Chapter 1

Thorax
OVERVIEW OF THORAX
The thorax is the part of the body between the neck and abdomen. Commonly the term chest is used as a synonym for
thorax, but the chest is much more extensive than the thoracic wall and cavity contained within it. The chest is
generally conceived as the superior part of the trunk that is broadest superiorly owing to the presence of the pectoral,
or shoulder, girdle (clavicles and scapulae), with much of its girth accounted for by the pectoral and scapular
musculature and, in adult females, the breasts.
The thoracic cavity and its wall have the shape of a truncated cone, being narrowest superiorly, with the
circumference increasing inferiorly, and reaching its maximum sie at the !unction with the abdominal portion of the
trunk. The wall of the thoracic cavity is relatively thin, essentially as thick as its skeleton. The thoracic skeleton takes
the form of a domed birdcage. The thoracic cage (rib cage), with the horiontal bars formed by ribs and costal
cartilages, is also supported by the vertical sternum (breastbone) and thoracic vertebrae ("ig. 1.1). "urthermore, the
floor of the thoracic cavity (thoracic diaphragm) is deeply invaginated inferiorly (i.e., is pushed upward) by viscera of
the abdominal cavity. Conse#uently, nearly the lower half of the thoracic wall surrounds and protects abdominal
rather than thoracic viscera (e.g., liver). Thus the thorax and its cavity are much smaller than one might expect based
on external appearances of the chest.
The thorax includes the primary organs of the respiratory and cardiovascular systems. The thoracic cavity is divided
into three ma!or spaces$ the central compartment or mediastinum that houses the thoracic viscera except for the
lungs and, on each side, the right and left pulmonary cavities housing the lungs.
The ma!ority of the thoracic cavity is occupied by the lungs, which provide for the exchange of oxygen and carbon
dioxide between the air and blood. %ost of the remainder of the thoracic cavity is occupied by the heart and
structures involved in conducting the air and blood to and from the lungs. &dditionally, nutrients (food) traverse the
thoracic cavity via the esophagus, passing from the site of entry in the head to the site of digestion and absorption in
the abdomen.
&lthough in terms of function and development the mammary glands are most related to the reproductive system, the
breasts are located on and are typically dissected with the thoracic wall' thus they are included in this chapter.
THORACIC WALL
The true thoracic wall includes the thoracic cage and the muscles that extend between the ribs as well as the skin,
subcutaneous tissue, muscles, and fascia covering its anterolateral aspect. The same structures covering its posterior
aspect are considered to belong to the back. The mammary glands of the breasts lie within the subcutaneous tissue of
the thoracic wall. The anterolateral axioappendicular muscles (see Chapter () that overlie the thoracic cage and form
the bed of the breast are encountered in the thoracic wall and may be
considered part of it, but are distinctly upper limb muscles based on function and innervation. They will be mentioned
only briefly here.
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FIGURE 1.1. Thoracic se!eto". The osteocartilaginous thoracic cage includes the sternum, 1+ pairs of ribs and
costal cartilages, and 1+ thoracic vertebrae and intervertebral discs. The clavicles and scapulae form the
pectoral (shoulder) girdle, one side of which is included here to demonstrate the relationship between the
thoracic (axial) and upper limb (appendicular) skeletons. The red dotted line indicates the position of the
diaphragm, which separates the thoracic and abdominal cavities.
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The domed shape of the thoracic cage provides remarkable rigidity, given the light weight of its components, enabling
it to$
)rotect vital thoracic and abdominal organs (most air or fluid filled) from external forces.
-esist the negative (sub.atmospheric) internal pressures generated by the elastic recoil of the lungs and
inspiratory movements.
)rovide attachment for and support the weight of the upper limbs.
)rovide the anchoring attachment (origin) of many of the muscles that move and maintain the position of the
upper limbs relative to the trunk, as well as provide the attachments for muscles of the abdomen, neck, back, and
respiration.
&lthough the shape of the thoracic cage provides rigidity, its !oints and the thinness and flexibility of the ribs allow it
to absorb many external blows and compressions without fracture and to change its shape for respiration. /ecause the
most important structures within the thorax (heart, great vessels, lungs, and trachea), as well as its floor and walls,
are constantly in motion, the thorax is one of the most dynamic regions of the body. 0ith each breath, the muscles of
the thoracic wall1working in concert with the diaphragm and muscles of the abdominal wall1vary the volume of the
thoracic cavity, first by expanding the capacity of the cavity, thereby causing the lungs to expand and draw air in and
then, due to lung elasticity and muscle relaxation, decreasing the volume of the cavity and causing them to expel air.
The Bottom Line
OVERVIEW OF THORAX
The thorax, consisting of the thoracic cavity, its contents, and the wall that surrounds it, is the
part of the trunk between the neck and abdomen. #The shape and size of the thoracic cavity and
thoracic wall are different from that of the chest (upper torso) because the latter includes some
upper limb bones and muscles and, in adult females, the breasts. #The thorax includes the
primary organs of the respiratory and cardiovascular systems. #The thoracic cavity is divided into
three compartments: the central mediastinum, occupied by the heart and structures transporting
air, blood, and food and the right and left pulmonary cavities, occupied by the lungs.
Skeleton of Thoracic Wall
The thoracic se!eto" forms the osteocartilaginous thoracic cage ("ig. 1.1), which protects the thoracic viscera and
some abdominal organs. The thoracic skeleton includes 1+ pairs of ribs and associated costal cartilages, 1+ thoracic
vertebrae and the intervertebral (23) discs interposed between them, and the sternum. The ribs and costal cartilages
form the largest part of the thoracic cage' both are identified numerically, from the most superior (1st rib or costal
cartilage) to the most inferior (1+th).
RI#$% CO$TAL CARTILAGE$% A&' I&TERCO$TAL $(ACE$
Ri)s (4. costae) are curved, flat bones that form most of the thoracic cage ("igs. 1.1 and 1.+). They are remarkably
light in weight yet highly resilient. 5ach rib has a spongy interior containing bone marrow (hematopoietic tissue),
which forms blood cells. There are three types of ribs that can be classified as typical or atypical$
1. Tr*e +verte)rocosta!, ri)s (1st.*th ribs)$ They attach directly to the sternum through their own costal cartilages.
+. Fa!se +verte)rocho"-ra!, ri)s (6th, 7th, and usually 18th ribs)$ Their cartilages are connected to the cartilage of
the rib above them' thus their connection with the sternum is indirect.
,. F!oati"g +verte)ra!% .ree, ri)s (11th, 1+th, and sometimes 18th ribs)$ The rudimentary cartilages of these ribs do
not connect even indirectly with the sternum' instead they end in the posterior abdominal musculature.
Ty/ica! ri)s (,rd.7th) have the following components$
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Hea-0 wedge.shaped and has two facets, separated by the crest o. the hea- ("igs. 1.+ and 1.,)' one facet for
articulation with the numerically corresponding vertebra and one facet for the vertebra superior to it.
&ec0 connects the head of the rib with the body at the level of the tubercle.
T*)erc!e0 located at the !unction of the neck and body' a smooth articular part articulates with the
corresponding transverse process of the vertebra, and a rough nonarticular part provides attachment for the
costotransverse ligament (see "ig. 1.6/).
#o-y (shaft)$ thin, flat, and curved, most markedly at the costa! a"g!e where the rib turns anterolaterally. The
angle also demarcates the lateral limit of attachment of the deep back muscles to the ribs (see Table 9.( in
Chapter 9). The concave internal surface of the body has a costa! groove paralleling the inferior border of the rib,
which provides some protection for the intercostal nerve and vessels.
Aty/ica! ri)s (1st, +nd, and 18th.1+th) are dissimilar ("ig. 1.,)$
The 1st rib is the broadest (i.e., its body is widest and nearly horiontal), shortest, and most sharply curved of
the seven true ribs. 2t has a single facet on its head for articulation with the T1 vertebra only and two transversely
directed grooves crossing its superior surface for the subclavian vessels' the grooves are separated by a sca!e"e
t*)erc!e and ridge, to which the anterior scalene muscle is attached.
The 2nd rib is has a thinner, less curved body and is substantially longer than the 1st rib. 2ts head has two facets
for articulation with the bodies of the T1 and T+ vertebrae' its main atypical feature is a rough area on its upper
surface, the t*)erosity .or serrat*s a"terior% from which part of that muscle originates.
The 10th-12th ribs, like the 1st rib, have only one facet on their heads and articulate with a single vertebra.
The 11th and 12th ribs are short and have no neck or tubercle.
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FIGURE 1.1. Ty/ica! ri)s. A. The ,rd.7th ribs have common characteristics. 5ach rib has a head, neck,
tubercle, and body (shaft). #. Cross section of the midbody of a rib.
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