Intercostal space: Difference between revisions

Intercostal space
Intercostal space
	Intercostal spaces, viewed from the right.
	Sternocostal and interchondral articulations. Anterior view.
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Identifiers
Latin	spatium intercostale
TA98	A02.3.04.007
TA2	1102
FMA	12243
	Anatomical terminology [edit on Wikidata]

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The intercostal space (ICS) is the anatomic space between two ribs (Lat. costa). Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it.^[1]

Structures in intercostal space

several kinds of intercostal muscle
intercostal arteries and intercostal veins
intercostal lymph nodes
intercostal nerves

Order of components

Muscles

There are 3 muscular layers in each intercostal space, consisting of the external intercostal muscle, the internal intercostal muscle, and the thinner innermost intercostal muscle.^[2]^[3] These muscles help to move the ribs during breathing.^[4]

Neurovascular bundles

Neurovascular bundles are located between the internal intercostal muscle and the innermost intercostal muscle.^[3] The neurovascular bundle has a strict order of vein-artery-nerve (VAN), from top to bottom.^[2] This neurovascular bundle runs high in the intercostal space, and the smaller collateral neurovascular bundle runs just superior to the lower rib of the space (in the order NAV from superior to inferior). Invasive procedures such as thoracentesis are performed with oblique entry of the instrument, directly above the upper margin of the relevant rib, to avoid damaging the neurovascular bundles.^[2]

Nerves

In reference to the muscles of the thoracic wall, the intercostal nerves and vessels run posterior to the internal intercostal muscles: therefore, they are generally covered on the inside by the parietal pleura, except when they are covered by the innermost intercostal muscles, innermost intercostal membrane, subcostal muscles or the transversus thoracis muscle.

References

^ Troyer, A. D., Kelly, S., Macklem, P. T., & Zin, W. A. (1985). Mechanics of intercostal space and actions of external and internal intercostal muscles. Journal of Clinical Investigation, 75(3), 850-857. doi:10.1172/jci111782
^ ^a ^b ^c Jacob, S. (January 1, 2008), Jacob, S. (ed.), "Chapter 3 - Thorax", Human Anatomy, Churchill Livingstone, pp. 51–70, doi:10.1016/b978-0-443-10373-5.50006-3, ISBN 978-0-443-10373-5, retrieved November 16, 2020
^ ^a ^b Rakovich, George; Fréchette, Éric; Deslauriers, Jean (January 1, 2010), Lewis, Michael I.; McKenna, Robert J.; Falk, Jeremy A.; Chaux, George E. (eds.), "8 - Thoracic Surgical Anatomy and Procedures", Medical Management of the Thoracic Surgery Patient, Philadelphia: W.B. Saunders, pp. 95–105, doi:10.1016/b978-1-4160-3993-8.00008-8, ISBN 978-1-4160-3993-8, retrieved November 16, 2020
^ Watkins, James; Mathieson, Ian (January 1, 2009), Watkins, James; Mathieson, Ian (eds.), "CHAPTER 3 - The skeleton", The Pocket Podiatry Guide: Functional Anatomy, Edinburgh: Churchill Livingstone, pp. 67–105, doi:10.1016/b978-0-7020-3032-1.00003-2, ISBN 978-0-7020-3032-1, retrieved November 16, 2020

External links

Anatomy figure: 18:04-00 at Human Anatomy Online, SUNY Downstate Medical Center - "Structural organization within an intercostal space."
Anatomy photo:18:01-0108 at the SUNY Downstate Medical Center - "Thoracic Wall: The Anterior Thoracic Wall"

This anatomy article is a stub. You can help Wikipedia by expanding it.

[1] Troyer, A. D., Kelly, S., Macklem, P. T., & Zin, W. A. (1985). Mechanics of intercostal space and actions of external and internal intercostal muscles. Journal of Clinical Investigation, 75(3), 850-857. doi:10.1172/jci111782

[:0-2] Jacob, S. (January 1, 2008), Jacob, S. (ed.), "Chapter 3 - Thorax", Human Anatomy, Churchill Livingstone, pp. 51–70, doi:10.1016/b978-0-443-10373-5.50006-3, ISBN 978-0-443-10373-5, retrieved November 16, 2020

[:1-3] Rakovich, George; Fréchette, Éric; Deslauriers, Jean (January 1, 2010), Lewis, Michael I.; McKenna, Robert J.; Falk, Jeremy A.; Chaux, George E. (eds.), "8 - Thoracic Surgical Anatomy and Procedures", Medical Management of the Thoracic Surgery Patient, Philadelphia: W.B. Saunders, pp. 95–105, doi:10.1016/b978-1-4160-3993-8.00008-8, ISBN 978-1-4160-3993-8, retrieved November 16, 2020

[4] Watkins, James; Mathieson, Ian (January 1, 2009), Watkins, James; Mathieson, Ian (eds.), "CHAPTER 3 - The skeleton", The Pocket Podiatry Guide: Functional Anatomy, Edinburgh: Churchill Livingstone, pp. 67–105, doi:10.1016/b978-0-7020-3032-1.00003-2, ISBN 978-0-7020-3032-1, retrieved November 16, 2020

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@@ Line 1: / Line 1: @@
+{{Short description|Anatomic space between two ribs}}
-{{Infobox Anatomy |
+{{Use American English|date = January 2019}}
-  Name         = {{PAGENAME}} |
+{{Use mdy dates|date = January 2019}}
-  Latin        = spatium intercostale |
+{{Infobox anatomy
-  GraySubject  = 28 |
-  GrayPage     = 123 |
+| Name        = Intercostal space
-  Image        = Gray530.png |
+| Latin       = spatium intercostale
+| Image       = Gray530.png
-  Caption      = Intercostal spaces, viewed from the left. |
+| Caption     = Intercostal spaces, viewed from the right.
-  Image2       = Gray315.png |
-  Caption2     = Sternocostal and interchondral articulations. Anterior view. |
+| Image2      = Gray315.png
+| Caption2    = Sternocostal and interchondral articulations. Anterior view.
-  System       = |
+| System      =
-  MeshName     = |
-  MeshNumber   = |
-  DorlandsPre  = s_16 |
-  DorlandsSuf  = 12746516  |
 }}
-The '''intercostal space''' (ICS) is the space between two ribs (Lat. costa). Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it.
+The '''intercostal space''' ('''ICS''') is the [[spatium|anatomic space]] between two [[Rib cage|ribs]] (Lat. costa). Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it.<ref>Troyer, A. D., Kelly, S., Macklem, P. T., & Zin, W. A. (1985). Mechanics of intercostal space and actions of external and internal intercostal muscles. Journal of Clinical Investigation, 75(3), 850-857. doi:10.1172/jci111782</ref>
-==Importance of intercostal space==
+== Structures in intercostal space ==
-Because the chest is protected by the [[rib cage]], the intercostal spaces are important access points in medicine, for example:
-* access for surgical procedures, e.g. [[Segmental resection|resection]] of (part of) the lung ([[pneumonectomy]]), or insertion of a [[chest tube]]
-* performing [[pericardiocentesis]]
-* penetrating trauma of the [[thorax]]
-* proper lead placement for V1 through V6 in an [[electrocardiogram]]
-* for percussion and auscultation of underlying structures, e.g. sites for [[heart auscultation]], [[Percussion (medicine)|percussion]] in [[Traube's space]], etc.
-==Structures in intercostal space==
 * several kinds of [[intercostal muscle]]
-* [[intercostal arteries]] and associated [[veins]]
+* [[intercostal arteries]] and [[intercostal veins]]
-* [[lymphatics]]
+* [[intercostal lymph nodes]]
-* [[nerves]]
+* [[intercostal nerves]]
-==Order of components==
+== Order of components ==
-Comprehensive insight in the anatomy of the intercostal spaces is mandatory for everyone who practices medicine. One particular concept is that the [[neurovascular bundle]] has a strict order: V-A-N, or vein-artery-nerve, from top to bottom (as illustrated). This neurovascular bundle runs high in the intercostal space: therefore, the intercostal space should be penetrated as low as possible by invasive procedures.
+=== Muscles ===
-In reference to the muscles of the thoracic wall, the intercostal nerves and vessels run just behind the internal intercostal muscles: therefore, they are generally covered on the inside by the parietal [[pleura]], except when they are covered by the innermost intercostal muscles, [[subcostal muscles]] or the [[transversus thoracis muscle]].
+There are 3 [[Muscular layer|muscular layers]] in each intercostal space, consisting of the [[External intercostal muscles|external intercostal muscle]], the [[Internal intercostal muscles|internal intercostal muscle]], and the thinner [[innermost intercostal muscle]].<ref name=":0">{{Citation|last=Jacob|first=S.|title=Chapter 3 - Thorax|date=2008-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780443103735500063|work=Human Anatomy|pages=51–70|editor-last=Jacob|editor-first=S.|publisher=Churchill Livingstone|language=en|doi=10.1016/b978-0-443-10373-5.50006-3|isbn=978-0-443-10373-5|access-date=2020-11-16}}</ref><ref name=":1">{{Citation|last=Rakovich|first=George|title=8 - Thoracic Surgical Anatomy and Procedures|date=2010-01-01|url=http://www.sciencedirect.com/science/article/pii/B9781416039938000088|work=Medical Management of the Thoracic Surgery Patient|pages=95–105|editor-last=Lewis|editor-first=Michael I.|place=Philadelphia|publisher=W.B. Saunders|language=en|doi=10.1016/b978-1-4160-3993-8.00008-8|isbn=978-1-4160-3993-8|access-date=2020-11-16|last2=Fréchette|first2=Éric|last3=Deslauriers|first3=Jean|editor2-last=McKenna|editor2-first=Robert J.|editor3-last=Falk|editor3-first=Jeremy A.|editor4-last=Chaux|editor4-first=George E.}}</ref> These muscles help to move the ribs during [[breathing]].<ref>{{Citation|last=Watkins|first=James|title=CHAPTER 3 - The skeleton|date=2009-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780702030321000032|work=The Pocket Podiatry Guide: Functional Anatomy|pages=67–105|editor-last=Watkins|editor-first=James|place=Edinburgh|publisher=Churchill Livingstone|language=en|doi=10.1016/b978-0-7020-3032-1.00003-2|isbn=978-0-7020-3032-1|access-date=2020-11-16|last2=Mathieson|first2=Ian|editor2-last=Mathieson|editor2-first=Ian}}</ref>
+=== Neurovascular bundles ===
+Neurovascular bundles are located between the internal intercostal muscle and the innermost intercostal muscle.<ref name=":1" /> The [[neurovascular bundle]] has a strict order of [[Intercostal veins|vein]]-[[Intercostal arteries|artery]]-[[Intercostal nerves|nerve]] (VAN), from top to bottom.<ref name=":0" /> This neurovascular bundle runs high in the intercostal space, and the smaller collateral neurovascular bundle runs just superior to the lower rib of the space (in the order NAV from superior to inferior). Invasive procedures such as [[thoracentesis]] are performed with oblique entry of the instrument, directly above the upper margin of the relevant rib, to avoid damaging the neurovascular bundles.<ref name=":0" />
+==== Nerves ====
+In reference to the muscles of the [[thoracic wall]], the intercostal nerves and vessels run posterior to the internal intercostal muscles: therefore, they are generally covered on the inside by the parietal [[pleura]], except when they are covered by the innermost intercostal muscles, innermost intercostal membrane, [[subcostal muscles]] or the [[transversus thoracis muscle]].
+== References ==
+<references />
+== External links ==
-==External links==
-* {{MUNAnatomy|thorax/space}}
-* {{eMedicineDictionary|Intercostal+space}}
 * {{SUNYAnatomyFigs|18|04|00}} - "Structural organization within an intercostal space."
 * {{SUNYAnatomyLabs|18|01|01|08}} - "Thoracic Wall: The Anterior Thoracic Wall"
 {{Bones of torso}}
+{{Authority control}}
-[[Category:Thorax]]
+[[Category:Thorax (human anatomy)]]
-{{anatomy-stub}}
+{{anatomy-stub}}
-[[de:Intercostalraum]]
-[[es:Espacio intercostal]]
-[[hr:Međurebreni prostor]]
-[[pt:Espaço intercostal]]