INTERCOSTAL SPACE AND THORACIC MUSCLES AND RESPIRATORY MOVEMENTS

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INTERCOSTAL SPACE AND THORACIC MUSCLES AND
RESPIRATORY MOVEMENTS

• DR. shazia mangi

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. INTERCOSTAL SPACE

• It means the space between two ribs. Each space
  contains three muscles and neurovascular bundle.
  The arrangement of neurovascular bundle is as
  from above to downward is intercostal vein,
  intercostal artery, intercostal nerve.

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• Intercostal nerve
• This is a spinal nerve coming out from the inter
  vertebral foramen, passes around the
  neurovascular plane between internal intercostal
  muscle and transverse thoracic group of muscles.
  It gives of collateral branch which supply the
  intercostal muscles, the paritel pleura and
  periosteium of ribs (it has no cutaneous branch).
  

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• The main nerve gives of lateral cutaneous branch
  and one terminal branch which pierces the
  intercostal muscles and overlying muscles of the
  body wall along the mid axillary line and divide
  in to anterior and posterior branches to supply
  over the space. Anterior cutaneous branch in
  upper six space passing anterior to internal
  thoracic artery by piercing the intercostal
  muscles and reaches to skin. The nerve lies below
  the artery and vein.

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• At the back of intercostal space the nerve
  crosses behind the artery where as in front of
  intercostal space the nerve crosses in front of
  the artery.

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• 1st intercostal nerve Is the smaller nerve
  beneath the flat, inferior surface of 1st rib and
  in contact with endothoracic fascia and pleura.
  It supplies the 1st intercostal space muscles
  with motor and propioreceptive fibres and the
  adjacent rib and plura with sensory fibres. It
  does not supply the skin and does not have
  lateral and anterior terminal cutaneous branch.

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• Subcostal nerve (12th thoracic) arising in thorax
  and enters into the abdomen.

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• Intercostal arteries
• They inter in space from back to front. The upper
  two spaces are supplied by superior intercostal
  artery which is the branch of costocervical trunk
  which is the branch of second part of subclavian
  artery which is from arch of aorta /
  brachiocephalic trunk.
• It enters in thorax by passing in front of neck
  of 1st rib having the sympathetic trunk on its
  medial side. The remaining nine intercostal
  spaces are a supplied each with separate branch
  of descending thoracic aorta.

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• On the posterior surface all these eleven
  arteries supply. At front of each inter costal
  space the internal thoracic artery in upper six
  intercostal spaces and musculo cutaneous branches
  in lower intercostal space. It gives of two
  anterior intercostal arteries which pass back
  ward and make end to end anastomosis with
  posterior vessels.

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• Internal thoracic or the mammary artery from the
  1st part of S/C artery, it goes down ward from
  the border of sternum.
• In each intercostal space it gives two anterior
  intercostal arteries.
• It divides and gives superior epigastric and
  musculo phrenic artery, pericardiophrenic and
  perforating branches.

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• Venous supply
• These are two anterior intercostal veins in each
  of upper nine spaces accompanying the
  corresponding arteries. Upper six veins end in
  internal thoracic veins and lower end in
  musculophenic vein.
• There is one posterior intercostal vein in each
  space and they have tributaries.
• The tributaries of veins are from vertebral
  canal, vertebral venous plexus, muscles and skin
  of back.

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• Lower eight posterior veins drain in to azygous
  vein on right side and hemiazygous and accessory
  azygous on left side.
• 1st intercostal vein drain into right
  brachiocephalic or vertebral vein on right side
  and left brachiocephalic veins on left side.
• On the right side second and third intercostal
  vein joint to from right fourth superior
  intercostal vein which drain into azygus vein.

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• Second and third intercostal veins on the left
  side joint to form left superior intercostal
  veins which drain into left brachiocephalic vein.
  
• Lymphatics
• Anterior intercostal nodes (internal mammary
  nodes).
• Posterior intercostal nodes.

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RESPIRATORY MOVEMENTS
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• During the respiratory process (expiration and
  inspiration) the lungs may inflate (expand) or
  deflate (retract).
• Inspiration Inflate expand
• Expiration deflate retract
• These movements alter the capacity of thoracic
  because of the movements of thoracic wall.
• These movements are carried out at different
  joints of thoracic cavity i.e. vertebrosternal
  and vertebrochondral.

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• Increase in the volume of thoracic cavity creates
  the intrathoracic pressure with sucks air into
  the lung.
• These movements occur at costovertebral (all
  joints of thorax) and manibrosternal joints.
• Thoracic wall expels air from lungs during
  expiration.
• Pump handle movement
• In this movement A/P diameter of thorax is
  increased.
• This occurs at vertebrosternal ribs (1-7) ribs.

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• Body of sternum moves up and down showing the
  pump handle movement.
• Buket handle movement
• The middle of shaft of rib lies on sternum causes
  increase in transverse diameter at
  vertebrocondral ribs.
• Ap. Diameter increase in pump handle movement at
  2 6 ribs.
• Transverse diameter increase at 7 10 ribs.
  Bucket handle movement.
• Contraction of diaphragm causes the increase in
  vertical diameter.

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• Respiratory muscles
• Diaphragm and intercostal muscles (Inspiration)
• Elastic recoil of lungs (Expiration)
• In forced breathing (Inspiration) Diaphragm,
  intercostal muscles St. Cl. Mastoid. Pectoral is
  minor and serratus anterior and alaque nasi
  (Expiration) muscles of abdominal wall and
  latismus dorsi.

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THANK YOU