Rib cage. Atlas of human anatomy manubrium of the sternum Folk remedies for bruises

08.02.2017

The sternum, sternum, belongs to the flat bones and consists of three sections: the manubrium, manubrium stemi, the body, corpus sterni, and the xiphoid process, proc. xiphoideus.

The sternum, sternum, belongs to the flat bones and consists of three sections: the manubrium, manubrium stemi, the body, corpus sterni, and the xiphoid process, proc. xiphoideus. In addition, sometimes there are unstable suprasternal bones in the sternum, ossa suprasternalia.

The manubrium is the most massive section of the sternum, on the upper edge of which there is a jugular notch, incisura
jugularis, and on the lateral ones - clavicular notches, incisurae claviculares, under which there are costal openings
cutting, incisurae costales, for connection with the cartilages of the first ribs.

The body of the sternum is connected to the manubrium using the manubrium-sternal synchondrosis, synchondrosis
manubriosternalis. For articulation with the cartilages of the II-VII ribs, there are joints on the lateral surfaces of the body of the sternum.
corresponding rib notches.

The xiphoid process is variable in shape and size; it may be fork-shaped or enclose an opening along the midline. The xiphoid process is connected to the body of the sternum by means of xiphosternal synchondrosis, synchondrosis xiphosternalis.

Styling

Oblique anterior projection. When performing radiographs of the sternum in an oblique anterior projection, positioning is performed with the patient in the prone position. The head is turned to the right. Left upper limb dropped
along the body, the right one is retracted to the side and upward. The right half of the chest rises above
table so that an angle of 25-30° is formed between the frontal plane of the body and the plane of the table.

The mammary glands in women are retracted outward. The cassette is located in the plane of the table under the sternum area. The central beam of rays is directed perpendicular to the plane of the table between the medial edge
right scapula and spinal column at the level of the V thoracic vertebra. On the radiograph, the sternum is clearly visible against the background of the pulmonary pattern.

Raising the left half of the chest above the table and directing the central beam of rays between
medial edge of the left scapula and the spinal column, the image of the sternum is obtained against the background of the heart
vascular bundle. Similar radiographs can be obtained if the patient is placed symmetrically on the anterior surface of the chest and the central beam of rays is directed at the sternum area at an angle
25-30° to the median plane.

If the patient’s condition allows, radiography of the sternum is performed in a vertical position with
storing the above-described relationships between the patient, the cassette and the central beam of rays.

Lateral projection. When performing an X-ray of the sternum in a lateral projection, positioning is done in
position of the patient on his side. The upper limbs are retracted posteriorly. The cassette is located in the plane of the table
under the sternum area. The frontal plane of the body is perpendicular, and the sagittal plane is parallel
table plane. The central beam of rays is directed perpendicular to the plane of the table, tangential to the body
sternum. A similar radiograph can be obtained with the patient in a vertical position under the control of a screen, maintaining the same relationships between the patient, the cassette and the central beam of rays.

X-rays of the sternum are taken with the patient holding his breath.

X-ray anatomical analysis

Oblique anterior projection. On a radiograph of the sternum in an oblique anterior projection (Fig. 122) all sections
The sternum is clearly defined outside the shadow of the spinal column against the background of pulmonary tissue or against the background of the cardiovascular bundle, which is due to the variant of placement. The shadow of the sternum is projectively intersected by the posterior sections of the V-X ribs.

The manubrium (1) is the most massive section of the sternum. The jugular notch (2) is visible on the upper edge of the handle, and
On the lateral sections, the clavicular notches are identified (3). Due to the fact that in the described projection the sternum is located somewhat obliquely, the right and left clavicular notches do not have a symmetrical display: the notch projectively located closer to the spinal column is concave, the distant one is projectionally flattened.

A comparative analysis of the sternoclavicular joints in this projection is impossible. The manubrium of the sternum is connected to the body (5) by the manubrium-sternal synchondrosis (6), which looks like a horizontal stripe of clearing with clear contours.

The body of the sternum is represented by an elongated plate, slightly expanding in the caudal direction.

The body passes into a narrow and thin xiphoid process (7), sometimes separated by a stripe of clearing caused by xiphosternal synchondrosis. Forked cleft of the xiphoid process or
the presence of a clearly defined clearing is a variant of the norm.

On the lateral surfaces of the sternum there are costal notches (8) for ribs I-VII, which have clear, intense contours. The notches for the 1st ribs are located on the lateral surfaces of the manubrium, the notches for the 2nd ribs are at the border of the manubrium and the body, the notches for the 3rd-6th ribs are at the level of the body of the sternum, and for the 7th ribs - at the border of the body of the sternum with the xiphoid process.

Rice. 122. X-ray of the sternum in an oblique anterior projection.

1 - manubrium of the sternum; 2 - jugular notch; 3 - clavicular notches; 4 - X-ray joint space of the sternoclavicular joint; 5 - body of the sternum; c - manubrium-sternal synchondrosis; 7 - xiphoid process; 8- rib notches; 11 - sternal end of the clavicle.

Lateral projection. On an x-ray of the sternum in a lateral projection (Fig. 123), the sternum has the appearance of a slightly convex anterior plate 1-2 cm wide, limited by clear, intense contours determined by the cortical substance of the anterior (9) and posterior (10) surfaces.

Between the manubrium (1) and the body of the sternum (5) a clearing with clear contours can be traced, formed by the manubrium-sternal synchondrosis (6).

Unlike the body, which has two contours (anterior and posterior), an additional triangular shadow is adjacent to the posterior contour of the manubrium of the sternum, the base of which faces upward. According to experimental
research by V. S. Maykova-Stroganova and M. A. Finkelstein. its morphological substrate is the lateral edge of the manubrium of the sternum, distant from the cassette (1a).

Parallel to the anterior contour of the sternum, a low-intensity shadow is determined, caused by the soft tissues of the anterior chest wall. Their volume and intensity depend on age, gender and individual characteristics. Parallel to the posterior contour of the sternum, a strip of soft tissue 2-3 mm wide can be traced, which is a reflection of the internal fascia of the chest. Posterior to the sternum, against the background of the organs of the chest cavity, the anterior sections of the costal bones can be traced.

Rice. 123. X-ray of the sternum in the lateral projection.

1 - manubrium of the sternum; 1a - distant lateral edge of the manubrium of the sternum; 5 - body of the sternum; b - manubrium-sternal synchondrosis; 9 - anterior surface of the sternum; 10 - posterior surface of the sternum.

Protrusion of the manubrium of the sternum occurs with congenital or acquired pathology of the chest. After a severe injury, the front bone becomes displaced and protrudes outward. In congenital diseases, the defect develops gradually. The incorrect structure of the musculoskeletal system leads to disruption of the functions of internal organs and is a difficult psychological aspect.

Structure of the manubrium of the sternum

The sternum is a flat, elongated shape located in the frontal zone of a person. It consists of three separate fragments: the manubrium of the sternum, the body, and the process. During childhood, the parts of the sternum are connected by cartilage tissue, which hardens over time and acquires a bone-like structure.

The manubrium sternum is the upper portion of the sternum. It has an irregular quadrangular shape and is the widest part of the bone. On the sides there are special notches for fastening to the collarbone. Just below there are symmetrical grooves for connection with the cartilages of the first ribs. The upper notch of the manubrium of the sternum is called the jugular. In people of asthenic type, the manubrium can be easily felt through the muscle layer.

The anterior bone is one of the important components of the pectoral corset. It protects internal organs from mechanical stress and damage from bruises. One of the main zones of the chest contains bone marrow and is a hematopoietic organ. In case of injuries and congenital anomalies of the sternum, the following systems are affected:

• respiratory;
• musculoskeletal;
• cardiovascular.

Let's look at common reasons why the manubrium of the sternum protrudes and hurts.

Keeled chest

If the structure of the bone corset is incorrect, the handle of the sternum protrudes. The causes of the disease are associated with a birth defect called “keeled breasts.” This malformation is more common in patients with structural features of the body: tall stature, elongated limbs, lack of subcutaneous fat. Peel-shaped deformity of the chest (KDCH) has received an apt name among the people - “breast of a pigeon.” Clinical picture of the disease:

• prominent bone in the middle front of the chest;
• retraction of connective cartilaginous tissue;
• sunken, weakly defined ribs.

The pathology is detected at the birth of a child, and with age the symptoms only intensify. Patients experience shortness of breath and rapid heartbeat when walking, and complain of fatigue. If the defect is not treated, then over time the person’s lung capacity decreases and the supply of oxygen to the body decreases.

Treatment of CDHA

To improve the general condition of the patient, the following measures are taken:

• regular exercise;
• pressing on the keel (in adolescents);
• breathing exercises;
• wearing orthopedic devices;
• physical therapy.

To completely eliminate the cosmetic defect, surgery will be required.

With a barrel-shaped chest, the intercostal spaces increase, the chest frame moves forward and the manubrium of the sternum protrudes. Why does this deformation occur? There may be several answers:

1. The most common cause of pathology is emphysema. There is an increase in the lungs and displacement of the costal arches. The disease occurs against the background of chronic bronchitis, tuberculosis and smoking, and is accompanied by coughing attacks and shortness of breath.
2. Osteoarthritis is a joint disease in which the cartilage tissue wears out. If arthritis affects the anterior ribs, the sternum moves forward.
3. Bronchial asthma. As a consequence of chronic pneumonia, the upper part of the osseous frame expands and loses its correct anatomical proportions.
4. Cystic fibrosis. The genetic disease causes mucus to accumulate in organs, including the lungs. Often the pathology leads to the appearance of a barrel-shaped chest.

To reduce sternum deformity, the underlying disease is treated first.

Sternum fracture

A car accident, blunt force trauma, or fall often causes a fracture between the manubrium and the body of the sternum. In severe cases, due to injury, the manubrium of the sternum protrudes, and the structure of the bones is disrupted. The victim experiences unbearable pain, which intensifies with a deep breath.

A hematoma with edema forms in the area of ​​the fracture. With a significant displacement of the sternum in some patients, bone fragments are felt during palpation. Damage to internal organs is also possible: lungs, heart, pleura. If medical care is not provided in a timely manner, complications occur - accumulation of air and blood in the chest cavity. To diagnose a fracture, complex measures are carried out: computed tomography and radiography.

Treatment

Patients are prescribed an oral or intramuscular course of painkillers. A novocaine blockade is placed in the injured area. To speed up the fusion of the sternum, a reposition is made in which the bone fragments are correctly compared. In case of a displaced fracture, the manubrium of the sternum is fixed in the desired position with special screws.

After a month, the sternum is completely fused. In the future, it is recommended to carry out rehabilitation measures:

• massage;
• water aerobics;
• breathing exercises;
• swimming;
• exercises for posture.

After an injury, the chest is tightened with a medical elastic band or bandage. To prevent the risk of cracks appearing at the site of injury, excessive physical exertion should be avoided.

If the manubrium of the sternum hurts due to a bruise, do the following:

1. Provide the victim with bed rest.
2. To reduce the pain of the injury, a tight bandage is applied to the chest and secured on the healthy side.
3. Ice is applied to the manubrium of the sternum; this procedure will reduce hemorrhage and swelling.
4. For severe pain, take painkillers (Nise, Spazgan, Baralgin).
5. On the third day after the injury, they begin to treat the hematoma - they apply warm compresses.

If pain in the manubrium of the sternum does not go away within a week, you need to consult a specialist. The doctor will conduct a medical examination and, based on the results, prescribe treatment procedures, such as electrophoresis. The medical procedure involves applying direct electric current to the injured area. Positive effects during treatment:

• swelling decreases;
• muscle tone relaxes;
• tissue regeneration accelerates;
• the body's defenses increase;
• microcirculation improves;
• pain syndrome is eliminated.

In case of serious damage to blood vessels, treatment is carried out surgically. If after a week the tumor has not resolved, then blood stagnation in the sternum is suspected. The doctor makes a puncture in the injured area, and excess fluid comes out.

Folk remedies for bruises

For a slight bruise of the manubrium of the sternum, you can use traditional methods of treatment:

1. Horseradish root is grated on a fine grater and a compress is applied to the injured area. This method of treatment relieves pain well, but it cannot be used during the first two days after the injury.
2. To resolve the hematoma, vinegar (9%) is mixed with honey and applied as a bandage to the sternum.
3. Cilantro has a good analgesic effect. Take 50 g of fruit for 1 liter of boiling water and leave for 15 minutes. Strain and take warm, 2-3 cups per day.
4. Chopped parsley is used for dressings. Crushed leaves are applied to the sternum and secured with a bandage.

If a person slips on ice, the fall may injure the ribs, sternum, and arm. With such bruises, the body aches and hurts for a very long time. To reduce suffering, it is recommended to apply a circular elastic bandage. When tugging, the mobility of the sternum is limited, and it is easier for a person to endure pain.

When pressing on the manubrium of the sternum, pain may appear, radiating to other parts of the chest. The causes of the pathology are degenerative changes in the joints, disorders in the cardiovascular, digestive and respiratory systems.

1. If, when pressing the handle, unpleasant sensations occur in the process of the sternum, then this may indicate diseases of the gastrointestinal tract.
2. If there is nagging pain in the manubrium of the sternum that lasts more than a week, an aortic aneurysm is suspected.
3. If, when pressing on the bone corset, a burning sensation is felt, and the pain moves to the left shoulder or shoulder blade, then this is a clear sign of latent angina.
4. Often, pain in the sternum is caused by pathological processes in the respiratory organs: sarcoidosis, bronchitis, tuberculosis, pneumonia. Associated symptoms are weakness, severe cough, sweating.

Pathologies in which the manubrium of the sternum protrudes and hurts can be quite serious. Therefore, if you feel discomfort when pressing and notice external changes in the sternum area, then consult a specialist.

The xiphoid process is part of the skeleton of the sternum. This is the smallest and shortest part of it. It can be different in shape and size, with a hole in the center and a forked top. The apex can be blunt or sharp, facing anteriorly or posteriorly.

Where is the xiphoid process of the chest located?

This element forms dense bone tissue with the body of the sternum, which is connected using cartilage tissue. However, with age, the xiphoid process ossifies and fuses with the body of the sternum.

Where is the xiphoid process located? The sternum consists of three parts:

• lever;
• body;
• xiphoid process.

These three parts are connected to each other. If you move your hand from the place where the neck ends (in the front central part of it) and follow straight down to the stomach, then this is the body of the sternum. Its lowermost part is the xiphoid process. It is connected tightly to the body, and at the point of contact with the bone there are hyaline cartilages.

Functions of the sternum

The sternum performs the following important functions:

• protects internal organs from mechanical damage;
• participates in the process of hematopoiesis, since it contains bone marrow;
• this function is used in the treatment of blood cancer when it is necessary to perform a puncture, since it has the most convenient location for performing this procedure.

The xiphoid process of the sternum hurts when pressed

Pain in this area of ​​the chest, especially with pressure, may indicate various pathologies of the organs of both the thoracic part of the body and those adjacent to the sternum.

These bodies are:

• heart;
• lungs;
• stomach;
• pancreas;
• gallbladder.

Of course, with serious illnesses, pain is observed not only with pressure, but also with movement, as well as at rest and after eating.

In addition, the cause of pain is often trauma to this anatomical area. For example, serious injuries produce the characteristic slippery rib cartilage. Its appearance causes very strong pain in the chest, but after a certain period it will disappear and will only manifest itself as a dull pain when pressing on the xiphoid process. When severe pain disappears, it may seem that the disease has passed. However, this is a dangerous misconception. If you do not seek qualified medical help in a timely manner, inflammation of the xiphoid process may occur.

Some injuries can tear the muscles in the front of the abdominal area and also cause tumors to develop.

Damage to the gastrointestinal tract can also cause pain. For example, with a stomach ulcer, inflammatory processes can radiate to the chest. In this case, the patient himself does not understand where the source of pain is. And only by symptoms can you determine the cause of pain:

• lack of appetite;
• vomiting and nausea;
• heartburn.

Pathologies and injuries

The main damage to this anatomical area can be:

• hernia;
• injuries;
• xyphoidalgia;
• tumors.

Hernia

Hernia symptoms:

• severe chest pain;
• atypical bulging in the area of ​​the process of the sternum;
• the hernial sac is easily palpated;
• sometimes the hernia needs to be reduced;
• during reduction, you can palpate the edges of the hernia gate.

For an accurate diagnosis, it is necessary to undergo instrumental examination: X-ray, computed tomography (CT) and magnetic resonance imaging (MRI). As a rule, only surgical treatment is used to treat a hernia. But before the operation, differential diagnosis must be carried out, since these symptoms are characteristic of a number of other diseases. The operation to remove a hernia is not too complicated. The gate of the process opening is sutured, and the hernial sac is processed. Then an incision of approximately 10 cm is made in order to disconnect the process from the sternum.

Injuries

Sternum injuries are quite common. They appear as a result of road accidents, falls from great heights, and strong impacts. Traumatic injuries to the sternum are called “motorist injuries.” Fractures and bruises of the sternum are rarely independent; more often they are accompanied by fractures of the ribs, spine or limbs. In some cases, fractures may result in the formation of bone fragments that can damage internal organs. There is slight soft tissue swelling and pain at the site of injury. If the fragments are displaced, the treatment is surgical. In this case, it is necessary to compare the bone fragments for better fusion.

Xyphoidalgia

This is inflammation of the xiphoid process or, as it is also called, xiphoid process syndrome. With this disease, organs that communicate and have common innervation with the process are affected:

• diaphragm;
• stomach (with ulcer);
• inflammation of the lymph nodes (lymphadenitis).

In such cases, it is not the process that hurts in patients, but the area located behind it. You may also experience an attack of nausea and a feeling of constriction in the throat. Eating large amounts of food or vigorous movement may increase these symptoms and discomfort. The pain is aching in nature, variably intensifying and weakening.

With xyphoidalgia, poor posture is observed. It can be pronounced or slightly noticeable. Painful sensations with xyphoidalgia must be differentiated from other pathologies:

• heart pain;
• pain in the digestive system;
• pathologies of the pulmonary system.

This disease may have the most common symptoms. Treatment begins only when the diagnosis is accurately established.

For an accurate diagnosis, the following studies are carried out:

• radiography;
• ECG (electrocardiogram);
• FGS (fibrogastroscopy) of the stomach;
• magnetic resonance imaging (MRI).

Treatment of the disease lies in the correct position of the spine (straighten the shoulder blades). When pain occurs, ice wrapped in soft tissue is applied to the appendix.

With xyphoidalgia, it is strictly prohibited:

• spinal traction;
• physiotherapy;
• straightening the spine independently with the help of gymnastic exercises.

Why can't I do the above steps? Because they can provoke severe pain. In addition, pain in this disease is difficult to relieve with the help of analgesics (analgin, novocaine, ketorol). Such diseases can only be cured by a qualified chiropractor.

Tumors

Diagnosis of tumor processes at the first stage is difficult, since symptoms are not always clearly expressed. A characteristic symptom is pain that is transient. And only over time the pain intensifies and becomes more intense at night. An elastic compaction appears below the sternum, which is easily palpable. Gradually it increases and expands. The tumor quickly grows into neighboring tissues and metastasizes.

Sternum, sternum, is an unpaired bone of elongated shape with a slightly convex anterior surface and a correspondingly concave posterior surface. The sternum occupies a section of the anterior wall of the chest. It distinguishes the manubrium, body and xiphoid process. All these three parts are connected to each other by cartilaginous layers, which ossify with age.

Manubrium of the sternum, manubrium sterni, - the widest part, thick at the top, thinner and narrower at the bottom, has on the upper edge a jugular notch, incisura jugularis, easily palpable through the skin. On the sides of the jugular notch are the clavicular notches, incisurae claviculares, the places of articulation of the sternum with the sternal ends of the clavicles.

Sternum video

Somewhat lower, on the lateral edge, is the notch of the 1st rib, incisura costalis I, the place of fusion with the cartilage of the 1st rib. Even lower there is a small depression - the upper section of the costal notch of the second rib; the lower portion of this notch is located on the body of the sternum.

The body of the sternum, corpus sterni, is almost 3 times longer than the manubrium, but narrower. The body of the sternum is shorter in women than in men.

The anterior surface of the sternum has traces of the fusion of its parts during embryonic development in the form of weakly expressed transverse lines.

The cartilaginous connection of the upper edge of the body with the lower edge of the handle is called synchondrosis of the manubrium of the sternum, synchondrosis manubriosternalis, while the body and manubrium converge, forming an obtuse angle of the sternum, open posteriorly, angulus sterni. This protrusion is located at the level of the articulation of the second rib with the sternum and is easily palpable through the skin.

On the lateral edge of the body of the sternum there are four complete and two incomplete costal notches, incisurae costales. - places of articulation of the sternum with the cartilage of the II-VII ribs. One incomplete notch is located at the top of the lateral edge of the sternum and corresponds to the cartilage of the 2nd rib, the other is located at the bottom of the lateral edge and corresponds to the cartilage of the 6th rib; four complete notches lie between them and correspond to ribs III-VI.

The areas of the lateral sections lying between two adjacent costal notches have the shape of semilunar recesses.

xiphoid process, processus xiphoideus, is the shortest part of the sternum, can be different in size and shape, with a forked apex or with a hole in the middle. The sharp or blunt apex faces either anteriorly or posteriorly. In the superolateral part of the xiphoid process there is an incomplete notch that articulates with the cartilage of the 7th rib.

The xiphoid process forms with the body of the sternum synchondrosis of the xiphoid process, synchondrosis xiphosternalis. By old age, the xiphoid process, ossified, fuses with the body of the sternum.

Sternum

The sternum, sternum, is an unpaired bone of an elongated shape with a slightly convex anterior surface and a correspondingly concave posterior surface. The sternum occupies a section of the anterior wall of the chest. It distinguishes the manubrium, body and xiphoid process. All these three parts are connected to each other by cartilaginous layers, which ossify with age.

The manubrium sterni, the widest part, thick at the top, thinner and narrower at the bottom, has a jugular notch on the upper edge, incisura jugularis, easily palpable through the skin. On the sides of the jugular notch are the clavicular notches, incisurae claviculares, the places of articulation of the sternum with the sternal ends of the clavicles.

Somewhat lower, on the lateral edge, there is the notch of the 1st rib, incisura costalis I, the place of fusion with the cartilage of the 1st rib. Even lower there is a small depression - the upper section of the costal notch of the second rib; the lower portion of this notch is located on the body of the sternum.

The body of the sternum, cogrus sterni, is almost 3 times longer than the manubrium, but narrower. The body of the sternum is shorter in women than in men.

The anterior surface of the sternum has traces of the fusion of its parts during embryonic development in the form of weakly expressed transverse lines.

The cartilaginous connection of the upper edge of the body with the lower edge of the manubrium is called synchondrosis of the manubrium of the sternum, synchondrosis manubriosiernalis, while the body and manubrium converge, forming an obtuse angle of the sternum, open posteriorly, angulus slerni. This protrusion is located at the level of the articulation of the second rib with the sternum and is easily palpable through the skin.

On the lateral edge of the body of the sternum there are four complete and two incomplete costal notches, incisurae costales, the places of articulation of the sternum with the cartilages of the 11th-7th ribs. One incomplete notch is located at the top of the lateral edge of the sternum and corresponds to the cartilage of the 2nd rib, the other is at the bottom of the lateral edge and corresponds to the cartilage of the 7th rib; four complete notches lie between them and correspond to the III - VI ribs.

The areas of the lateral sections lying between two adjacent costal notches have the shape of semilunar recesses.

The xiphoid process, processus xiphoideus, is the shortest part of the sternum, can be different in size and shape, with a forked apex or with a hole in the middle. The sharp or blunt apex faces either anteriorly or posteriorly. In the superolateral part of the xiphoid process there is an incomplete notch that articulates with the cartilage of the 7th rib.

The xiphoid process forms with the body of the sternum synchondrosis of the xiphoid process, synchondrosis xiphosternaiis. By old age, the xiphoid process, ossified, fuses with the body of the sternum.

Sometimes above the manubrium of the sternum, in the thickness of the hyoid muscle group or in the medial leg of the sternocleidomastoid muscle, 1-3 pectoral claws, ossa suprastemalia, are located. They articulate with the manubrium of the sternum.

1 - jugular notch; A - 1st rib; B - II rib:
2 - clavicular notch; 1 - tubercle of the rib;
3 - manubrium of the sternum; 2 - rib angle;
4 - rib notches; 3 - rib neck;
5 - body of the sternum; 4 - rib head;
6 - xiphoid process 5 - rib body

The chest, compares thoracis, consists of the thoracic spine, ribs (12 pairs) and sternum.

The thorax forms the chest cavity, cavitas thoracis, which has the shape of a truncated cone, with its wide base facing downwards and its truncated apex facing upwards. 8 The thorax is distinguished by the anterior, posterior and lateral walls, the upper and lower openings, which limit the thoracic cavity.

The anterior wall is shorter than the other walls, formed by the sternum and cartilage of the ribs. Positioned obliquely, it protrudes more anteriorly with its lower sections than with its upper ones. The posterior wall is longer than the anterior one, formed by the thoracic vertebrae and sections of the ribs from the heads to the corners; its direction is almost vertical.

On the outer surface of the posterior wall of the chest, between the spinous processes of the vertebrae and the corners of the ribs, two grooves are formed on both sides - dorsal grooves; The deep muscles of the back lie about the peak. On the inner surface of the chest, between the protruding vertebral bodies if pefiep, two grooves are also formed - pulmonary grooves, sulci pulmonales; they are adjacent to the vertebral part of the costal surface of the lungs.

The lateral walls are longer than the front and back, formed by the bodies of the ribs and are more or less convex.

The spaces bounded above and below by two adjacent ribs, in front by the lateral edge of the sternum and behind by the vertebrae, are called intercostal spaces. spatia intercostalia; they are made of ligaments, intercostal muscles and membranes.

The chest, compares thoracis, bounded by the indicated walls, has two openings - upper and lower, which are called apertures.

The upper aperture of the chest, area thoracis superior, is smaller than the lower one, limited in front by the upper edge of the manubrium, on the sides by the first ribs and behind by the body of the first thoracic vertebra. It has a transverse oval shape and is located in a plane inclined from back to front and downwards. The upper edge of the chest manubrium™ is located at the level of the gap between the II and III thoracic vertebrae.

The lower aperture of the chest, apertura thoracis inferior, is limited in front by the xiphoid process and the costal arch formed by the cartilaginous ends of the false ribs, on the sides by the free ends of the XI and XII ribs and the lower edges of the XII ribs, and behind by the body of the XII thoracic vertebra.

The costal arch, arcus costalis, at the xiphoid process forms an open substernal angle, angulus infrasternal "is.

The shape of the chest varies from person to person (flat, cylindrical or conical). In persons with a narrow chest, the inframammary angle is sharper and the intercostal spaces are wider, and the chest itself is longer than in persons with a wide chest. The chest in men is longer, wider and more cone-shaped than in women. The shape of the chest also depends from age.