Join the QUB CardioSoc weekly teaching series and delve into thoracic anatomy! This is part one of two lectures that will cover the basics of thoracic anatomy with a clinical correlation to thoracic surgery. This session is aimed at preclinical students embarking on their cardiac studies, and clinical students seeking a refresher. Enhance your anatomical understanding and enrich your medical knowledge base in this peer-to-peer learning platform.
Thoracic Anatomy Part I
Summary
In this session, Donovan Campbell dives into the complexities of thoracic anatomy, focusing on topics such as the Thoracic Wall, Sternum, and Breast. Donovan, a dedicated Intercalating Experimental Medicine student, tackles theoretical and applied components, from ribs and vertebrae to complex conditions like Flail Chest. Participants will find the interactive style of teaching, which involves questions after each section, engaging and refreshing. The session will also cover topics like ribs osteology, the neurovascular bundle, and even the musculature of the thoracic cage. Medical professionals aiming for a comprehensive understanding of thoracic anatomy should not miss out on this enriched learning opportunity. The teaching session uses resources from Gray's Anatomy for Students, Thieme Atlas of Anatomy, Radiopaedia, and TeachMe Anatomy, providing a well-rounded view of the subject.
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Learning objectives
- To understand the anatomical structures and features of the thoracic wall and thoracic cage, including ribs and vertebrae, musculature, and neurovasculature.
- To comprehend the relevance and impact of thoracic anatomical structures on conditions such as Flail Chest.
- To identify and describe the origins, insertions, innervation, and functions of thoracic and adjacent muscles including the intercostals, Pectoralis Major and Minor, Subclavius, Serratus Anterior, Scalene Muscles, Transversus Thoracis and Latissimus Dorsi.
- To gain knowledge of the breast's dimensions, mammory glands, connective tissue stroma, pectoral fascia, as well as its arterial and venous supply, nervous supply, and lymphatic drainage.
- To be able to answer questions related to thoracic anatomy such as the insertion point of pectoralis major, the medial border of the triangle of safety, and the artery that provides medial supply to the breast.
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ThoracicAnatomyI Donovan Campbell Intercalating Experimental MedicineStudent Overview •Thoracic Wall oOsteology ▪Ribs ▪Vertebrae oMusculature oNeurovasculature Bundle •Breast Sternum Support andProtect Manubrium • Jugularnotch • Clavicular notch • 1stcostalnotch • 2nd costal notch Body • 2nd-7thcostalnotches • Two andsevenaredemifacets XiphoidProcess • Cartilaginousoriginally>ossifies~40yearsold. • T10SternumThoracicCageThoracicCage RibOsteology–TypicalRibs Containahead,neck andbody. Theheadhastwoarticular facets: • One articulates withthe corresponding vertebra • One articulates withthe vertebra above. Where neck meets body =roughed tubercle,with afacetfor articulationwiththe transverseprocessofthe corresponding vertebra. Thebodyis flatandcurved.Theinternalsurfaceoftheshafthas a groove for the neurovascular supply ofthethorax. RibOsteology–AtypicalRibs Only one facet Tuberosity for articulation fromwhich withits serratus corresponding anterior vertebra. originates. 11 -12 ?10 - Only one Noneckand facet. only contain one facet. FlailChest FlailChest Traumatic conditionthat occurswhen twoormoreribs locatednext to each otherare fractured in twoormore places. Paradoxical breathing. Haemodynamiccompromise.FlailChestThoracicVertebrae ThoracicVertebrae Large vertebralbodies tosupport ribs Question1 At whatvertebral levelis the angle ofLouie (sternal angle)? 1. T2 2. T3 3. T4 4. T5 5. T6 Question1 At whatvertebral levelis the angle ofLouie (sternal angle)? 1. T2 2. T3 3. T4 4. T5 5. T6 Question2 The tuberosityonrib 2 is the origin of which muscle? 1. Latissimus Dorsi 2. External Intercostal 3. Serratus Anterior 4. T eresMinor 5. InternalIntercostal Question2 The tuberosityonrib 2 is the origin of which muscle? 1. Latissimus Dorsi 2. External Intercostal 3. Serratus Anterior 4. TeresMinor 5. InternalIntercostal Intercostals Muscle Origin Insertion Innervation Action Externalintercostal Lower marginof Upper marginofnext lower rib 1st-11th Elevatesribs rib intercostal on inspiration. (obliquely forward and downwardfrom costaltubercleto chondro-osseousjunction) Internalintercostal Lower marginof Upper margin ofnext lowerrib 1st-11th Depresses ribs rib (obliquely forward andupward intercostal on expiration. fromcostalangle tosternum) Innermost intercostal Lower marginof Sameas above 1st-11th Depresses rib intercostal ribs onexpiration. Intercostals External Intercostals Inferiormarginofsuperiorrib> superiormarginof inferior rib Obliquely forward(hands inpocket) Internal Intercostals Uppermargin ofnext lower rib (obliquely forward and upwardfrom costalangle tosternum) Innermost Intercostals Uppermargin ofnext lower rib (obliquely forwardand upwardfrom costalangle tosternum)NeurovascularBundle Chest Drain Insertion Incise+ dissect ABOVE therib.SurgicalChestDrainSetUpPneumothorax/Haemothorax ThoracicWallMusclesContinued.. Muscle Origin Insertion Innervation Action Pectoralis Major Medial½ of clavicle, Lateral lip Medial+ lateral Adduction, ant. surface of sternum, of intertubercular pectoral nerves humeral flexion and 1st7 costal cartilages sulcusof humerus medial rotation + external obliqueaponeurosis Pectoralis Minor Ant. surfaceof ribs 3- Coracoidprocess Medialpectoral nerve Pullsclavicle 5 and deep medially stabilising SC fascia associated joint. Depressesshoulder with associated tip intercostal space Subclavius 1st ribbetween Grooveon inferior Nerve to subclavius Depressesshoulder tip. cartilageand rib middle 1/3of clavicle Protracts scapula Serratus Anterior Lateral aspects of ribs 1- Costal surfaceof Long thoracicnerve Rotatesscapula 8 themedial borderof + protracts scapula thescapula. PectoralisMajor Origin • Clavicularhead >anteriorsurface ofthe medial clavicle. • Sternocostal head > anterior surface of the sternum,the superior6 costal cartilages and theaponeurosisofthe external oblique muscle. PectoralisMajor Insertion • Lateral lipof intertubercularsulcus of humerus Innervation • Medial +lateral pectoralnerves Function • Adduction, humeralflexionand medialrotation PectoralisMinor Origin • Ant. surface of ribs3-5 anddeepfascia Insertion •Coracoidprocess Innervation •Medial pectoral nerve Function • Pullsclaviclemedially stabilising SC joint. • Depresses shouldertip Subclavius Origin • 1stribbetweenthe cartilageandrib Insertion • Groove on inferior middle1/3 ofclavicle Innervation • Subclaviannerve Function 1. Depressesshouldertip 2. Protractsscapula SerratusAnterior Origin • Lateral aspect of ribs 1-8 • Rib 2tuberosity? Insertion • Costal surfaceofthe medial border ofthe scapula. Innervation • Long thoracic nerve (wingedscapula) Function • Rotates scapula + protractsscapula Question3 What isthe insertionpointof pectoralismajor? 1.Lateral lip of intertubercularsulcus ofhumerus 2.Medial lipof intertubercularsulcus ofhumerus 3.Inferior lip of intertubercularsulcus ofhumerus 4.Anterior surface of the medial clavicle 5.Anterior surface of thesternum Question3 What isthe insertionpointof pectoralismajor? 1.Lateral lip of intertubercular sulcus ofhumerus 2.Medial lipof intertubercularsulcus ofhumerus 3.Inferior lip of intertubercularsulcus ofhumerus 4.Anterior surface of the medial clavicle 5.Anterior surface of thesternum EvenMore... Muscle Origin Insertion Innervation Action AnteriorScalene C3-6 – 1st rib(ant. Anteriorrami of Ribsmobile (inspiration) – transverse processes Scalene tubercle) C4-6 elevatesupperribs. (anterior) MiddleScalene C1- 1st ribposterior Anteriorrami of Ribsmobile (inspiration) – 2 tranverseprocesses tosubclaviangroove C3-8 elevatesupperribs. C3- 7 tranverseprocesses (posterior) Posterior Scalene C5-7 2ndrib AnteriorC6-8 Ribsmobile (inspiration) – transverse processes elevatesupperribs. (posterior) Subcostal Lower marginoflower Ribs2-3 below Adjacent Depresses ribs ribs intercostal on expiration TranversusThoracis Sternum 2nd-6thribs 2nd-6th Weakly depresses ribs (innersurface) (costalcartilage) intercostal on expirationScaleneMuscles Elevates upper ribs on inspiration TransversusThoracis Origin • Sternum (inner surface) Insertion • 2nd-6thribs(costal cartilage) Innervation •2nd-6thintercostal Function • Weakly depressesribs on expiration LatissimusDorsi Origins 1. Spinousprocesses ofT6-T12 2. Thoracolumbarfascia 3. Iliaccrest 4. Inferior threeribs. Insertion • Intertubercular sulcusofthehumerus. Innervation • Thoracodorsalnerve. Function • Extends,adducts andmedially rotates theupper limb.MuscleSparingThoracotomiesBreastAnatomy Dimensions • From lateralsternum tomidaxillaryline. • From 2ndto6th costalcartilages. Mammary Glands They consist of15-20 ductsand secretory lobules. Eachlobule consists ofmany alveolidrained by asingle lactiferous duct. ConnectiveTissueStroma Supportive structuresurroundingmammary glands. It hasa fibrousanda fatty component. Fibrous>suspensory lig. (Coopers) Pectoral Fascia Attachmentpoint forthe suspensory ligaments. Loose CTknownas retromammary space.BreastAnatomy Dimensions • From lateralsternum tomidaxillaryline. • From 2ndto6th costalcartilages. Mammary Glands They consist of15-20 ductsand secretory lobules. Eachlobule consists ofmany alveolidrained by asingle lactiferous duct. ConnectiveTissueStroma Supportive structuresurroundingmammary glands. It hasa fibrousanda fatty component. Fibrous>suspensory lig. (Coopers) Pectoral Fascia Attachmentpoint forthe suspensory ligaments. Loose CTknownas retromammary space. BreastVasculature ArterialSupply Medial - Internal Thoracic Artery Lateral - LateralThoracic - Thoracoacromial - LateralMammary - Mammary BranchofAnteriorIntercostal Venous Medial - Internal Thoracic Vein Lateral - Same asarterial Thieme AtlasofAnatomy BreastNervousSupply • Anterior andlateral cutaneous branchesofthe4thto6thintercostal nerves. • Input from the Supraclavicular nerves. These nerves contain both sensory and autonomicnervefibres. • Autonomicfibres regulate smoothmuscle andbloodvessel tone. Thieme AtlasofAnatomy BreastLymphatics Drainagein 3groups: • Axillarynodes (75%) • Parasternal nodes (20%) • Posterior intercostal nodes (5%) Skin Drains to the axillary, inferior deep cervical andinfraclavicular nodes. Nipple and areola Drains to the subareolar lymphaticplexus. Question4 Whatarterygivesmedialsupplytothebreast? 1. Thoracodorsal 2. Mammarybranchoftheanterior intercostal 3. Mammarybranchoftheposteriorintercostal 4. Internal mammary 5. Medial Thoracic Question4 Whatarterygivesmedialsupplytothebreast? 1. Thoracodorsal 2. Mammarybranchoftheanterior intercostal 3. Mammarybranchoftheposteriorintercostal 4. Internalmammary(Internalthoracic) 5. Medial Thoracic Question5 Whatis themedial borderof thetriangle of safety? 1. Lateral edgeof teres minor 2. Lateral edgeof pectoralisminor 3. Lateral edgeof pectoralismajor 4. Lateral edgeof teres major 5. Lateral edgeof serratus anterior Question5 Whatis themedial borderof thetriangle of safety? 1. Lateral edgeof teres minor 2. Lateral edgeof pectoralisminor 3. Lateral edgeofpectoralis major 4. Lateral edgeof teres major 5. Lateral edgeof serratus anterior Resources •Gray's Anatomy for Students •Thieme AtlasofAnatomy •Radiopaedia •TeachMe Anatomy •KenhubThoracicAnatomyII Donovan Campbell Intercalating ExperimentalMedicine Student 25/02/25