Thoracic Wall

THORACIC WALL
DR FARKHANDA JABEEN
MUSCLES
• The Thoracic Wall Is Made Up Of Five Muscles:

• The External Intercostal Muscles
• Internal Intercostal Muscles
• Innermost Intercostal Muscles
• Subcostalis
• Transversus Thoracis.
• These Muscles Are Primarily Responsible For Changing The Volume Of The
Thoracic Cavity During Respiration.
INTERCOSTALS
• The intercostal muscles lie in the intercostal spaces between ribs. They are
organised into three layers
EXTERNAL INTERCOSTAL
MUSCLE
There are 11 pairs of external intercostal
muscles. They run infero-anteriorly from
the rib above to the rib below, and
are continuous with the external oblique of
the abdomen.
Attachments: Originate at the lower
border of the rib, inserting into the superior
border of the rib below.
Actions: Elevates the ribs, increasing the
thoracic volume.
Innervation: Intercostal nerves (T1-T11)
INTERNAL INTERCOSTAL
MUSCLE
These flat muscles lie deep to the external intercostals. Like
the external intercostals, they run from the rib above to the
one below, but in an opposite direction (inferoposteriorly).
They are continuous with the internal oblique muscle of the
abdominal wall.
Attachments: Originates from the lateral edge of the costal
groove and inserts into the superior surface of the rib below.
Actions: The interosseous part reduces the thoracic volume
by depressing the ribcage, and the interchondral part
elevates the ribs.
Innervation: Intercostal nerves (T1-T11).
INNERMOST
INTERCOSTAL
These muscles are the deepest of the intercostal muscles,
and are similar in structure to the internal intercostals.
They are separated from the internal intercostals by the
intercostal neurovascular bundle and are found in the most
lateral portion of the intercostal spaces.
Attachments: Originates from the medial edge of the costal
groove and inserts into the superior surface of the rib below.
Actions: The interosseous part reduces the thoracic volume
by depressing the ribcage, and the interchondral part
elevates the ribs.
Innervation: Intercostal nerves (T1-T11)
TRANSVERSUS THORACIC
• These muscles of the thoracic cage are
continuous with transversus abdominis
inferiorly.
• Attachments: From the posterior surface of
the inferior sternum to the internal surface of
costal cartilages 2-6.
• Actions: Weakly depress the ribs.
• Innervation: Intercostal nerves (T2-T6).
SUBCOSTALS
• The subcostal muscles are found in the inferior portion of the
thoracic wall. They comprise of thin slips of muscle, which
run from the internal surface of one rib, to second and third
ribs below. The direction of the fibers parallels that of the
innermost intercostal.
• Attachments: These originate from the inferior surface of the
lower ribs, near the angle of the rib. They then attach to the
superior border of the rib 2 or 3 below.
• Actions: Share the action of the internal intercostals
• Innervation: Intercostal nerves
ANTERIOR SUPERFICIAL
THORAX
• Pectoralis major and minor muscles
• Subclavius
• Serratus anterior
PECTORALIS MAJOR MUSCLE
• The pectoralis major is the most superficial muscle in the pectoral region. It is large
and fan shaped, and is composed of a sternal head and a clavicular head:
• Attachments:
• Clavicular head – originates from the anterior surface of the medial clavicle.
• Sternocostal head – originates from the anterior surface of the sternum, the
superior six costal cartilages and the aponeurosis of the external oblique muscle.
• The distal attachment of both heads is onto the intertubercular sulcus of the
humerus.
• Function: Adducts and medially rotates the upper limb and draws the scapula
anteroinferiorly. The clavicular head also acts individually to flex the upper limb.
• Innervation: Lateral and medial pectoral nerves
PECTORALIS MINOR MUSCLE
• The pectoralis minor lies underneath its larger counterpart

muscle, pectoralis major. Both muscles form part of the
anterior wall of the axilla region.
• Attachments: Originates from the 3rd-5th ribs and inserts
into the coracoid process of the scapula.
• Function: Stabilises the scapula by drawing it
anteroinferiorly against the thoracic wall.
• Innervation: Medial pectoral nerve
POSTERIOR
THORAX
•Levatores costarum
•Serratus posterior superior and inferior
muscle
LEVATOR COASTRUM
• Levatores costarum consists of 12 small

triangular muscles that connect the
thoracic vertebrae with the adjacent ribs
. Located along either side of the
posterior aspect of the thoracic vertebra
they descend adjacent to the spine,
spanning the thoracic region from C7 to
T12 levels.
SERRATUS POSTERIOR MUSCLES
• The serratus posterior muscles are two paired muscles located in the upper and
lower back. They include:
• The serratus posterior superior muscle
• The serratus posterior inferior muscle
• Together, these muscles comprise the intermediate layer of the
extrinsic musculature of the back.
• The serratus posterior muscles run from the spinous processes of vertebrae to the
ribs, which is why they are sometimes referred to as the spinocostal muscles.
SERRATUS POSTERIOR SUPERIOR MUSCLE
• The serratus posterior superior
muscle arises as a thin tendinous sheet
from the nuchal ligament and spinous
processes of vertebrae C7-T3, as well as
the associated supraspinous ligaments.
The muscle fibers extend inferolaterally
towards the lateral aspect of the posterior
thoracic cage. The insertion of the muscle
takes the shape of four finger-like
projections, each of which inserts onto
the posterosuperior aspect of ribs 2 to 5,
lateral to their angles.
SERRATUS POSTERIOR INFERIOR MUSCLE
• The serratus posterior inferior

muscle originates from the spinous processes
of vertebrae T11-L2 and their supraspinous
ligaments. From there, it ascends
anterolaterally to insert onto the
inferoposterior aspect of ribs 9 to 12, just
lateral to their angles
FLOOR OF THORACIC CAVITY
• The diaphragm is a double-domed musculotendinous sheet,
located at the inferior-most aspect of the rib cage. It serves two
main functions:
• Separates the thoracic cavity from the abdominal cavity (the
word diaphragm is derived from the Greek ‘diáphragma’,
meaning partition).
• Undergoes contraction and relaxation, altering the volume of
the thoracic cavity and the lungs, producing inspiration and
expiration
ATTACHMENTS
• The attachments of diaphragm can be divided into peripheral and

central attachments.
• It has three peripheral attachments:
• Lumbar vertebrae and arcuate ligaments.
• Costal cartilages of ribs 7-10 (attach directly to ribs 11-12).
• Xiphoid process of the sternum.
• The parts of the diaphragm that arise from the vertebrae are
tendinous in structure, and are known as the right and left crura:
• Right crus – Arises from L1-L3 and their intervertebral discs.
Some fibres from the right crus surround the oesophageal
opening, acting as a physiological sphincter to prevent reflux
of gastric contents into the oesophagus.
• Left crus – Arises from L1-L2 and their intervertebral discs
• The muscle fibres of the diaphragm combine to form a central
tendon. This tendon ascends to fuse with the inferior surface of the
fibrous pericardium. Either side of the pericardium, the diaphragm
ascends to form left and right domes. At rest, the right dome lies
slightly higher than the left – this is thought to be due to the
presence of the liver.
PATHWAYS THROUGH DIAPHRAGM
• The diaphragm divides the thoracic and abdominal cavities. Thus, any
structure that pass between the two cavities will pierce the diaphragm.
• There are three openings that act as conduit for these structures
Caval Hiatus Oesophageal Hiatus
Aortic Hiatus (T12)
T8 T10
• Inferior vana cava • Oesophagus • Aorta
• Terminal branches • Right and left • Thoracic duct
of right Phrenic vagus nerves • Azygous vein
Nerve • Oesophageal
branches of left
gastric artery/vein
A tip for remembering the vertebral levels: vena cava has eight
letters (T8), oesophagus has ten letters (T10), and aortic hiatus
has twelve letters (T12).
ACTIONS
• The diaphragm is the primary muscle of respiration. During inspiration, it

contracts and flattens, increasing the vertical diameter of the thoracic cavity.
This produces lung expansion, and air is drawn in. During expiration, the
diaphragm passively relaxes and returns to its original dome shape. This
reduces the volume of the thoracic cavity
INNERVATION AND VASCULATURE
• The halves of the diaphragm receive motor innervation from the phrenic nerve.
The left half of the diaphragm (known as a hemidiaphragm) is innervated by the
left phrenic nerve, and vice versa. Each phrenic nerve is formed in the neck
within the cervical plexus and contains fibres from spinal roots C3-C5.
• The majority of the arterial supply to the diaphragm is delivered via the inferior
phrenic arteries, which arise directly from the abdominal aorta. The remaining
supply is from the superior phrenic, pericardiacophrenic, and musculophrenic
arteries. The draining veins follow the aforementioned arterie

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THORACIC WALL

• The Thoracic Wall Is Made Up Of Five Muscles:

• The pectoralis minor lies underneath its larger counterpart

• Levatores costarum consists of 12 small

• The serratus posterior inferior

• The attachments of diaphragm can be divided into peripheral and

• The diaphragm is the primary muscle of respiration. During inspiration, it

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