UE I

Where is the jugular notch

T2 level

where are the nipples located

T4

True ribs

1-7

False ribs

8-10

floating ribs

11 & 12

Skeleton of the thoraic wall

a boney cartilaginous cage which protects the heart, lungs and upper abdominal organs

Thoracic wall

12 pairs of ribs

costal cartilages

sternum

12 thoracic vertebrae

3 parts of the sternum

manubrium

body of sternum

xiphoid process

manubrium

palpate jugular notch, clavicular notch, and tight junction with the 1st rib

body of sternum

the level of the T5-9 vertebrae

xiphoid process

lies at the level of the T10 vertebra and is a marker for the superior limit of the liver, the inferior border of the liver, the inferior border of the heart and the central tendon

typical ribs

3-9

head of rib

facets for articulation with vertebra above and below

neck of rib

between head and tubercle

tubercle of rib

for articulating with transverse process of vertebra

body of rib

thin, flat and markedly curves at the costal angle. the concave internal surface of the body has a costal groove on the inferior border where intercostal nerve and vessels are located

atypical ribs

1,2, 10-12

dissimilar

how is rib 1 atypical

one facet for articulation with only T1 vertebra and has grooves for subsclavian vessels

how is rib 2 atypical

a large tuberosity for the serratus anterior attachment

how are ribs 11 & 12 atypical

short no neck or tubercles

what does the clavicle articulate with

the manubrium of the sternum medially

acromion of the scapula laterally

Order of vertebrae

Cervicle 7 (breakfast @ 7 am)

thoracic 12 (lunch @ noon)

lumbar 5 (dinner @ 5)

breasts

prominent surface features of the anterior thoracic wall in the female

intermammary cleft

between breast

areola

circular pigmented area

axillary tail of breast

extends into armpit

extension of the upper outer (superior lateral) quadrant

4 quadrants of breast

superior lateral (upper outer)

superior medial (upp inner)

inferior lateral (lower outer)

inferior medial (lower inner)

Lactiferous ducts

drain the various lobules of mammary gland tissue and converge towards the nipple like spokes of a wheel

what layer of skin is the mammary gland attached to

dermis

suspensory ligaments

connective tissue fibrous bands that connect mammary glands to dermis

Arterial Supply of breast

lateral thoracic artery

branches of thoracoacromial artery

medial mammary branches of the internal thoracic artery

Where foes lympathic drainage of the breast go

axillary lymph nodes

lymphedema

swelling and hardening of the upper extremity

clinical signs of breast cancer

skin dimpling

edema

nipple retraction

abnormal contours

mammogram

radiographic image of the breasts that is used to detect abnormal masses

polythelia

extra nipple

ectopic

nipple on back

polymastia

extra boob

amastia

breasts fail to develop

gynecomastia

breast hypertrophy in males

macromastia

breast hypertrophy in females

Superficial musculature overlying the anterior thoracic wall

pectoralis major

serratus anterior

abdominal muscles

deep layer musculature overlying the anterior thoracic wall

pectoralis minor

subclavius

external intercostal muscles

pectoralis major origin

clavicular head — medial clavicle, sternocostal head — manubrium and body of sternum, costal cartilages of 2-6 ribs, abdominal part: aponeurosis of external oblique

pectoralis major insertion

lateral part of intertubercular groove of humerus

pectoralis major nerve

lateral and medial pectoral

pectoralis major function

ADDucts and medially rotates the humerus; clavicular head alone can flex humerus, from this position, the sternocostal head helps extend the humerus

ACTS ON HUMERUS

pectoralis minor origin

upper margins of ribs 3-5

pectoralis minor insertion

coracoid process of scapula

pectoralis minor nerve

medial pectoral nerve

pectoralis minor function

downward (inferior) rotation of the scapula; stabilizes scapula

ACT ON SCAPULA

Serratus anterior origin

anterior surface of upper 8-9 ribs

Serratus anterior insertion

medial border of scapula on costal side

Serratus anterior nerve

long thoracic nerve

Serratus anterior function

when the scapula is fixed, the serratus rasises the ribs (respiration)

it also protracts (ABducts) the scapula (punching or pushing a weight)

it also superiorly rotates the glenoid cavity of scapula to enable full abduction of arm

CAN ACT ON ITS ORIGIN

subclavius origin

1st rib-cartilage

subclavius insertion

inferior surface of midclavicle

subclavius nerve

nerve to subclavius (branches of C5-6)

subclavius functions

depresses lateral end of clavicle, stablizes clavicle

external intercostals

11 pairs

the outer layer and extend from tubercles of ribs posterioly to the costochondral junctions anteriorly

insert on the upper border of the rib below their origin and have an inferomedial orientation

elevate the ribs in inspiration

internal intercostals

11 pairs

run at right angles and deep to the external intercostals

extend from sternum to angles of ribs

insert on the edge of the rib above the rib of origin

superolateral orientation

lower ribs in forces expiration