amp WALL胸壁课件.ppt

THORACIC CAGEand WALL SURFACE LANDMARKS Lines of Orientation Refer: Text: pp 91-92 (91) Syllabus: p 44 Midsternal line Midclavicular line Anterior axillary line Posterior axillary line Lines of Orientation Midaxillary line Scapular line Surface Landmarks Jugular notch Sternal angle: Marks rib 2 Lies at level of T4-5 IV disc Apex heart beat: Left IC space 5; midclavicular line Aortic valve: Right IC space 2 Surface Landmarks Infrasternal angle: Important in CPR. Depression between is the infrasternal fossa. Xiphisternal joint within the fossa is at the level of the body of T9. Surface Landmarks Pulmonary valve Left IC space 2 Tricuspid valve Right IC space 5 Bicuspid valve Left IC space 5 Bifurcation of trachea Vertebral level T4-5 Surface Landmarks Posterior thorax: scapula: Scapular spine is at level of 3rd rib and T2 vertebra. Inferior scapular angle is at the level of the 7th rib, the spine of T7 or the body of T9. Costal margin: Superior part is marked by the 7th cartilage. Inferior part is marked by the 10th cartilage Cutaneous innervation Clavicular and scapular regions: C3-4 Region of xiphoid process: T6 Anterior thorax: T1-T6 Upper extremity: C5-T1 Lower thorax and anterior abdomen: T7-T12 OSTEOLOGY OF THE THORACIC CAGE Structure of the Thoracic Cage Twelve thoracic vertebrae Twelve pairs of ribs and their costal cartilages Sternum Intercostal muscles Superior Boundary (outlet) First thoracic vertebra First pair of ribs and costal cartilages Manubrium Refer to Fig. 14, p. 53 in syllabus Inferior Boundary (outlet) Twelfth thoracic vertebra Twelfth pair of ribs and costal cartilages Xiphisternal joint Refer to Fig. 14, p. 53 in syllabus Bones of the Thoracic Cage Manubrium Body of sternum: Four sternebrae Xiphoid process Manubriosternal joint: Symphysis Synostosis after age 30 in some Ribs Costa: = Rib bone + its cartilage Vertebrosternal ribs: 1-7 Vertebrochondral ribs: 8-10 Vertebral ribs