Intercostal Muscles & Diaphragm PDF

 Intercostal muscles External intercostal  Extension: From the tubercle to costo-chondral junction. Then continue as anterior intercostal membrane wy  Direction:...

 Intercostal muscles External intercostal  Extension: From the tubercle to costo-chondral junction. Then continue as anterior intercostal membrane wy  Direction: Downward forward & medially  Origin: lower border of rib above  Insertion: upper border of rib below  Action :inspiration da Internal intercostal  Extension: From sternal margin to the angle of rib. External inter-costal Then continue as posterior intercostal membrane  Direction: downward backward en  Origin: costalgroveof rib above  Insertion: upper border of rib below  Action :expiation Transversus thoracicH A.Innermost intercostlis R.  Extension: middle part of inter-costal space  Direction: downward backward  Origin: lower borderof rib above Internal intercostal D  Insertion: upper border of rib below  Action :expiation Innermost intercostal Anatomist “ICM & ICN”  B. Sterno-costalis  Extension: anterior part of inter-costal space  Direction: upward & laterally wy  Origin: inner surface of xiphoid process & lower body of sternum  Insertion: inner surface of 2-6 ribs  Action :expiation da en C. Sub-costalis  Extension: posterior part of inter-costal space H  Direction: downward & medially R.  Origin: inner surface of rib near the angle  Insertion: inner surface of 2 or 3 ribs below D  Action :expiation Anatomist “ICM & ICN"  Intercostal nerve “Ventral rami of thoracic spinal nerve” Typical inter-costal nerve  Number: 3rd - 6th wy  Course:  Passes between pleura & posterior inter-costal membrane  Passes between internal intercostal & inner most intercostalis  Passes in costal groove below intercostal vessels “VAN” da  End: pierce Internal inter-costal muscle & anterior intercostal membrane to continue as anterior cutaneous nerve  Branches: en 1) Rami Communicant rami with Sympathetic chain: “it gives white ramus & receive gray ramus” 2) Muscular: supply upper part of intercostal muscles 4) Sensory to parietal pleura H 3) Collateral: supply lower part of intercostal muscles 5) Anterior Cutaneous: supply front of thorax R. 6) Lateral cutaneous: supply side & back of thorax Atypical inter-costal nerve st  1 ICN : share in brachial plexus supplying the upper limb D  2nd ICN: has lateral cutaneous nerve “intercosto-brachial nerve” supplying the axilla  Lower 5 ICN: supply anterior abdominal wall N.B: ICN block is done at the lower border of rib behind mid-axillary line before it gives lateral cutaneous branch Anatomist "ICM & ICN"  Diaphragm Origin o Sternal origin Back of xiphoid process o Costal origin Inner surface of lower (6) rib wy o Vertebral origin  Right crus :from upper 3 Lumbar vertebrae  Left crus : upper 2 Lumbar vertebrae da  Median arcuate ligament: Connect 2 Crura  Medial arcuate ligament: From crus to transverse process of L1  Lateral arcuate ligament: From transverse process of L1 to last rib en N.B: vertebra-costal triangle:  Lies between costa origin, vertebral origin & last rib – lt lies behind the kidney H  It is larger on the left side – It is filled normally with fat  It is common side for internal henia  Insertion: Central tendon R. Nerve supply Motor: Phrenic nerve "C3,4,5" & Sensory: from lower 6 ICNs  Action Main respiratory muscle  Arterial supply D  Pericardio-phrenic & musclo-phrenic from internal thoracic artery  Superior phrenic from descending thoracic aorta  Inferior phrenic from abdominal aorta Anatomist "Diaphragm" Openings Major openings  Vena caval opening:  Costal level: 6th costal cartilage On the right side of central tendon Vertebral Level: T8 wy Structures passing: Inferior vena cava& Right phrenic nerve  Esophageal opening: Costal level: 7th costal cartilage On the left side Within the right crus Vertebral Level: T10 da Structures passing: Esophagus, 2 vagi & Esophageal branches of left gastric  Aortic opening: Costal level: 8th costal cartilage, Below median arcute ligament en Vertebral Level: T12 Structures passing: Aorta, Thoracic duct & Azygous vein Minor openings o H N.B: Hiatus Hernia: Wide esophageal opening causing passage of abdominal viscera through to the thorax Superior epigastric & Musclo-phrenic R. o Inferior hemiazygous vein o Lower (6) ICN, vessel o Left phrenic nerve D o Quadratus lumborum “passes behind lateral arcuate ligament” o Psoas major & Sympathetic chain & Splanchinic nerves “pass behind medial arcuate ligament” Anatomist "Diaphragm"