15. Costo-Vertebral Joints
Two convex facets from the head attach to two
adjacent vertebrae, at the inferior costal facet of the
superior vertebra, and the superior costal facet of the
inferior vertebra respectively. This forms
the synovial planar (gliding) joint.
@drsatyajitsaha
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18. Triradiate Ligament Attachment
Triradiate ligament associated
with
Attachment
Typical rib Attached to the anterior part of the head of each rib
• ascends and is connected with the body of the
vertebra above, the superior fasciculus
• descends to the body of the vertebra below,
the inferior one
• the middle one, is horizontal and is attached to the
intervertebral fibrocartilage,
1st Rib Fibers are attached to the body of the last cervical
vertebra (C7), as well as to that of the first thoracic (T1)
10th, 11th, 12th Rib The fibers of the ligament in each case are connected to
the vertebra above, as well as to that with which the rib
articulates
@drsatyajitsaha
18
21. Intraarticular Ligament of Head of Rib
Situated in the interior of the joint
Attached by one extremity to the inter-articular crest of the
head of the rib, other to the intervertebral fibrocartilage
Divides the joint into two cavities
@drsatyajitsaha
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26. Costo-transverse Joint
The joint formed between the facet of the tubercle of the rib and the
adjacent transverse process of a thoracic vertebra.
Synchondrosis type of joint
Allows only gliding movement
Absent in the eleventh and twelfth ribs
@drsatyajitsaha
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27. Costo-transverse Ligaments
Name of the
Ligament
Costal Attachment Vertebral
attachment
Posterior/inferior
Costo-transverse
ligament
Posterior surface of
the neck
Anterior surface of
the transverse
process of the
corresponding
vertebrae
Superior
costotransverse
ligament
Upper border of the
neck of a rib
Transverse
process of
the vertebra above
Lateral
costotransverse
ligament
Non-articular part of
the tubercle of the
rib.
Posterior surface of
the tip of
a transverse
process of
a corresponding
vertebra
@drsatyajitsaha
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28. Function of Costo-transverse Ligament
Support and prevent dislocation of ribs.
Their posterior surfaces provide attachment points
for the extensor muscles (deep group) of the back.
@drsatyajitsaha
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35. Intercostal Muscles
EXTERNUS:
Sternum to tubercle of
the ribs.
Anteriorly – ant
intercostal membrane.
Posteriorly – fleshy
Direction of fibers
Anteriorly –
downwards, medially.
Posteriorly -
downwards & laterally.
INTERNUS:
Sternum to posterior
angles of rib.
Anteriorly fleshy.
Posteriorly - post
intercostal membrane.
Direction of fibers
Anteriorly -
downwards & laterally.
Posteriorly -
downwards, medially.
@drsatyajitsaha
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36. Intercostal Muscles
INTIMUS:
Transversus thoracis
(subcostalis,sternocostalis)
Middle 2/4th of the ICS.
Absent in upper 2 spaces.
Direction of fiber same as
internus.
Neurovascular space
beween the INTERNUS &
INTIMUS.
@drsatyajitsaha
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37. Internal Thoracic Artery
Branch of 1st part of Subclavian artery.
Branches
Pericardiacophrenic artery.
Mediastinal.
Pericardial.
Sternal.
Anterior intercostal – upper 6 spaces.
Perforating – in females fourth to sixth are enlarged to supply the
breast.
Musculo-phrenic – 7th to 9th anterior intercostal arteries.
Superior epigastric artery – anastomoses with inferior epigastric
artery branch of external iliac artery.@drsatyajitsaha
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40. Ant Intercostal Artery
Upper 6 – Internal Thoracic Artery.
Lower 3 – Musculo-phrenic artery
(internal thoracic).
Breaks into 2 branches, upper one
along the lower border of upper rib
& lower one along the upper border
of lower rib.
Anastomose with the posterior
intercostal branch at the junc of the
ant 1/3rd & post 2/3rd of the space.
@drsatyajitsaha
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44. Coarctation of Aorta
In coarctation of aorta, blood
flow through the posterior
intercostal arteries is reduced.
To compensate for the
reduced flow, more blood
now flows through the
anterior intercostal arteries.
Because of this increased
blood flow through the
anterior intercostal arteries,
they become dilated and
tortuous. The dilated artery
erode the costal groove,
leading to rib notching, a
radiological feature.@drsatyajitsaha
45
46. Anterior Intercostal Veins
ANT INTERCOSTAL VEIN
Upper 6 – Internal thoracic v.
Lower 3 – Musculo-phrenic v
@drsatyajitsaha
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47. Posterior Intercostal Vein
Rt 1st: Rt Brachio-cephalic v.
Rt 2nd to 3rd : Rt sup intercostal v –
arch of azygos.
Rt 5th to 11th : vertical part of
azygos.
Lt 1st: Lt Brachio-cephalic v.
Lt 2nd to 3rd: Lt superior intercostal v
- Lt Brachio-cephalic v.
Lt 5th to 7th: Superior hemi-azygos v
– azygos v.
Lt 8th to 11th: Inferior hemi-azygos v
– azygos v.@drsatyajitsaha
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53. Direction of the Muscle Pull
A
B
C
A
B C
External Intercostal
Internal Intercostal
(interosseus part)
Internal Intercostal
(intercartilaginous
part)
@drsatyajitsaha
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55. Elevation of Ribs (Pump handle movement)
Increases the Antero-
posterior diameter
Action of External
Intercostal aided by inter-
chondral fibers of Internal
Intercostal.
@drsatyajitsaha
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56. Pump Handle Movement
Quiet respiration- only first pair of ribs moves but
little.
On hypernoea .the 2nd and 6th ribs which slopes
obliquely downwards and forwards from their joints
with the spinal column , moves upwards to assume a
more horizontal position due to contraction of the
external internal costal muscles.
Increases in the anterior- posterior diameter of the
thorax.
@drsatyajitsaha
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57. Elevation of Ribs (Bucket handle movement)
Increases the
transverse diameter
Action of External
Intercostal.
@drsatyajitsaha
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58. Bucket Handle Movement
This movements brings about the increase in
transverse diameter of the thorax by the movement
of the LOWER 7TH TO 10 RIB which swings outward
and upwards
@drsatyajitsaha
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59. Combination of Pump Handle & Bucket
Handle Movements
Increases the
antero-posterior &
transverse diameter
@drsatyajitsaha
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60. Contraction of the Diaphragm
Increases the vertical
diameter
Contraction of diaphragm,
pulls the diaphragm
downwards. This leads to
increase in the vertical
diameter.
@drsatyajitsaha
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61. C3,C4,C5 - Keeps me alive
1. During inspiration, Phrenic nerve (C3,C4,C5)
stimulation causes diaphragm to contract and draw
the central tendon part downwards.
2. Cause an increase in transverse diameter of the
thorax.
3. Accounts for 75% of the tidal volume.
4. Hence Phrenic nerve is the nerve of inspiration.
@drsatyajitsaha
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63. Muscles of Forced/Active Inspiration
Contraction of the accessory muscles of breathing :
Scalenes – elevates the upper ribs.
Sternocleidomastoid – elevates the sternum.
Pectoralis major and minor – pulls ribs outwards.
Serratus anterior – elevates the ribs (when the
scapulae are fixed).
Latissimus dorsi – elevates the lower ribs.
@drsatyajitsaha
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66. Muscles of Forced Expiration
Anterior abdominal muscles contracts – increases
intrabdominal pressure – pulls the lower ribs
downwards and medially – push the diaphragm
upwards
Internal intercostal muscles - passess obliquely
downward and posteriorly from ribs to ribs –
contracts – pull the upper ribs downward
@drsatyajitsaha
68
67. Types of respiration
In babies and young children, the ribs are nearly horizontal. Thus,
babies have to rely mainly on the descent of the diaphragm to increase
their thoracic capacity on inspiration. Because this is accompanied by a
marked inward and outward excursion of the anterior abdominal wall,
which is easily seen, respiration at this age is referred to as the
abdominal type of respiration.
After the 2nd year of life, the ribs become more oblique.
Females tend to rely mainly on the movements of the ribs rather than
on the descent of the diaphragm on inspiration. This is referred to as
the thoracic type of respiration.
Males use both the thoracic and abdominal forms of respiration but
mainly the abdominal form.
@drsatyajitsaha
69
77. Costal Pleura (Tracing in Front)
Directed medially downwards from sternoclavicular
jt to sternal angle.
Directed downwards up to 4th costal cartilage on
both sides.
On the right side, the line passes vertically
downwards up to the xiphisternal jt and turn laterally
across the right costo-xiphoid angle & continues
with the costo-diaphragmatic line of reflection.
On the left side, the line deviates laterally from the
sternum and descends close to the sternum up to
the 6th costal cartilage & turns laterally at the costo-
diaphragmatic line of reflection.
@drsatyajitsaha
79
78. Posteriorly continuous with the mediastinal pleura along
the costo – vertebral reflexion extending from a point 2.5
cm lateral of the 7th cervical spine to a point 2.5cm lateral
to the 12th thoracic spine.
Continuous with the cervical pleura along the inner border
of the 1st rib.
Costal Pleura (tracing behind)
Costal Pleura (tracing above)
@drsatyajitsaha
80
79. Continuous with the diaphragmatic pleura along a
line known as the costo- diaphragmatic reflexion.
Formed by joining the following points:
Xiphi-sternal joint (Rt)/left 6th costo-sternal joint.
8th costal cartilage in the mid-clavicular line.
10th rib in the mid-axillary line.
A point 2.5 cm lateral to the 12th thoracic spine.
Costal Pleura (tracing below)
@drsatyajitsaha
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81. Suprapleural Membrane/Sibson’s Fascia
1. Musculo-fascial expansion.
2. Dome shaped.
3. Protects the apex of lung and the cervical pleura from the
structures at the root of neck.
4. Musculo part – scalenus minimus.
5. Fascial part – endothoracic fascia.
6. Posteriorly attached to the tip of transverse process of the 7th
cervical vertebra.
7. Anteriorly attached to the inner border of the first rib.
8. Medially continuous with the pretracheal fascia by the side of
the trachea.@drsatyajitsaha
83
82. Mediastinal Pleura (Above The Root Of Lung)
Structures on right side:
Rt brachio-cephalic vein.
Superior vena cava.
Arch of azygos vein.
Brachio-cephalic trunk.
Right phrenic & vagus nerve.
Trachea & oesophagus.
Structures on left side:
Left brachio-cephalic vein.
Superior intercostal vein.
Arch of aorta.
Left common carotid artery.
Left subclavian artery.
Left phrenic & vagus nerve.
Left recurrent laryngeal nerve.
Trachea & oesophagus.
@drsatyajitsaha
84
84. Mediastinal Pleura (At The Root Of Lung (Above
Downwards Right Side)
Structures on right
side:
Rt brachio-cephalic
vein.
Superior vena cava.
Arch of azygos vein.
Brachio-cephalic
trunk.
Right phrenic & vagus
nerve.
Trachea &
oesophagus.@drsatyajitsaha
86
85. Mediastinal Pleura (At The Root Of Lung (Above
Downwards Left Side)
• Left brachio-cephalic
vein.
• Superior intercostal
vein.
• Arch of aorta.
• Left common carotid
artery.
• Left subclavian artery.
• Left phrenic & vagus
nerve.
• Left recurrent laryngeal
nerve.
• Trachea & oesophagus.
Arch of Aorta
@drsatyajitsaha
87
86. RIGHT SIDE
ABOVE DOWNWARDS:
Upper lobe bronchus.
Pulmonary artery.
Rt principal bronchus.
Lower pulmonary vein
BEFORE BACKWARDS:
Upper Pulmonary vein.
Pulmonary artery.
Bronchus.
LEFT SIDE
ABOVE DOWNWARDS:
Pulmonary artery.
Lt principal bronchus.
Lower pulmonary vein.
BEFORE BACKWARDS
Upper Pulmonary vein.
Pulmonary artery.
Bronchus.
Mediastinal Pleura(At The Root Of Lung)
@drsatyajitsaha
88
87. Mediastinal Pleura(Below The Root Of Lung)
Forms a bilaminar fold known as the Pulmonary
ligament.
@drsatyajitsaha
89
88. Pleural Space/Cavity
The potential space between the two layers of the
pleura i.e the visceral & parietal.
Contains pleural fluid which helps in maintaining the
surface tension & hence the two can slide over each
other.
No anatomical connection between the two pleural
cavities on two sides.
Pleural fluid is a serous fluid which is secreted by the
pleura.
@drsatyajitsaha
90
97. ARRANGED INTO THREE GROUPS:
Retro Sternal –
Origins of sterno-thyroid & sterno-hyoid muscle (strap muscles)
Thymus gland (if present)
SVC, Right and left brachio-cephalic vein, Left superior
intercostal vein.
Intermediate –
Arch of aorta and its 3 branches.
Phrenic nerve, Vagus nerve & Cardiac nerves.
Paravertebral –
Trachea, Oesophagus, Thoracic duct.
Left Recurrent laryngeal nerve.
Origin of longus colli muscle.
STRUCTURES IN THE SUPERIOR
MEDIASTINUM
@drsatyajitsaha
99
98. Superior & inferior sternopericardial ligaments.
Loose areolar tissue & retro-sternal lymph nodes.
Mediastinal artery.
STRUCTURES IN THE ANTERIOR
MEDIASTINUM
@drsatyajitsaha
100
99. Pericardium with the heart.
Ascending aorta and the pulmonary trunk.
Four (4) pulmonary veins.
Lower part of SVC and the arch of azygos vein.
Bifurcation of trachea, right & left bronchi.
Phrenic nerves & pericardiacophrenic vessels.
STRUCTURES IN THE INTERMEDIATE
MEDIASTINUM
@drsatyajitsaha
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100. STRUCTURES IN THE POSTERIOR
MEDIASTINUM
Pulmonary Ligament
@drsatyajitsaha
102
101. STRUCTURES IN THE POSTERIOR
MEDIASTINUM
Pulmonary Ligament
@drsatyajitsaha
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102. LONGITUDINAL STRUCTURES:
Esophagus.
Descending aorta.
Azygos & hemi- azygos vein.
Thoracic duct.
Vagus nerve.
Splanchnic nerves.
Posterior mediastinal lymph nodes.
TRANSVERSE STRUCTURES:
Termination of superior & inferior hemi – azygos vein.
Deviation of thoracic duct from right to left.
Posterior intercostal arteries.
Posterior intercostal vein.
STRUCTURES IN THE POSTERIOR
MEDIASTINUM
@drsatyajitsaha
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103. Inspiration is an active process, thoracic cavity
changes in size- how?
Phrenic nerve stimulation causes diaphragm to
contract (and drop)
Thoracic cavity enlarges, air pressure drops and
atmospheric pressure forces air in
External intercostal contract, elevate sternum
Pleural membranes moves out (and together)
@drsatyajitsaha
105
