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Lab 6: Thorax and Diaphragm

OBJECTIVES: - List the parts of the sternum. - Name the different types of ribs and their parts. - Name and describe the importance of the inter‐costal muscles. - Name and describe the location of the inter‐costal nerves, arteries and veins.

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Lab 6: Thorax and Diaphragm

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  1. OBJECTIVES: - List the parts of the sternum. - Name the different types of ribs and their parts. - Name and describe the importance of the inter‐costal muscles. - Name and describe the location of the inter‐costal nerves, arteries and veins. - Describe the innervation and vascularization of the diaphragm. - List the three major hiatuses and the vessels that go through each Lab 6: Thorax and Diaphragm Christopher Ramnanan, Ph.D. cramnana@uottawa.ca

  2. Thoracic Cage: Sternum, 12 pairs of Ribs, 12 Thoracic Vertebrae Focus on The Sternum • Jugular • Notch Sternum: Manubrium Body Xiphoid Process Sternal Angle: 2nd Costal CartiIage T4/T5 IV Disc Bifurcation of Trachea Azygos Arch Aortic Arch(Lig. Arteriosum, L. Recurrent Laryngeal N.) Sum of 2 Costal Margins: Subcostal/Infrasternal Angle Note: Sternum articulates with ribs (via costal cartilages, sternocostal joints); manubrium makes up one boundary of the superior thoracic aperture

  3. The Thorax of Infants Before birth, the liver is a major hematopoeticorgan. The liver is enlarged (relative to the anatomy of the adult), pushing the diaphragm up, and therefore making the thoracic cavity relatively small • Especially the pulmonary cavities/space occupied by the lungs

  4. Thoracic Cage: Focus on Ribs True Ribs(1-7): articulate w/ sternum via own costal cartilage False Ribs (8-10): articulate w/ sternum via costal cartilage of rib above it Floating Ribs(11-12): no articulation with sternum All ribs articulate with thoracic vertebrae posteriorly

  5. Features of a Typical Rib (3rd-9th ribs typical) Typical Ribs: -Head (2 articular facets to form joints with 2 thoracic vertebrae bodies) -Tubercle (1 articular site to form joint with thoracic vertebra transverse process) -Costal groove to convey intercostal neurovascular bundle

  6. Atypical Ribs (Superior Views) 1st rib: shortest; broadest; most sharply curved; grooves for subclavian vessels; one articular facet on head (T1 vertebrae) 2nd rib: short and broad; rough superior tuberosity Ribs 10-12: only one articular facet on head Ribs 11 and 12: short; no articulation with sternum

  7. Thoracic Cage: Focus on Vertebrae

  8. Costovertebral Joints (Example here: 7th rib)

  9. Intercostal Muscles Innermost Intercostal M. ‘hands on chest’ TransversusThoracis External Intercostal M. ‘hands in pocket’ Internal Intercostal M. ‘hands on chest’ Note: These muscles are supplied by intercostal nerves, arteries, and drained by intercostal veins

  10. Expiration Inspiration Quiet breathing Passive recoil of lungs, rib cage Secondary SCM Scalenes Primary External intercostals Internal intercostals (interchondral part) Diaphragm Active breathing Internal intercostals (interosseous part) Abdominal muscles

  11. Intercostal Arteries and Veins Posterior Body Wall: Generally, Posterior Intercostal arteries supplied by thoracic aorta; Posterior intercostal veins drain to azygos system Anterior Thoracic Wall: Anterior intercostal arteries supplied by internal thoracic a.; Anterior intercostal vein drain to internal thoracic v. Posterior View, Ant. Body Wall

  12. Intercostal Nerves Anterior Rami of T1-T11 Motor and Sensory supply to body wall (also supplies sympathetics) Courses laterally from sympathetic trunk Intercostal Nerve

  13. Intercostal Nerve Dermatomes Segmental Organization in Thorax T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 Note: T4 and T10 landmarks

  14. The Diaphragm Diaphragm consists of central tendon(derived from cervical region in development, supplied by C3-C5) and lateral components (derived from body wall, supplied by T5-T12) Central tendon Central tendon

  15. The Diaphragm Diaphragm consists of central tendon(derived from cervical region in development, supplied by C3-C5) and lateral components (derived from body wall, supplied by T5-T12) Central tendon Central tendon Caval opening (T8) in central tendon: transmits IVC, right phrenic n., liver lymphatics Esophageal hiatus (T10): transmits esophagus and ant/post vagal trunks Aortic hiatus (T12): transmits aorta, thoracic duct, and azygos vein

  16. Origin: Ribs/Costal Cartilages, Sternum, Lumbar Vertebrae Insertion: Central Tendon Esophageal Hiatus Median Arcuate Ligament: arc over aorta (unpaired) Medial Arcuate Ligament: arc over psoas major (bilateral); sympathetic chains pass posterior to this ligament Lateral Arcuate Ligament: arc over quadratuslumborum (bilateral) R and L Diaphragmatic Crus: both crura form aortic hiatus and median arcuatelig.; right crus forms esophageal hiatus

  17. Blood Supply Pericardiacophrenic a/v (courses with phrenic nerves) Musculophrenic a/v (one terminal branch of the internal thoracic a/v) Superior and inferior phrenic arteries (off the aorta either above or below the diaphragm)

  18. FYI: Memorial Service for our Anatomical Donors • http://www.med.uottawa.ca/anatomy/eng/memorial.html • The ceremonies will be held at 11:00am and 2pm, Tuesday, June 3rd, 2014 at Pinecrest Crematorium, 2500 Baseline Road, Ottawa • Rewarding experience for every med student in attendance; every med student in attendance is appreciated by the families of our donors

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