The Thoracic Wall:

Bony Thoracic Cage

 Thoracic Wall

• Structure:
skin  fascia  muscle  bone
blood vessels & nerves

• Functions:
1. protection of thoracic
viscera

2. provides the mechanical

function of breathing
 Thoracic Cage
The bony part of thoracic
wall

- 12 pairs of ribs & CC

- 12 thoracic vertebrae
- Sternum
 Ribs
- Flat curved bones with high
resilience

- Form most of the thoracic cage

-3 types:
1. True (1st – 7th )

2. False (8th – 10th )

3. Floating (11th & 12th )

 Features of Typical Ribs

1. Head: wedge-shaped with 2 articular facets

2. Neck: connects the head with the body

3. Tubercle: articular &

non-articular parts

4. Shaft (Body): angle &

costal groove
 Typical Ribs
3rd – 9th ribs are considered
typical
1. Articular facets
2. Crest of Head
3. Neck
4+5. Tubercle
6. Angle
7. Costal groove
8. shaft
 Atypical Ribs
• 1st rib
Flat, scalene tubercle & grooves for subclavian v.

• 2nd rib
rough tuberosity for serratus anterior m.

• 10th rib
one facet on the head

• 11th & 12th

one facet on the head & no neck or tubercle
 1st Rib
1. Flat rib

2. Scalene Tubercle

3. Grooves for
subclavian vessels

4. One Facet on the

head
 Clinical: Cervical Rib

• Extra rib arise from C7 vertebra

• Present in ∼ 1% of people

• Complications:

Causes pressure on nerves & arteries supplying the

upper limb

Tingling & numbness  Partial paralysis

ischemic muscle pain (due to?)

Cervical Rib
 Rib Fractures

• Common chest injuries (middle ribs, 5-10)

• Mostly in weakest part (the angle)

• Present as a sever localized pain

• Complications: inj. to underlying structures

pneumothorax (air in pleural cavity)
 Structure of Vertebrae
Body

Vertebral arch
(P & L)

7 processes
Distinguishing Features of Thoracic
Vertebrae
 Sternum

(G, Sternon: chest bone)

Flat, vertically elongated

bone that forms the middle
anterior part of the thoracic
cage

3 parts:
Manubrium

Body

Xiphoid process
 Manubrium
Shaped

(L, Handle)

* Several notches:
Jugular  Clavicular 
Costal

* Manubriosternal Joint:
2o fibrocartilaginous
Sternal angle
 Sternal Angle
Angle of louis
Manubriosternal
joint

Easily palpated

Opposite to T4-
T5 disc

2nd costal cartilage:

Counting the ribs & intercostal
spaces
 Body: T5 – T9, costal notches 3rd – 7th
Xiphoid process: T10, hyaline cartilage 
ossified
 Openings of Thoracic Wall
Boundaries of superior
thoracic opening:
T1,
1st rib,
manubrium

Boundaries of inferior
thoracic opening:
T12,
11th & 12th ribs,
7-10 CC,
xiphisternal joint
 Thoracic Outlet Syndrome
• On the superior thoracic opening (anatomical inlet)
• Compression of subclavian art. between the clavicle & 1st rib
(Costoclavicular syndrome)
• Pale color & coldness on the skin of upper limb
• Diminished radial pulse
 Joints of Thoracic Cage
Posteriorly:

1. Intervertebral joints 1
(2o cartilaginous)

2
2. Costovertebral joints
(synovial plane)

3. Costotransverse joints
3
(synovial plane)
 Joints of Thoracic Cage
Anteriorly:
1. Costochondral joints
(1o cartilaginous)

2. Sternocostal joints
(synovial plane,
except 1st CC)

3. Manubriosternal joint
(2o cartilaginous)

4. Xiphisternal joint
(1o cartilaginous)
 Intercostal Muscles
3 layers of m. that cover intercostal spaces

From outside to inside:

1. External intercostal m.:

runs downward toward sternum (your ant.

pockets)

replaced anteriorly by membrane

2. Internal intercostal m.:

runs downward toward VC (your post.

pockets)

replaced posteriorly by membrane

3. Innermost intercostal & Transversus
Thoracic
IIm:
on lateral sides only

TTm:
4-5 slips of muscles
From post. surface of sternum
To 2nd -6th costal cartilages

Bld. Vessels & nerves run

between:
Internal & innermost IMs