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69 Cards in this Set
- Front
- Back
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Which muscles make up the thoracic region? |
1. Intercostals 2. Subcostal 3. Transversusthoracis |
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What are the layers of the intercostals? |
1. external 2. internal 3. innermost |
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Which direction do the external intercostals run and what do they attach to? What is their action? |
-Direction: inferoanteriorly -Origin: tubercle of the rib -Insertion: costochondral junction -Action: Elevate ribs |
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Which direction do the Internal intercostals and the innermost intercostals run and what do they attach to? What is their action? |
-Direction: inferoposteriorly -Origin: sternum -Insertion: angle of the rib -Action: 1) Elevate ribs (interchondral part) 2) Depresses ribs (intecostal part)
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What is the external intercostal membrane? |
Because the external intercostal muscle does no reach sternum (ends at costochondral junction), this thin membrane extends from the end of exeternal intercostal muscle to the sternum (covering the internal intercostal muscle). |
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What is the internal intercostal membrane? |
Because the internal intercostal muscle does no reach the verterbral column (tubercle of rib) and ends rather at the angle of the rib, this thin membrane extends from the end of internal intercostal muscle to the vertebral colum (covering the external intercostal muscle - interiorly). |
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Where are the subcostal muscles found? Which direction do the fibres run and what do they attach to? What is their action? |
-Often found only in lower thoracic wall -Origin: inferior border of rib above
-Insertion: superior border of rib 2-3 levels below -Action: Depress ribs during forced respiration -Innervation: Intercostal Nerves |
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Which other muscle fibres do the subcostal muscle fibres blend with?? |
-Fibers blend with innermost intercostals |
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Where is VAN found with respect to the muscles in the thoracic region? |
Between the internal intercostal layer and the innermost intercostal layer |
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Where does the transversus thoracis attach? what is its innervation and its action? |
Origin: internal surface of costal cartilages 2-6 Insertion: internal surface of lowersternum Innervation: Intercostalnerves Action: Weakly depress ribs; proprioception |
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Which muscle is the transversus thoracis continuous with? |
Transversus thoracis is continuous with transversus abdominus below |
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What makes up the Phrenic nerve? |
APRs of C3-C5 |
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Where does the diaphragm attach? What innervates it? What is it's action? |
-Attachments: Inferior thoracic aperture -Innervation: 1) Motor and sensation = Right and left phrenic nerves (APRC3-C5) 2) Peripheral sensation = intercostal& subcostal nerves T5-T12 -Action: Domes of the diaphragm descend (starts to flatten) Pushes abdominal viscera inferiorly Increases intraabdominalpressure Decreases intrathoracicpressure *Change in abdo and thoracic pressures causes a pump for venous return |
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What are the landmarks of the Diaphragm? |
*Remember: I 8 10 eggs At 12 I, 8 = IVC at T8 10, eggs = Esophogus at T10 At, 12 = Aorta T12 |
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What are the ligaments associated with the diaphragm? |
1. Median Arcuate Ligament 2. Medial Arcuate Ligament 3. Lateral Arcuate ligament |
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What does the Medial Arcuate ligament cover? |
Psoas |
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What does the Lateral Arcuate ligament cover? |
Quadratus Lumborum |
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What is the movement of the upper ribs? Which diameter increases/decreases? |
-PUMP HANDLE -Rotation take place around thelongitudinal axis passing through the neck of the rib - this rotation elevates/depresses the chondral endof the rib and sternum - Greatest movement occurring at the end of the “pump handle” - thesagittal diameter increases/decreases |
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What is the movement of the lower ribs? Which diameter increases/decreases? |
BUCKET HANDLE -glidingtakes place along the longitudinal axis passing through the neck of the rib -this gliding moves the shaft of the riblaterally/medially -Greatest movement occurring in the middle of the “bucket handle” -Transverse diameter increases/decreases |
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What muscles/joints contribute to the increased verticle dimension of the ribs? |
Contraction/flattening of diaphragm |
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What muscles/joints contribute to the increased sagital dimension of the ribs? |
-Contraction of external intercostals and interchondral part of internal intercostals muscles. -Upper ribs (primarily) - PUMP HANDLE |
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What muscles/joints contribute to the increased lateral dimension of the ribs? |
-Contraction of the external intercostals -Lower ribs (primarily) - BUCKET HANDLE |
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What are the only two muscles that elevate the ribs? |
External interchondrals and interchondral part of internal interchondrals |
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What does the spinal nerve exiting the IVF split into? |
PPR and APR |
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Where do the PPRs go? |
-Posterioraspect of vertebrae -Skin and muscle of the back |
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Where to the APRs go? |
-skinand muscles in the neck -antero-lateraltrunk -upper and lower limbs |
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What is the function of the white rami communicans? |
Go to the sympathetic trunk |
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What is the function of the gray rami communicans? |
Go from the sympathetic trunk |
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What innervates the structures of the spinal canal? |
Sinuvertebral Nerve (Returns through IVF) |
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Which intercostal nerves are TYPICAL? What do they form from? How do they run? |
-Intercostal nerves 3-6 -They form from APRs of spinal nerves -Begin on inferior side of rib in the groove (with vein and artery) -branch off around angle of the rib forming collateral nerves (and vessels) which run on superior side of lower ribs |
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between what structures can you find the typical intercostal nerves? |
-Initiallyrun in the endothoracicfascia btwn theparietal pleura (which they supply) and internal intercostal membrane - Atthe angle of the ribs: Runbtwnthe innermost and internal intercostal mm |
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How do the typical intercostal nerves split? |
-At midaxillary line, lateral cutaneous branch splits off which has anterior and posterior branches -At parasternal line it turns into the anterior cutaneous branch which has s medial and lateral branches |
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Which muscles are innervated by the typical intercostal nerves? |
-intercostal muscles -Transversus thoracis muscle -serratus posterior mucles |
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Which intercostal nerves are atypical? |
IC 1 IC 2 IC 7-11 |
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Where does intercostal nerve 1 come from? what does it supply? and why is it ATYPICAL? |
-From inferior branch of T1 spinal n. (superior goes to brachialplexus) -Supplies intercostal muscles
-No costal groove in 1st rib so it courses alonginternal surface of rib -Often no lateral or anterior cutaneous branches |
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What makes Intercostal nerve 2 atypical? |
-No costal groove so it courses along internal surface of rib - Large lateral cutaneous branch – 1st intercostobrachialnerve supplies floor of axilla and communicates w medial brachial cutaneous nerve (medial cutaneous n of arm) |
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What makes intercostal nerve 3 sort of atypical? |
-Large lateral cutaneousbranch - 2nd intercostobrachial nerve supplies floor of axilla |
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What nerves form the thoracoabdominal nerves? |
Thoracoabdominal nerves are from the intercostal nerves T7-T11 |
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Why are the intercostal nerves from T7-T11 ATYPICAL? |
Called the Thoracoabdominal nerves -Have both anterior cutaneous branch lateral cutaneous branch - supply intercostal muscles, Transversus thoracis muscle, serratus posterior mucles (Like typical) BUT ALSO -abdominal muscles when beyond costal margin |
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What are the muscles of the anterior abdominal region? (in order of most superficial to deep) |
1) Rectus abdominis 2) Obliques 3) Transversusabdominis 4) Pyramidalis |
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What is the O, I, N, A of the rectus abdominus? |
Origin: -Pubic symphysis -Pubiccrest Insertion: -Xyphoidprocess -5th–7th costal cartilage Innervation: (APRT5 – T12) -5thand 6thintercostal nerves --Thoracoabdominalnerves (T7-T11) -Subcostaln. (T12) Action: -Flexes trunk -Compresses abdominal viscera -Stabilizes pelvis -Controls tilt of pelvis (ANTILORDOSIS) |
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What are the different types of oblique muscles? |
Internal and external |
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What is the O, I, N, A of the external oblique? |
Origin: -External surfaces of 5th – 12th ribs (posterior border!) Insertion: -Linea alba -Pubic tubercle -Anterior half of iliac crest *FORMS the Inguinal ligament btwn ASIS and pubic tubercle Innervation: (APR T7 – T12) -Thoracoabdominal nerves (T7 – T11) -Subcostal n. (T12) Action: - Flexes trunk - Rotates trunk - ipsilateralshoulder moves forward -Compress abdominal viscera |
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Wheres is the inguinal ligament and what forms it? |
between ASIS and Pubic tubercle External oblique forms it |
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The fibres of the external oblique run in the same direction as what other muscle fibres? |
External intercostals *Think hands in my pockets! |
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What is the O, I, N, A of the internal oblique? |
Origin: -Thoracolumbarfascia -Anterior 2/3 of iliac crest -Lateral 1/2 of inguinal ligament Insertion: -Inferior border of 10th – 12th ribs -Linea alba -Pectenpubis (via conjoint tendon) Innervation: (APRT7 –L1) -Thoracoabdominalnerves (T7 – T11) -Subcostal n.(T12) -Iliohypogastric n.(L1) -Ilioinguinal n.(L1) Actions: -Flexes trunk -Rotate trunk -Ipsilateralshoulder moves backwards - Compress abdominal viscera |
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What is the O, I, N, A of the transversus abdominus? |
Origin: -Internalsurfaces of 7th – 12th costal cartilages -Thoracolumbar fascia -Iliaccrest -Lateral1/3 of inguinal ligament Insertion: -Lineaalba -Pubiccrest -Pecten pubis (via conjoint tendon) Innervation: (APR T7 –L1) -Thoracoabdominalnerves (T7 – T11) -Subcostaln. (T12) -Iliohypogastricn. (L1) -Ilioinguinaln. (L1) Actions: -Compressesabdominal viscera |
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What is the pyrimidalis? where is it found? |
-Smalltriangular muscle -Missing in 20% of people -Anterior to rectus abdominis -Origin/insertion: Anteriorsurface of pubis & Lineaalba -Function:Tenseslinea alba |
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What makes up the iliohypogastric nerve? |
T12, L1 |
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What makes up the ilioinguinal nerve? |
L1 |
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What are the folds of the anterior abdominal wall? where are they found and what do they cover? |
1) Medianumbilical fold (1): -from apex of urinary bladder to umbilicus -covers medianumbilical ligament 2) Medialumbilical folds (2): -lateral to median umbilical fold -covers medial umbilicalligaments 3)Lateralumbilical folds (2): -lateral to medial umbilical folds -cover inferior epigastricvessels -ep inguinal ring immediately lateral to itIliopubictract: thickened inferior margin of transversalisfasciar |
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What was the median umbilical ligament in the fetus? |
urachus - brought urine from fetus to mother to be excreted |
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What was the medial ligament in the fetus? |
umbilical arteries |
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What are potential sites for herniation? |
Fossae |
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What are the fossae of the abdominal wall? |
1) Supravisical fossa 2) medial inguinal fossa 3) Lateral inguinal fossa |
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What is the iliopubic tract? |
Thickened inferior margin of transversalisfascia |
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Where is the supraviscal fossa? What type of hernia may occur here? |
-Between median and medial umbilical folds -most inferior part = projection of superficial inguinal ring -potential site for supravesicalhernia (Indirect) |
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Where is the medial inguinal fossa? What other name does it have? |
-Hesselbach triangle -Between medial and lateral umbilical folds -potential site for direct inguinal hernia |
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Where is the lateral inguinal fossae? |
-lateral to lateral umbilical folds -includes deep inguinal rings -potential site for indirect inguinal hernia |
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Which is the most common site for a hernia? |
lateral inguinal fossae where indirect inguinal hernias occur |
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Which fossae includes the deep inguinal ring and which includes the superficial inguinal ring? |
Deep inguinal ring is in the lateral fossae Superficial Inguinal ring is in the supravesicle fossa |
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What is the deep inguinal ring? What forms it? What passes through it? where is it found? |
-abdominal opening into inguinal canal -formed by evagination of transversalisfascia (and other layers of abdominal wall) -the vas deferens/round ligament ofthe uterus and gonadalvessels pass through this opening to enter the inguinal canal - ~1cm superior to the middle part of the inguinal ligament |
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What structures form the anterior and posterior inguinal canal borders? |
AntWall: -aponeurosis of external oblique Postwall: -transversalisfascia -medially it is reinforced by conjoint tendon |
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What are the regions and quandrants of the abdomen? |
Quadrants: 1) RUQ: Right upper quadrant 2) LUQ: Left upper quadrant 3) RLQ: Right lower quadrant 4) LLQ: Left Lower quadrant Regions: 1) RH: Right hypochondrium 2) RL: Right flank (lateral) 3) RI: Right Inguinal 4) E: Epigastric 5) U: Umbilicus 6) P: Pubis 7) LH: Left hypochondrium 8) LL: Left flank (lateral) 9) LI: Left inguinal |
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What seperates the 4 quadrants? What seperates the nine regions? |
Vertical line: Median Plane Horizontal line: Transumbilical plane Vertical lines: semilunar Horizontal (top): Subcostal Plane Horizontal (bottom): Intertubercular plane |
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What are the boundaries of the anterior abdominal wall? |
Superior: -Xyphoid process -costal margin (cartilage of ribs 7-10) Inferior: -pubic crest -pubic symphysis -iliac crest (anterior part) -inguinal ligament *differences in anterolateral and anterior abdominal wall |
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what are the layers of subcutaneous tissue? |
Above umbilicus only one layer. Below umbilicus 2 layers: 1) Camper fascia = superficial layer of subcutaneous tissue 2) Scarpa fascia = deep membranous layer of subcutaneous tissue |
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What are the Investing layers of fascia? |
- invest muscles of abdominal wall 1) Superficial -Surrounds external oblique 2) Intermediate -Surrounds internal oblique -Continuous with middle layer of Thoracolumbar fascia 3) Deep -Surrounds transversus abdominus -continuous with anterior layer of thoracolumbar fascia |
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How do the layers of investing fascia change in regards to the arcuate line? |
Always surround EO, IO and transversus abdominus the same. With regards to rectus abdominus it depends on whether we are above or below arcuate line. Above arcuate line: -Deep to rectus abdominus: deep investing layer of fascia and intermediate investing fascia -superficial to rectus abdominus: superficial layer of investing fasciam and intermediate investing fascia *Intermediate splits in 2 and surrounds rectus abdominus Below arcuate line: All layers of investing fascia are found superficial to rectus abdominus (no splitting of intermediate) |
