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CHAPTER 21

The Musculature of
the Thoracic Wall
THE EXTRINSIC MUSCLES The scalene muscles elevate first and second
ribs during deep inspiration.
These muscles are attached to the external surface
of thoracic cage. They help in the movements of
THE INTRINSIC MUSCLES
shoulder girdle, upper extremity and the neck.
Some of these muscles also help to a great The intrinsic muscles consist of three layers of
extent in the respiratory movements of thoracic intercostal muscles, that fill up the intercostal
cage. spaces.
I. The pectoralis major connects medial half of a. The outer layer has external intercostal muscles
clavicle, upper six costal cartilages and front (Fig. 21.1).
of sternum to the lateral lip of bicipital groove b. The intermediate layer has internal intercostal
of humerus. muscles
The muscle elevates upper six ribs during c. The inner layer is incomplete and consists of
forced inspiration. i. Sternocostals (transversus thoracic)
II. The pectoralis minor connects third, fourth, and anteriorly
fifth ribs to coracoid process of scapula. ii. Innermost intercostal (intercostalis intimus)
It helps to elevate third, fourth, and fifth located in middle two-fourth part of inter-
ribs during deep inspiration. costal space
III.The sterno-cleidomastoid muscle passes from iii. Subcostalisposteriorly.
manubrium sterni and medial one-third of
clavicle to mastoid process and superior nuchal The External Intercostal Muscles
line of skull.
There are eleven pairs of external intercostals filling
It elevates manubrium sterni
up all eleven intercostal spaces.
IV. The scalene muscles
a. The scalenus anterior connects anterior
tubercles of transverse processes of third
to sixth cervical vertebrae to scalene
tubercle of first rib
b. The scalenus medius connects posterior
tubercles of transverse processes of second
to sixth cervical vertebrae to first rib
c. The scalenus posterior (when present)
connects posterior tubercles of transverse
processes of fifth and sixth cervical verte- Fig. 21.1: Part of thoracic wall showing
brae to second rib. three layers of muscles
The Musculature of the Thoracic Wall 195

Attachments Attachments
UpperSharp inferior border of the rib Upperthe floor of the costal groove of
above the rib above
LowerOuter edge of thick superior border Lowermiddle part of thick superior border
of the rib below of rib below
Extent Extent
AnteriorlyThe external intercostal extends AnteriorlyThe muscle extends up to the
up to costo-chondral junction. It is replaced side of sternum
in between the costal cartilages by anterior PosteriorlyIt extents up to the angle of
(external) intercostal membrane the rib, beyond that it is replaced by internal
PosteriorlyThe muscle extends up to the (posterior) intercostal membrane
posterior end of the intercostal space. Direction of fibers is upwards, forwards and
Direction of fibersis downwards forwards medially in anterior part of chest wall, nearly at
and medially in front of chest wall. right angles to the fibers of external intercostal
Nerve supplyis by the corresponding inter- muscle.
costal nerve (i.e. ventral ramus of thoracic Nerve supplyis by the corresponding inter-
nerve) costal nerve (ventral ramus of thoracic nerve).
ActionsElevation of the rib during inspiration. Actions
i. The intra-cartilaginous part helps to elevate
The Internal Intercostal Muscles the anterior ends of the rib.
There are eleven pairs of internal intercostal ii. The rest of the muscle helps in depression
muscles, that fill up all eleven intercostal spaces. of the rib (Fig. 21.2).

Fig. 21.2: TS thoracic wall showing intercostal muscles and intercostal arteries
196 Essentials of Human Anatomy

The Innermost Intercostal


(Intercostalis Intimus)
This muscle of the inner layer of thoracic wall
covers only middle two-fourth part of the intercostal
space.
Attachments
UpperInner surface of the upper rib
above costal groove
LowerInner edge of the thick upper border
of the rib below
ExtentThe muscle covers only middle two-
fourth part of the intercostal space
Direction of fiberssame as internal intercostal
Nerve supplyis by the corresponding inter-
costal nerve (ventral ramus of thoracic nerve)
Fig. 21.3: The sternocostalis muscle
Actions
i. Functionally the muscle is part of internal
intercostal. The innermost intercostal is The Subcostalis
separated from the internal intercostal by
The subcostalis is a part of inner layer of intercostal
intercostal vessels and nerve (neuro-vascular
plane) muscles, that is attached to posterior part of ribs
ii. The three intercostal muscles also help to as digitations. The subcostalis is better developed
prevent bulging in and bulging out of in lower part of thoracic cage.
intercostal spaces during inspiration. Thus Attachments
they maintain the integrity of intercostal UpperInternal surface of one rib near its
spaces. angle
LowerInternal surface of second or third
The Sternocostalis rib below
(Transversus Thoracis) Direction of fibersSame as internal intercostal
The sternocostalis is a part of inner layer of Nerve supplyis by corresponding intercostal
intercostal muscles, that is attached to sternum (Fig. nerves
21.3). ActionsThe subcostalis depresses posterior
OriginPosterior surface of lower third of parts of ribs during expiration.
body sternum
Muscle bellyconsists of digitations that pass MUSCLES CONNECTING THORACIC
upwards and a little laterally towards costal CAGE TO VERTEBRAL COLUMN
cartilages I. The Serratus Posterior Superior
InsertionInner surface second to sixth costal
cartilages It is a thin quadrilateral muscle covering upper
Nerve supplyThird to sixth intercostal nerves posterior part of thoracic cage.
(ventral rami of thoracic nerves) Origin
ActionsIt depresses anterior ends of second Lower part of ligamentum nuchae
to sixth ribs. Spine of seventh cervical vertebrae
The Musculature of the Thoracic Wall 197

Spines of upper two or three thoracic III. The Levatores Costarum


vertebrae These are twelve pairs of strong bundles of muscles
InsertionUpper border and external surfaces fibers connecting vertebrae with the posterior parts
of second to fifth ribs of the ribs.
Nerve supplySecond and third intercostal Origin: Seventh cervical to eleventh thoracic
nerves (Ventral rami of second and third thoracic transverse processes at their tips.
nerves) Insertion: Upper edge and external surface of
ActionsThe muscles elevates second to fifth neck of the rib below.
ribs during inspiration. Nerve supply: Lateral branches of dorsal rami
of corresponding thoracic spinal nerves.
II. The Serratus Posterior Inferior Actions: The levatores costarum elevate
posterior parts of the ribs.
It is also a thin quadrilateral muscle covering lower
posterior part of thoracic cage. THE THORACIC DIAPHRAGM
Origin
The thoracic diaphragm is a musculo-tendinous
Spines of lower two or three thoracic
bidomed structure, that separates thoracic cavity
vertebrae
from the abdominal cavity.
Spines of upper two or three lumbar The diaphragm completely fills up the thoracic
vertebrae through lumbar fascia outlet.
InsertionInferior border and outer surfaces Origin (Fig. 21.4)
of lower four ribs a. Sternal is by two slips from inner surface
Nerve supplyVentral rami of ninth to twelfth of xiphisternum.
thoracic spinal nerves b. Costal is by slips from inner surface of
ActionsIt depresses lower four ribs. lower six costal cartilages of both sides.

Fig. 21.4: The thoracic diaphragm


198 Essentials of Human Anatomy

c. Lumbar is by means of two cruramus- Insertion


culo-tendinous structuresand two paired The muscular fibers from all sidesi.e. from
ligaments. sternum, costal cartilages and the two crura,
i. The right crus is larger and is attached ascend upwards and medially and are inserted
to front of bodies of upper three lumbar on Central tendona fibrous aponeurosis in
vertebrae and intervertebral discs. the center, from all sides.
ii. The left crus is smaller and is attached Nerve supply
to front of bodies of upper two lumbar Motor fibers are supplied by two phrenic
vertebrae and intervertebral disc. nerves (C3, C4, C5)
The two ligaments are: Sensory (proprioceptive fibers)
i. Lateral arcuate ligament (lateral lumbo- For central portion by the phrenic nerves
costal arch) is attached from tip of first
For peripheral part of the lower five
lumbar transverse process to lower border
intercostals and subcostals (T7 to T12
of twelfth rib.
ventral rami)
ii. Medial arcuate ligament (Medial lumbo-
Actions
costal arch) is attached from the side of
crus to transverse process of first lumbar i. The thoracic diaphragm is the main muscle
vertebra. of inspiration. When it contracts, it descends
Muscle belly and increases the vertical diameter of
The muscular fibers from the three origins thoracic cavity.
ascend upwards and converge medially ii. The diaphragm helps in all voluntary expul-
towards the central tendon. sive efforts, e.g. micturition, defecation,
The diaphragm forms two domes or coughing, sneezing, vomiting and parturition
cupolae. The right dome is a little higher (in females).
due to liver below it. iii. The diaphragm helps to maintain and control
The fibers of right crus cross towards left the intra-abdominal pressure.
of the median plane and form a sling-like iv. The fibers of right crus of diaphragm exer-
elliptical opening for giving passage to the cise a sphincteric control over esophageal
esophagus. opening (Table 21.1).

Table 21.1: Major openings of diaphragm

Inferior vena caval opening Esophageal opening Aortic opening


1. Position In central tendon, between Muscular part of diaphragm Behind median arcuate ligament

2. Vertebral level

3. Shape
right and central leaflet
8th thoracic vertebra

Quadrangular
surrounded by fibre of right crus
10th thoracic vertebra

Elliptical
{ of diaphragm
12th thoracic vertebra (lower
border)
Oval
4. Structures Inferior vena cava Esophagus Descending aorta
passing
through { Branches of right phrenic
nerve
{ Anterior and posterior gastric nerves
Branches of left gastric artery
{ Thoracic duct
Azygos vein
Some lymphatics
5. Effect of con- The inferior vena caval Esophageal opening is closed No effect on aortic opening
traction of opening is dilated (venous
diaphragm return takes place)
The Musculature of the Thoracic Wall 199

Other Structures Passing movements of paralyzed hemidiaphragm,


Through Diaphragm resulting in poor oxygenation of blood.
I. The superior epigastric artery passes between II. Hiccups are recurrent spasms of diaphragm,
sternal and costal slips. phrenicotomy is done sometimes to relieve
II. The musculo phrenic artery passes between chronic case of hiccups.
slips of seventh and eighth costal cartilages. III. Diaphragmatic hernia is a rare type of hernia
III. The lower five intercostal nerves (T7 to T11) that occurs due to a defect in development
pass between costal slips. of diaphragm.
IV. The subcostal vessels and nerve pass out deep
to lateral arcuate ligament. THE MOVEMENTS OF RESPIRATION
V. The sympathetic trunk passes out deep to
medial arcuate ligament. The respiratory movements can be divided into:
VI. The three splanchnic nervesgreater, lesser The costsal movements
and lowerpierce the crus of diaphragm. The diaphragmatic movements
VII. The hemiazygos vein pierces left crus of
diaphragm. The Costal Movements
Development a. Normal Costal Inspiration
The thoracic diaphragm develops from the
The external intercostals and intra-chondral
following embryonic structures
parts of internal intercostals contract and move
1. Septum transversum-(median part of
the ribs upwards and outwards (bucket-handle
secondary mesoderm) that forms the central
movements).
tendon of diaphragm.
The concave inner surface of ribs is also turned
2. Two pleuro-peritoneal membranes.
outwards. By these movements the transverse
3. Muscular components from lateral and
diameter of thoracic cavity is increased.
dorsal body walls.
Simultaneously with movements of ribs, the
4. Mesentery of esophagus in which the
crura of diaphragm develop. sternum moves forwards and upwards, thereby
increasing the anteroposterior diameter of thora-
Anomalies cic cavity (pump-handle type of movements).
By increasing transverse and anteroposterior
Incomplete fusion of developmental parts may diameter of thorax, the intrathoracic pressure
result in congenital defects or anomalies in becomes lower and lungs expand, thus bringing
diaphragm. more air by inspiration.
a. Incomplete closure of pleuro-peritoneal canal
results in diaphragmatic hernia. It is more b. Forced Costal Inspiration
common on left side.
b. Foramen of Morgagni is result of incomplete Apart from the intercostal, pectoral muscles assist
closure of sterno-costal triangle, between in maximal elevation of ribs. The sterno-mastoid
sternal and costal origins. This is also a site for and the scalene muscles further elevate the first rib
rare type of diaphragmatic hernia. and manubrium sterni. These muscles, therefore,
help in further increasing the transverse and
Applied Anatomy anteroposterior diameters of thoracic cavity.
Forced inspiration is required for ventilating a
I. The phrenic nerve lesion paralyses half the larger part of lung for greater oxygenation of
diaphragm. It may lead to paradoxical blood.
200 Essentials of Human Anatomy

c. Normal Costal Expiration Active diaphragmatic movements lower the


dome of diaphragm as much as 10.0 cm.
No muscular effort is needed to expel the air from
During diaphragmatic contraction, the
the lungs.
abdominal contents are displaced.
Quiet (normal) expiration is done mainly by the
This movement is helped by slight relaxation of
elastic recoil of the costal cartilages and the
abdominal wall muscles.
lungs.
External elastic recoilis provided by the costal
b. The Diaphragmatic Expiration
cartilages, that are deformed during normal quiet
inspiration. They, now, turn back to their normal The abdominal wall muscles act as antagonists
shape. Gravity also helps in this process. This to diaphragm. When they contract, they push
elastic recoil of costal cartilages decreases as the abdominal viscera upwards, thus they stretch
age advances. the diaphragm in thoracic cavity and reduce
Internal elastic recoilis provided by the lungs. the vertical diameter and volume of thoracic
The elastic fibers of interstitial tissue between cavity.
the alveoli of lungs, tend to cause shrinkage of
The abdominal musculature comes into effect
lung tissue.
when respiratory requirements are more than
The tension between two surfacesvisceral and
parietal pleuraseparated by a thin film of fluid normal.
produces a very high degree of adhesive effect In erect posture, gravity tends to lower the
(surface tension). This force called intratho- diaphragm.
racic pressure tends to pull the chest wall But when one is in supine position, the gravity
inwards. tends to push up the abdominal viscera and
Diseases like emphysema, that reduce the stretch the diaphragm. So when a person has
elasticity of lung tissue, affects this type of respiratory difficulty, he has to be propped up
movements. for proper ventilation of lungs.
The normal balance between the costal and
d. Forced Costal Expiration diaphragmatic movements depends upon many
Forced costal expiration is caused by additional factors like sex, body type, profession, state of
muscular effort. health and clothing.
The internal intercostal muscles contract and The children and elderly people breathe more
decrease the transverse and anteroposterior by the abdominal type of respiration.
diameters of thoracic cavity. Fat persons and women in advanced pregnancy
Quadratus lumborum muscle lowers and fixes cannot have abdominal type of respiration, so
the twlfth rib so that thoracic cage can be they respire mainly due to the movements of
depressed effectively. ribs (costal respiration).
The Diaphragmatic Movements Applied Anatomy
a. The Diaphragmatic Inspiration
1. Pneumothorax: A penetrating wound or rupture
The contraction of diaphragm lowers the level of of pulmonary tissue or tear of pleura allows the
its two domes, thereby increasing the vertical entry of air into pleural cavity, thereby abolishing
diameter of thoracic cavity. This decreases the intra- the negative intra-thoracic pressure and results
thoracic pressure. in collapse of lung.
The Musculature of the Thoracic Wall 201

[A negative intrathoracic pressure (as compared withstand the decrease in intra-thoracic


to the atmospheric pressure) and surface tension pressure and during expiration the flat
normally holds the lungs against thoracic wall.] portion moves outwards (paradoxical respi-
a. A sucking pneumothorax is accompanied by ratory movements). This results in reduced
hyper-expansion of chest wall on normal ventilation of lungs.
side. This causes mediastinal flutter, a slight 4. The respirators
shift of mediastinal contents towards normal Negative pressure devices of iron lung or
side during inspiration and injured side respiratory lower the extra thoracic and
during expiration. intra-pulmonary pressure below the
atmospheric pressure thereby simulating
b. A tension penumothorax is created when
natural negative pressure breathing.
due to nature of wound air is sucked in
Positive pressure devices elevate the
during each thoracic expansion, without atmospheric pressure above normal, so that
expelling out the air. The resultant air is forced inside the lung.
pneumothorax pushes mediastinal contents
significantly towards the normal side, The Blood Vessels of the Thoracic Wall
thereby interfering with vital capacity of
The Arteries
normal lungs.
2. Pleural effusion: Fluid may collect in the pleural a. The internal thoracic artery supplies anterior
cavity due to part of the thoracic wall (Fig. 21.5)
a. Inflammation of pleura (pleurisy with OriginThe internal thoracic artery arises
effusion) from inferior surface of first part of sub-
clavian artery.
b. Secondary to congestive heart failure, as a
part of generalized edema of body.
Such collections reduce the vital capacity
of lung and thus reducing the
oxygenation taking place in the lung.
As little as 500 ml of fluid may be seen
in X-ray of the chest as it obscures the
costo-diaphragmatic angle.
The fluid in the pleural cavity can be
aspirated out if it causes embarrassment
to function of the lung.
3. Fracture of rib may penetrate thoracic wall,
tear visceral pleura and cause pneumothorax
Tearing of associated blood vessels (inter-
costal vessels) may cause hemothorax
(collection of blood in the pleural cavity).
Fracture of several ribs in two locations
(anterior and posterior) diminishes the
structural integrity of thoracic cage. It leads
to flat chest. The thoracic wall cannot Fig. 21.5: The internal thoracic artery
202 Essentials of Human Anatomy

Course margin, supplying inter-costal muscles


The artery descends behind internal and diaphragm.
jugular and right brachio-cephalic vein b. The intercostal arteries: The intercostal arteries
to enter thoracic inlet behind first costal supply the thoracic wall
cartilage. The upper nine intercostal spaces have two
As it enters thorax, the phrenic crosses anterior and one posterior intercostal arteries.
in front of the artery from lateral to The lower two intercostal spaces are small
medial side. and have only one posterior intercostal
The internal thoracic artery descends artery.
deep to the upper six costal cartilages I. The anterior intercostal arteries are two
and intercostal spaces, lying about superior and inferior-in each space
1.2 cm from side of sternum. Origin
TerminationThe artery divides into its two The anterior intercostal arteries in upper
terminal branchessuperior epigastric and six spaces are branches of internal
musculophrenicin the sixth intercostal thoracic artery
space. In seventh, eighth and ninth space they
Branches are branches from musculophrenic
i. The pericardio-phrenic branch: A slender artery.
artery that accompanies phrenic nerve Course
and after supplying pericardium supplies The anterior, superior intercostal artery
the diaphgram. runs in the costal groove between inter-
ii. The mediastinal branches supply lymph costal vein above the intercostal nerve
nodes and other structures in media- below. The anterior inferior intercostal
stinum artey runs along the upper border of the
iii. The pericardial branches supply the rib below. The intercostal vessels and
fibrous pericardium. nerve lie in the neuro-vascular plane of
iv. The sternal branches supply the sternum thoracic wall between internal intercostal
v. The paired anterior intercostal bran- and innermost intercostal.
chessuperior and inferiorfor upper The anterior intercostal arteries are
six intercostal spaces supply anterior part smaller and supply only anteior one third
of thoracic wall part of intercostal space.
vi. The perforating branches accompany The anterior superior intercostal artery
second to sixth intercostal nerves anastomoses with the posterior inter-
In second, third and fourth spaces in costal artery.
females the perforating branches are large The anterior inferior intercostal artery
and supply the mammary gland. anastomoses with the collateral branch
vii. The superior epigastric artery enters the of posterior intercostal artery.
rectus sheath in anterior abdominal wall, II. The posterior intercostal arteries are larger and
between sternal and costal slips of orign supply nearly two-third part of the intercostal
of diaphragm. space.
viii. The musculo-phrenic artery passes Origin (Fig. 21.6)
between seventh and eighth costal slips In upper two spaces, the posterior inter-
of diaphrarm and runs along costal costal arteries are branches of superior
The Musculature of the Thoracic Wall 203

meninges and also give radicular branch


of spinal cord.
ii. The collateral branch supplies the inter-
costal muscles
iii. The small muscular branches are also
given
iv. The lateral cutaneous branch accom-
panies the lateral cutaneous nerve. In
females, the lateral cutaneous branch in
second, third and fourth spaces supply
mammary gland.
v. The right bronchial artery arises from
the first right aortic intercostal artery.

The Veins
a. The internal thoracic artery is accompanied by
a pair of venae comitantes up to the lower
border of third costal cartilage
Above that, there is only one internal
thoracic vein, that ascends, medial to internal
thoracic artery.
Fig. 21.6: The intercostal arteries
The internal thoracic vein ends in brachio-
cephalic vein.
intercostal branch of costo-cervical The internal thoracic veins receive tribu-
trunk for first part of subclavian artery. taries corresponding to the branches of
In lower nine intercostal spaces, the internal thoracic artery.
posterior intercostal arteries are branches b. The intercostal veins
of descending thoracic aorta. I. The anterior intercostal veins are two in each
Course upper nine intercostal spaces.
The posterior intercostal artery runs in These veins accompany the corres-
the costal groove with intercostal vein ponding arteries, lying in the neuro-
above and intercostal nerve below, in the vascular plane of thoracic wall.
neuro-vascular plane of thoracic wall. They drain venous blood from anterior
It gives a collateral branch, near the part of thoracic wall.
angle of rib, that runs along the upper In upper six intercostal spaces, the
border of rib below and anastomoses anterior intercostal veins end in internal
with anterior inferior intercostal artery. thoracic veins.
The posterior intercostal artery anasto- In lower three intercostal spaces, the
moses with anterior superior intercostal anterior intercostal veins end in venae
artery comitantes of musculophrenic artery.
Branches II. The posterior intercostal veins are one in
i. The dorsal branch supplies the muscles each eleven intercostal spaces, accom-
of the back and gives a spinal branch panying posterior intercostal artery (Fig.
that enters vertebral canal to supply 21.7).
204 Essentials of Human Anatomy

anterior to arch of aorta and ends in left


brachiocephalic vein.
The fifth, sixth, seventh, and eighth
posterior intercostal veins join to form
accessory hemiazygos vein that ends
in azygos vein.
The ninth, tenth, and eleventh posterior
intercostal veins join the hemiazygos
vein that also ends in the azygos vein.

The Nerve Supply of the Thoracic Wall


The muscles and the skin of the thoracic wall
are supplied by the intercostal nerves (ventral
rami of first to eleventh thoracic spinal nerves).
A typical intercostal nerve is one that supplies
the skin and muscles of the thoracic wall only.
Third to sixth intercostal nerves are typical.
The first intercostal nerve mainly joins the
branchial plexus.
The second intercostal nerve gives an inter-
Fig. 21.7: The posterior intercostal veins costo-brachial nerve that supplies the skin of
The posterior intercostal veins, run in upper part medial side of arm.
the costal grooves of the ribs above the The seventh to eleventh intercostal nerves after
intercostal artery, lying in the neuro- supplying thoracic wall, enter anterior abdominal
vascular plane of the thoracic wall. wall to supply muscles and skin.
They drain venous blood from most part
of intercostal space and receives The Typical intercostal Nerve (Fig. 21.8)
tributaries corresponding to the branches BeginningThe typical intercostal nerve begins
of posterior intercostal arteries. near the inter-vertebral foramen, where the spinal
On right side nerve divides into a ventral ramus and a dorsal
The first posterior intercostal vein ends ramus.
in the right brachiocephalic vein. CourseThe typical intercostal nerve enters
The second, third, and fourth posterior posterior part of intercostal space by passing
intercostal veins join to form right behind the intercostal vessels
superior intercostal vein that ends in
The nerve runs forwards in the costal groove
azygos veins.
below the intercostal artery and vein lying
The fifth to eleventh posterior intercostal
veins join the azygos vein. in the neuro-vascular plane of the thoracic
On left side wall between internal intercostal and
The first posterior intercostal vein ends innermost intercostal.
in left brachiocephalic vein. In anterior part of intercostal space, the
The second, third, and fourth posterior intercostal nerve passes in front of internal
intercostal veins join to form left thoracic vessels, pierces internal intercostal
superior intercostal vein that crosses muscle, anterior intercostal membrane,
The Musculature of the Thoracic Wall 205

Fig. 21.8: TS thoracic wall showing a typical intercostal nerve

pectoralis major and its fascia and comes border of rib below. It may rejoin the
out as the anterior cutaneous nerve. parent stem.
Branches b. Small muscular branches supply the
I. The communicating branches are two and three layers of intercostal muscles, sub-
connect the intercostal nerve to the corres- costalis and sterno-costalis.
ponding sympathetic ganglion.
III.The cutaneous branches are twolateral
a. The white ramus communicans (WRC)
cutaneous and anterior cutaneous.
lies laterally and contains preganglionic
a. The lateral cutaneous branches pierces
sympathetic fibers from the nerve to the
ganglion. the muscles along mid-axillary line and
b. The grey ramus communicans (GRC) divides into anterior and posterior
lies medially and contains postganglionic branches to supply skin of lateral part
sympathetic fibers from the ganglion to of thoracic wall.
the intercostal nerve. b. The anterior cutaneous branch pierces
II. The muscular branches are twocollateral the muscles, about 1.2 cm lateral to the
and smaller muscular branches sternum. It divides into a medial and a
a. The collateral branch is given near the lateral branch to supply skin of anterior
angle of the rib, and runs along the upper part of thoracic wall.