic Cavity

The space within the rib cage that houses, protects, and supports the heart, lungs, and other essential organs.

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Thoracic Outlet

The opening at the top of the thoracic cavity where structures pass from the chest into the neck and upper limb.

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Suprapleural Membrane

A strong layer of fascia that covers the top of the thoracic cavity, preventing the lungs from expanding upwards.

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Thoracic Outlet Syndrome (TOS)

A condition resulting from compression of nerves and/or blood vessels in the thoracic outlet.

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Endothoracic Fascia

A strong, fibrous connective tissue lining that extends throughout the thoracic cavity, providing support and structure.

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Trapezius

A large, triangular muscle spanning the upper back, neck, and shoulder, crucial for various movements.

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Descending Part of Trapezius

The part of the trapezius muscle that runs from the base of the skull to the clavicle, responsible for head control and shoulder elevation.

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Transverse Part of Trapezius

The part of the trapezius muscle that spans across the upper back from the neck vertebrae to the scapula, responsible for shoulder rotation and retraction.

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Ascending Part of Trapezius

The part of the trapezius muscle that runs from the mid-back vertebrae to the scapula, responsible for scapular depression and upward rotation.

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Scalene Muscles

A deep neck muscle that helps with neck flexion, rotation, and rib elevation.

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Anterior Scalene

The anterior scalene muscle plays a role in neck flexion, lateral flexion, and contralateral rotation.

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Middle Scalene

The middle scalene muscle assists in neck flexion and lateral flexion.

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Posterior Scalene

The posterior scalene muscle aids in neck lateral flexion and rib elevation.

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What is the physiology of inhalation?

Breathing in is an active, but unconscious process involving the diaphragm and intercostal muscles, which contract to expand the chest cavity, decreasing pressure and drawing air into the lungs.

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What occurs during exhalation?

Breathing out is a passive process at rest, involving relaxation of the diaphragm and intercostal muscles, which decreases the chest cavity volume, increasing pressure and pushing air out of the lungs.

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What is the primary force driving air into and out of the lungs?

The change in air pressure between the atmosphere and the lungs drives the movement of air during breathing.

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What is the role of the diaphragm in breathing?

The diaphragm, a dome-shaped muscle, flattens and moves downwards during inhalation, increasing the chest cavity volume. During exhalation, it relaxes and moves upwards, decreasing the chest cavity volume.

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How do intercostal muscles contribute to breathing?

The intercostal muscles, located between the ribs, assist in breathing. External intercostals contract during inhalation, lifting and expanding the rib cage. Internal intercostals contract during forced exhalation, pulling the ribs down and inwards.

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How does breathing change during forceful exhalation?

During exercise or situations requiring forceful breathing, additional muscles like abdominal muscles and internal intercostal muscles are recruited to increase the force of exhalation.

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Describe the two types of rib movement during breathing.

Bucket handle movement primarily involves the lower ribs (7-10) moving upwards and outwards during inhalation, increasing the anterior-posterior diameter of the chest. Pump handle movement involves the upper ribs (1-6) rotating and moving laterally outwards, increasing the transverse diameter of the chest.

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What are the differences between quiet and forced breathing?

Normal, quiet breathing, also known as tidal breathing, involves a relatively small volume of air movement. Forced breathing, like during exercise, requires a larger volume of air movement and utilizes additional muscles.

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Study Notes

Anatomy of the Chest Wall

  • The chest wall has 10 layers
  • It includes epidermis, dermis, superficial and deep fascia
  • It contains skeletal muscles (e.g., internal & external intercostals)
  • Ribs, sternum, and spine are part of the bony structure
  • Endothoracic fascia and parietal pleura are also components
  • The structure of the rib cage includes the thoracic spine (T1-T12), clavicle, ribs (true, false, and floating), costal cartilage, sternum (manubrium, body, xiphoid process)

Learning Objectives

  • Students will learn to identify the bony structures of the chest wall.
  • Students will learn to identify the muscular and soft tissue structures of the chest wall.
  • Students will learn to identify the nervous system involved in breathing.
  • Students will learn to understand and explain the mechanics of breathing including inspiration, expiration and control of breathing.
  • Students will learn the relevance to physiotherapy

Thoracic Cage

  • Clavicle: The first costal cartilage attaches to the manubrium
  • The second costal cartilage attaches to the sternal angle.
  • True Ribs (1-7): Attach directly to the sternum via costochondral joints
  • False Ribs (8-10): Attach indirectly to the sternum via costal cartilage and interchondral joints.
  • Floating ribs (11-12): These ribs do not attach to the sternum but attach posteriorly by the costal cartilage.
  • The sternum has three parts: manubrium, body, xiphoid process
  • These bones form the rib cage and protect vital organs

Thoracic Spine (T2-T9)

  • Each thoracic vertebra has a vertebral body, spinous process, and two articular processes
  • Unique features like superior costal facets and inferior costal facets are also found.

Thoracic Spine (T10-T12)

  • These thoracic vertebrae have varying structural elements differentiating them from typical T2-T9 thoracic vertebrae including only a single pair of costal facets
  • T10, T11 and T12 will have varying features to other thoracic vertebrae

Ribs (Ribs 3-10)

  • Typical ribs have two articular facets (superior and inferior demifacets) and a tubercle that articulates with the transverse process of the corresponding vertebra
  • The ribs are attached to the thoracic vertebra via costovertebral joints and facet joints

Types of Breathing

  • Quiet/Tidal breathing
  • Forced breathing (exercise breathing)

Muscles of Respiration

  • Inspiration at rest: intercostal muscles, diaphragm
  • Inspiration during distress/exercise: scalene, sternocleidomastoid, pectoralis major, pectoralis minor, serratus anterior, trapezius, iliocostalis lumborum, quadratus lumborum, latissimus dorsi, Erector spinae
  • Expiration at rest: relaxation of intercostal muscles and diaphragm
  • Expiration during distress/exercise: rectus abdominis, external oblique, internal oblique, and transversus abdominis.

Accessory Muscles of the Shoulder Girdle

  • Trapezius: important for drawing the scapula superomedially/medially and inferomedially
  • Serratus anterior: crucial for drawing the scapula anterolaterally
  • Pectoralis minor plays a role in drawing the scapula anteroinferiorly, anchoring the scapula on the thoracic wall, and scapularis rotation.

Accessory Muscles of the Neck & Upper Back

  • Scalenes (anterior, middle, and posterior): elevate the ribs and assist with respiration.
  • Sternocleidomastoid: primarily involved in neck movements
  • Iliocostalis: involved in back extension, lateral flexion.
  • Quadratus lumborum: needed for back extension, lateral flexion

Vascular Supply to the Chest Wall

  • Thoracic wall receives blood from the posterior intercostal arteries (from the thoracic aorta), anterior intercostal arteries (from the internal thoracic arteries), pericardiaphrenic branches, and diaphragm.

Neurology of the Chest Wall

  • Sensory innervation via the intercostal nerves, which extend from the anterior rami of spinal nerves T1-T12.
  • Motor innervation via the anterior rami of spinal nerves T1-T11, also a segment of nerves originating in the cervical spine that directly innervate the diaphragm via the phrenic nerve.
  • These nerves, along with other associated nerves provide innervation to the intercostal muscles, and parietal pleura.

The Lymphatic System

  • The lymphatic system drains excess tissue fluid (lymph) from the body tissues, and filters blood from foreign particles
  • Lymphatic vessels and nodes are located both superficially and deep throughout the body
  • The lymphatic system of the chest wall drains to the axillary nodes (anterior and posterior chest wall), parasternal nodes (medially).

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