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External Intercostal Muscle
- Superior Attachment: Inferior border of rib from back to anterior axillary line
- Inferior Attachment: Superior border of rib below from back to anterior axillary line
- Innervation: Intercostal nerve (T1-9)
- Main Actions: Elevate ribs
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Internal Intercostal Muscle
- Superior Attachment: Inferior border of rib from ~ angle of ribs forward between costal cartilage
- Inferior Attachment: Superior border of rib below from ~ angle of ribs forward between costal cartilage
- Innervation: Intercostal nerve (T1-9)
- Main Actions: Depress ribs
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Transversus Thoracis
- Superior Attachment: Posterior surface of lower sternum
- Inferior Attachment: Internal surface of costal cartilages 2-6
- Innervation: Intercostal nerve
- Main Actions: Depress ribs
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Diaphragm
- Proximal Attachment/origin: Thoracic outlet: xiphoid, costal margin, ribs 11 and 12, T12-L1 vertebrae
- Distal Attachment/insertion: Converge into central tendon
- Innervation: Phrenic nerve
- Actions: draws central tendon down and forward during inspiration
- Aortic hiatus: at T12
- Esophageal hiatus: at T10
- Caval foramen: at T8
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Superior border of heart (base)
L 2nd costal cartilage --> R 3rd costal cartilage
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R border of heart
R 3rd costal cartilage --> R 6th costal cartilage
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Inferior boder of heart
R 6th costal cartilage --> L 5th ICS, MCL
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L border of heart
L 5th ICS, MCL --> L 2nd costal cartilage
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Aortic valve auscultation
R 2nd ICS
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Pulmonic valve auscultation
L 2nd ICS
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Tricuspid valve ausculation
L 4th ICS
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Biscupid/mitral valve auscultation
L 5th ICS, MCL
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Thoracic outlet
manubrium --> 1st rib --> T1
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Phrenic n.
- Originates: VR C3-5
- Innervates: pericardium; diaphragm
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Vagus n.
- CN X - parasympathetic
- Runs down neck in carotid cheath with internal jugular v. and internal --> common carotid
- L side devides under aortic arch
- R side divides under brachiocephalic trunk
- lower divisions form plexuses: cardiac (heart - slows); pulmonary (bronchioles and bronchii - constricts); esophageal (esophagus - stimulates to contract)
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Recurrent laryngeal
branches of the vagus n., innervate larynx (voicebox)
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sympathetic trunk
- back agains vertebral column
- carries sympathetic innervation to all areas of body
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