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Bony Thorax
Tanya Nolan
Bony Thorax
Sternum 12 Ribs 12 Thoracic Vertebrae
FunctionSupports walls of pleural cavity & diaphragmVolume of cavity able to change during respirationProtects heart and lungs
Sternum Flat bone 6 in in length Supports
clavicles and provides attachment to 1st seven costal cartilages of ribs
T2-T3
Sternal Angle
T-10
Provides bony landmark for superior liver and inferior heart
12 Rib Pairs True Ribs
1-7 Attached to the
Sternum False Ribs
8-12 Do not attach directly
to the sternum; attach to costal cartilage of 7th rib
Floating Ribs 11 and 12 Attached only to the
vertebrae
Number Variation Cervical Ribs
Articulate with C7 but rarely attach to sternum
Lumbar Ribs Less Common
Ribs Angle Oblique plane
slanting anteriorly and inferiorly Anterior ends lies 3-5
inches below the level of the vertebral end.
Angle increases from the rib 1-9 then decreases 9-12.
Ribs Vary in breadth and length Facet on head articulates with vertebrae
Vertebral End
Sternal End
Costal Groove
Costal arteries, veins, and nerves
Erythropoiesis Production of red blood cells.
Early Fetus Mesodermal cells of yolk sac
3-4 Months to Adolescence Spleen, Liver, and Skeletal involvement
Adulthood Vertebrae, Sternum, Pelvis, and Ribs
Principal means of delivering oxygen to the body
Bony Thorax Articulations
8 Joints Sternoclavicular Costovertebral
(1-12) Costotransverse
(1-10) Costochondral
(1-10) Sternocostal
(1-7) Interchondral
(6-10) Manubriosternal Xiphisternal
Sternoclavicular
Only points of articulation between the upper limbs and the trunk
Gliding Joints Permit free
movement
Manubriosternal
Joint
XiphisternalJoint
Costovertebral and Costotranverse
Costovertebral Synovial Gliding
Rib Head closely bound to the demifacets and 2 adjacent vertebral bodies
Costotransverse Synovial Gliding
Tubercle of rib articulates with transverse process of lower vertebra
Costochondral and Sternocostal
Sternocostal Cartilaginous
Synchondosis No Movement Articulation
between costal cartilages and true ribs
Costochondral 1st Rib: Cartilaginous
Synchondosis No Movement
2-7: Synovial Gliding Freely moveable
Articulation between rib costal cartilages and sternum
Sternocostal
Interchondral
Between 6-9 RibsSynovial Gliding
Freely moveable
Between 9-10 RibsFibrous
Syndesmosis Slightly moveable
Manubriosternal &Xiphersternal Cartilaginous
SynchondrosisLittle
Movement
Manubriosternal Joint
Xiphisternal Joint
Respiratory Movement Quiet Respiration
Olique rib orientation changes little
Deep Inspiration Degree of obliquity
decreases Ribs carried
anteriorly, superiorly, and laterally while necks are rotated inferiorly
Deep Expiration Degree of obliquity
increases Ribs carried inferiorly,
posteriorly, and medially while the necks are rotated superiorly
Diaphram
Ribs below diaphram best imaged through upper abdomen
Ribs above diaphram best imaged through air filled lungs
WHY?
Diaphram Location Changes
with Body Position Upright
Lowest
Supine Highest Anterior ends of ribs less sharply visualized in supine position
Repiratory Movement 1 ½ inches between deep inspiration and deep
expiration Less in hypersthenic More in hyposthenic
Oblique Projection of Sternum
Degree of angulation depends on the depth of the chest Deep Chest
Less angulation
Shallow Chest More angulation
Why must you do an oblique projection of the sternum versus an AP or PA projection?
Which Oblique Position??? RAO or LAO?
Why?
What technique? Why?
PA Oblique Projection (RAO)Sternum Estimate body
rotation by placing one hand on patient’s sternum and the other hand on the thoracic vertebrae to act as a guide
Top of IR 1.5 inches above jugular notchAverage body rotation is 15-20 degrees
PA Oblique Projection (RAO, LPO)Sternum
Minimal rotation Sternum
projected free from superimposition of the spine
Sternum projected over the heart
When would you use an LPO Position?
Lateral Projection (Upright)Sternum
Rotate patients hands posteriorly
Lock hands behind back
Film 24 x 30 cm lengthwise
IR 1.5 inches above jugular notch
Suspend deep inspiration
Lateral Projection (Supine)Sternum
Bring hands above head
Film 24 x 30 cm lengthwise
IR 1.5 inches above jugular notch
Suspend deep inspiration
Lateral ProjectionSternum
Pectus Excavatum
Sunken or “caved in” chest Most common congenital chest wall
abnormality in children. Severity ranges from a moderate
indentation to constriction of the internal organs.
Sunken chest appears to be a problem with the sternum or ribs, but the problem is with the cartilage piece that connects each rib to the sternum. This costal cartilage connector is deformed, pushing the breastbone inward.
PA ProjectionSternoclavicular Articulations
IR @ T3 (just posterior to jugular notch)
Arms rest by side of patient with palms up
Turn head toward affected side Rotates spine slightly
away from side being examined
Better visualization of lateral manubrium
Suspend at end of expiration
Sternoclavicular Articulations
Bilateral Unilateral
No Rotation Slight Rotation
PA Oblique Projection (RAO, LAO)SC Joints
Rotate patient 10-15 degrees
CR perpendicular to SC Joint closest to the IR (T2-T3)
LAO: Left side of interest
RAO: Right side of interestL R15
S
PA Oblique Projection (RAO, LAO)SC Joints
Ribs Localize Point
of InterestAnterior Ribs
PA Projection
Posterior Ribs AP Projection
Axillary Portion of Ribs Best demonstrated in oblique projection
lateral projection results in superimposition of both sides
Respiration
Upper Anterior RibsPA Projection
Do you use the same technique as you would for a chest x-ray?
Posterior Ribs: AP Projection
Ribs above diaphram1.5 inches above
shouldersFull Inspiration
Ribs below diaphramLower edge of IR at
iliac crestFull Expiration
Posterior RibsAP Projection
Axillary RibsAP Oblique Projection (RPO, LPO)
45 degree Oblique Place affected side
closest to the IR Center affected side
midway between midsagittal plane and lateral surface
Abduct arm of affected side and elevate to carry scapula away from rib cage
Axillary RibsAP Oblique Projection (RPO, LPO)
2 x distance between vertebral column and lateral border affected side visualized
Axillary ribs free of superimposition
Axillary RibsPA Oblique Projection (RAO, LAO) 45 degree oblique
45 degree oblique
Which is the side
of interest? Why?
Axillary RibsPA Oblique Projection (RAO, LAO)