Ribs and Sternum anatomy and pathology and critique

what is the bony thorax made up of?

• 12 pairs of ribs

• and 12 thoracic vertebrae

• formed by the sternum

what does the bony throax support?

walls of pleural cavity adn diaphragm that are used during respiration

the bony throax allows volume of cavity to be____

varied during respiration

the bony thorax protects

• heart

• lungs

the bony throax has a ___ shape?

conical

the ribs are a ___ bone

flat

what is the cartilage of the ribs that is attached anteriorly called?

costal cartilage

the ribs are situated in an ___ plane, slanting ____ and ____

oblique, anterior, inferior

the head of the rib articular with

body of vertebra

the neck of the rib is

flattened area between the head and tubercle

tubercle of the rib has a facet that articulates with

transverse process of vertebra

vertebral end is

end of rib which attaches to the thoracic vertebra

angle of rib:

posteriorly, before connection to vertebra

axillary portion of the ribs is the

lateral aspect curved section location near the axillary (armpit)

main part of the rib is

the body or shaft

the sternal end is

end of rib which attached anteriorly

the costal groove is locatied on the

inferior/internal border

the costal groove contains

• costal arteries

• veins

• nerves

trauma to the ribs can damage the costal groove and cause

• pain

• hemorrhaging

costovertebral joint is when

the head of the rib connects to vertebral body

• synovial gliding joint

costotranverse joint is when

the rubercle connects to transverse process

• synovial gliding joint

true ribs are

ribs 1-7

true ribs attach directly to

the sternum

false ribs are

ribs 8-12

false ribs do not

attach directly to the sternum

floating ribs are

ribs 11-12

floating ribs are attached to

vertebrae only

costochondral joint is

anterior connection of sternal end of rib with the costal cartilage

• cartilaginous synchondoses joints and allow no movement

the diaphragm move approximately ____ between deep inspiration and deep expiration

1.5 inches

ribs located ___ the diaphragm (1-9) best examined on inspiration

above

ribs located ____ the diaphragm (8-12) best examined on expiration

below

the rib cage is widest at ___ and ___ ribs

8th and 9th

what is the anomally that can happen?

there can be a “cervical rib”, comes off of C7

the sternum is a ___ bone

flat

the sternum consists of

• manubrium

• body

• xiphoid process

the sternum supports ___ and provides

• clavicle

• attachements to costal cartilages of the first 7

clavicular notches are

on the superior lateral sides where the sternal end of the clavicles articulate

attachment of the clavicles to the manubrium is termed

sternoclavicular joints (SC joints)

what type of joint are SC joints

synovial gliding joints

costal notch is

for the cartilage of the first rib attachment

the jugular notch corresponds to ____ in the erect position of the average person

T2/T3

the manubriosternal joint is

the joint spave between the manubrium and sternal body

• cartilaginous symphysis joint with little to no movement

the sternal angle is located at the

manubriosternal joint

the sternal angle is the area that

forms a slight angle, makes a palpable transvse ridge

• corresponds to the level of T4/T5

costal notches attach to ribs

2-7

attachment of the costal cartilage to sternum are termed

sternocostal joints

• synovial gliding joints

xiphoid process is ____ early in life then partially or completely ___ later in life

cartilaginous, ossifies

the xiphoid process is palpable and corresponds to the

superior portion of liver and inverior aspect of the heart

xiphisternal joint is the joint space between

the sternal body and xiphoid process

• cartilaginous synchodrosis joint which allow little or no movement

what is subcutaneous emphysema

presence of air in subcutaneous tissue

what is the radiogrpahic appearance of subcutaneous emphysema

streaks or lucency within the soft tissue of the chest that outlines the muscle bundles

what is hypercapnia

too much carbon dioxide in the blood

radiographic appearance of rib fractures

fracture lines seen within rib

what is flail chest

two or more continuous rib fractures with two or more breaks per rib

radiogrpahic appearance of flail chest

fracture of adjacent ribs in two or more places

what is pectus carinatum

uncommon birth defect in which a child’s breastbone protrudes outward abnormally

what is another name for pectus carinatum

pigeon chest

what is the radiogrpahic appearance of pectus carinatum

anterior protusion of the lower sternum and xiphoid process

what is pectus excavatum

condition in which the person’s breastbone is sunken into the chest

what is another name of pectus excavatum

funnel chest

what is the radiograohic appearance of pectus excavatum

depressed sternum

right anterior pain means you obtain

PA and LAO

left anterior pain means you obtain

PA and RAO

right posterio pain means you obtain

AP and RPO

left posterior pain means you obtain

AP and LPO

PA ribs means

side of interest away from the IR for oblique

AP ribs means

side of interest towards the IR for oblique

Ribs AP/PA Unilateral critique

• 1st through 9th ribs visible above diaphragm for upper image

• 8th through 12th ribs visible below diaphragm for lower image

• ribs visible through the lungs or abdomen

• no rotation

• ERECT marker on

specific area of pain o rbruising needs to be marked with

BBs

Ribs- AP/PA bilateral

• 1st through 9th ribs visible on upper image

• 8th through 12th ribs on lower image

• ribs visible through the lungs or abdomen

• no rotaiton

• Erect marker

• 14×17 collimaiton like normal chest

Ribs- AP or PA oblique Unilateral

• axilary portion o fthe ribs free from superimpostion with the throacic spine

• axillary portion of side of interest well visualized with adepuate obliquity and elongation

If initial image is PA

the bring side of interst away from the board

(RAO/LAO)

if initial image is AP

bring the side of interest toward the board

(RPO/LPO)

Sternum RAO

• entire sternum from jug not to tip of xiphoid process

• sternum projected over the heart, free from superimposition from the T spine

• minimally rotated

• blurred pulomonary markings

Ribs are done at what SID

72

Sternum is done at what SID

40

Merrills recommends what SID for sternum

30

sternum left lateral

• sternum in its entirety

• manubrium free of superimposition by the soft tissue of shoulders

• sternum free of superimposition by the ribs

• lower portion of the sternum unobscured by the breast of a female patient

sternum left lateral is done at what SID

72