7 Thoracic Wall 4, Neurovasculature PDF

The Thoracic Wall (4): Innervation & Vasculature Prof. Mohammed Z. Allouh Images included in this presentation were adapted from the following textbooks: Principles of Human Anatomy, 13th ed. Gerard Tortora & Mark Nielsen....

The Thoracic Wall (4): Innervation & Vasculature Prof. Mohammed Z. Allouh Images included in this presentation were adapted from the following textbooks: Principles of Human Anatomy, 13th ed. Gerard Tortora & Mark Nielsen. Copyrights © 2014 John Wiley & Sons, Inc. Grant’s Atlas of Anatomy, 13th ed. Anne M. R. Agur, Aruther F. Dalley. Copyright © 2012 Wolters Kluwer/Lippincott Williams & Wilkins. Clinical Anatomy by Regions, 9th ed. Richard S. Snell. Copyright © 2012 Wolters Kluwer/Lippincott Williams & Wilkins Moore Clinically Oriented Anatomy, 7th ed. Keith L. Moore, Arthur F. Dalley, Anne M. R. Agur. Copyright © 2014 Lippincott Williams & Wilkins, a Wolters Kluwer business. Gray’s Anatomy for Students, 4th ed. Richard L. Drake, A. Wayne Vogl, Adam W. M. Mitchell. Copyright © 2020 Elsevier Inc. ① skin Suscia ② superfacial Review: Layers of the Thoracic Wall ③ deep Fascia muscle intercostal ⑨ external means Internalintercostalfassic ⑦ Endthoracic ⑧ parietal plevra slayers in thoracic wall 1  VAN Intercostal Costal Groove: Vein sup-  Artery mid ,  O ⑳O Nerve ant. & ↳ far supporting branches Collateral neurovascular bundle: over upper borders of the ribs below - - largest branches from Intercostal VAN 5- & 98 Somatic- sensory/motor - abovesuncost Vasiral > - Sempathetic/parasempathetic je ⑤ - 11 pairs of nerves (1 nerve/IC space) Intercostal Nerves - Anterior Rami of thoracic spinal nerves - e 8onlineen · F - The nerve # 12 lies in abdomen G O  Subcostal nerve Main branches: 1- collateral branch: > - Mixed - passes inferior to the main nerve = on the upper border of rib below ne wor 2- lateral cutaneous: sensory, at midaxillary line - 3- anterior cutaneous: sensory 4- Muscular O to IC muscles branches: motor ⑳ - O to parietal pleura enethoracic 5- pleural branches: sensory O - Fascia external , internal , inner mostHer at 3 sensing 2  -intercosta nerve Larger) than Talesintender supply and supps back O anterior ramus: & = - - ~ > Internal memory artery 3  Attendance Clinical: Intercostal Nerve Block slayers serve not the nerve inesubs ①near on exmusa , Gove Injection of a local anesthetic agent around the intercostal nerve to relief pain in that o - - a specific intercostal nerve spicult * Objective To relief pain & allow pain-free respiratory movements ⑥ Indications - infilleration - liguge of O each one - Rib fractures several for of - Surgical incisions C - Herpes zoster infection (shingles) Tral y (virus) Procedure midial to angle of O - The needle is inserted posteriorly near the rib > - angle rib (5-7 cm from midline) because - The needle is directed near the lower border of the A - rib -herb Complications Pneumothorax injury /possbloed Hemorrhage vessel Nerve injury media 4  anterior 36 758 > - 9 > - 18 pairs > - arteries posterior - 11 > -> 11 pairs > - 22 mostportant He area Intercostal Arteries Interneci ↑ r se 3 arteries/IC space: 1 Large posterior IC artery -gives collateral branch Dan acadinga - 2 small anterior IC arteries abovea i 8 - u I Posterior IC arteries: & Tiresfrom 1st & 2nd arteries: branch 5 Superior intercostal of costocervical of Krefe arties indirectly - subclavian 3rd -11th: I posteriodrinia Descending thoracic aorta - min a Anterior IC arteries: 1st – O 6th: ↑ y Internal Thoracic a. Immory) brauem 7th – 9th: Superiorgastric Internal colophreni a c Musculophrenic a. to > - indirectly directly ⑳intera but musclesandgreat because it supply inercostal arteries neck rin large artery Costocervical trunk divided - into: deep cervical and - superior intercostal arteries 8 Ist - zud intercostal 2 actey the first 5  Intercostal Spaces - Anterior Intercostal (IC) Spaces: 9 I 2 3 Y - Posterior Intercostal (IC) & Spaces: II 6 10 T Il g & Second largest G Intercostal vein drains to -> brachiocephalic - SUSClargest head ephicvein Intercostal Veins + subclavian Jugular vein Jayual Internal chrome pnS 3 veins/IC space: 1 Large posterior IC vein 2 small anterior IC veins of in vei first No th double - all phalia in Posterior IC veins: ~ · Drain into azygos system of veins Right side Azygos vein + left asending lumber) Left 9-11 + left subcostal Left side 3Hemiazygos & left · - > (4-8) - Accessory hemiazygos veins - *exceptions: 1st IC vein (??) > brachiocephenic formed - superion intercostal Left 2nd & 3rd veins (??) > - Eterna Sinternal rain / RE Sup 1Cvain azygors -8-7-muse-int - > - If. > - brachiocephalic Anterior IC veins: Similar to anterior IC arteries into drain 16directtreat frie to internal Moracic muschominic rain thoracic a Idohto e inter ↳ will go 8 vains 6  Self Reading Material: Surface Anatomy of the Thorax Surface markings of Anterior Chest Clavicle Sternum: Jugular notch Sternal angle Body of sternum Xiphoid process Costal margins 7  Surface Anatomical Lines Anterior: 1. Median sagittal line: intersection of median plane with ant. chest wall 2. Midclavicular lines: Midpoints of clavicles to inguinal region Lateral: 1. Anterior axillary line: Along ant. axillary fold (formed by border of Pec. Major m.) 2. Posterior axillary line: Along post. axillary fold (formed by latissimus dorsi & teres major M.) 3. Midaxillary line: Runs from the apex of axilla Parallel to ant. & post. lines 8  Posterior: 1. Posterior median line: Over the tips of spinous processes of all vertebrae 2. Scapular lines: Through sup. & inf. angles of the scapula when arms at anatomical position 9