The bony basis of the segment is represented by the ribs, and the muscular basis is represented by the external and internal intercostal muscles, the neurovascular part consists of the intercostal nerve and intercostal vessels: from top to bottom - vein, artery,. nerve. Segments chest covered with soft tissues both inside and outside.

Topography: skin, subcutaneous fat, superficial fascia, pectoral fascia, muscles (pectoralis major or serratus anterior or latissimus dorsi), pectoral fascia, chest segment, intrathoracic fascia, tissue (prepleural, parapleural, pleural), costal pleura.

Treatment of purulent pleurisy:

Puncture pleural cavity.

Passive drainage according to Bulau.

Active aspiration.

Radical operations.

Puncture of the pleural cavity: in the 7-8 intercostal space. a puncture is made along the scapular or posterior axillary line along the upper edge of the rib chest wall a thick needle connected to a short rubber tube, which is clamped after removing each portion of pus.

Passive drainage, according to Bulau: a drainage tube connected to a jar from the Bobrov apparatus is inserted into the pleural cavity or a puncture in the 6-7 intercostal space (in adults with resection of the rib, but with preservation of the periosteum) along the midaxillary line using a thoracary, pus flows into the jar according to the law of communicating vessels.

Active aspiration: i.e., but a water jet pump is connected to a short tube, the pus flows out under the influence of negative pressure in the system, equal to 10-40 cm of water column.

46 Topography of the diaphragm

Along the right middle line, the dome of the diaphragm is located at the level of the 4th rib, and along the left middle line - at the 5th rib. The diaphragm is covered with serous membranes. On the side of the cavity, it is covered with the diaphragmatic pleura and partially with the pericardium. From the outside abdominal cavity the diaphragm is covered by the parietal peritoneum. The central part of the diaphragm is represented by the tendon center. The muscular section of the diaphragm consists of 3 parts: sternal, costal, lumbar. The sternal part begins from the posterior part of the xiphoid process. To the left of the xiphoid process between the sternum and costal parts there is a gap (described by Larrey) - the left sternocostal triangulation. To the right of the xiphoid process, between the sternum and costal parts of the diaphragm, there is a similar gap (described by Morgagni) - the right costosternal triangulation. The internal mammary artery passes through each of the slits. The lumbar part of the diaphragm is represented by powerful muscle bundles, forming 3 pairs of legs: internal, intermediate, lateral. Inner legs starting from the anterolateral surface of the bodies of 1-4 lumbar vertebrae. Going up, the inner legs converge, forming 2 holes. The first is at the level of the 7th-1st vertebrae and is called the aortic. The second is at the level of 11 degrees pos. and is called esophageal. Intermediate legs shorter and starting from the lateral part of the body of the 2nd vertebral belt. Lateral crura even shorter, they can start from the lateral surface of the body of the first or second vertebral belt. The descending aorta passes through the aortic opening, and the thoracic duct passes posteriorly and to the right. Through the esophageal opening, the cavity leaves the esophagus with the vagus nerves. On the left, between the internal and intermediate legs, the semi-zygos vein and splanchnic nerves pass. On the right, between similar legs, there is the azygos vein and celiac nerves. The sympathetic trunk passes between the intermediate and lateral crura on the left and right. Between the costal and waist sections of the diaphragm there are 2 triangles (described by Bokhdalik) - lumbocostal triangles. To the right of the midline in the tendon center of the diaphragm there is an opening through which the inferior vena cava passes. To the right of this opening, the branches of the right phrenic nerve pass through the tendinous center.

Right lung: right parasternal line - 6th intercostal space, midclavicular - 7th rib, anterior axillary - 8th rib, middle axillary - 8th intercostal space, posterior axillary - 9th rib, scapular - 10th rib.

Left lung: anterior axillary - 7th rib, middle axillary - 7th intercostal space, posterior axillary - 8th rib, scapular - 9th rib.

Mobility of the pulmonary edge is 6 cm.

The chest is painless on palpation.

Auscultation of the lungs: vesicular breathing over the entire surface of the lungs, no adverse respiratory sounds are heard.

Bronchophony is not detected.

Cardiovascular system:

The chest above the heart area is not deformed. The apical impulse is determined in the 5th intercostal space, 1 cm outward from the midclavicular line. There is no pathological pulsation of blood vessels in the neck and epigastrium. The pulsation of the blood vessels in the feet is clear.

Pulse - 74 beats per minute, rhythmic, satisfactory filling and tension, the same on both hands. There is no pulse deficit.

The apical impulse is palpated in the 5th intercostal space 1 cm outward from the midclavicular line, diffuse, of medium strength, with an area of ​​about 2 cm.

The upper limit of the relative dullness of the heart lies in the second intercostal space.

The border of the heart on the right is along the right edge of the sternum. The border of the heart on the left is 2 cm outward from the midclavicular line.

The tones are rhythmic. The first tone is muted. An accent of the second tone is heard on the aorta. At the apex, a systolic murmur is heard, which is not carried out anywhere.

The pulsation of peripheral arteries is preserved.

Blood pressure was the same in both arms and was 140/75.

Digestive organs:

The oral cavity has been sanitized.

The oral mucosa is moist, pale pink in color, and shiny.

The tongue is pale pink, moist, without plaque, no ulcers or cracks.

The gums are pale pink in color, without pathological changes.

Zev is calm, there are no dyspeptic disorders at the time of supervision.

The abdomen is symmetrical, round in shape, and participates in the act of breathing. Leather abdominal wall normal color, there is no visible peristalsis.

The percussion sound over the entire surface of the abdomen is the same. There is no free gas in the abdominal cavity. On superficial palpation: the abdomen is soft and painless.

Deep palpation of the cecum and transverse colon revealed no pain. On palpation sigmoid colon moderate pain. Symptoms of peritoneal irritation are negative.

The lower edge of the liver is palpated along the edge of the costal arch, smooth, elastic, painless. The Ortner-Grekov symptom is negative, the Mussi-Georgievsky symptom is negative.

Liver dimensions according to Kurlov: right - 9 cm, middle - 8 cm,

oblique - 7 cm.

The spleen is not palpable. Sizes of the spleen. revealed by percussion: longitudinal - 6 cm, transverse - 4 cm.

Inspection of the area anus No external hemorrhoids, inflammation, or neoplasms were detected. Examination of the rectum revealed: sphincter tone is normal, palpation is painful. There is a small amount of scarlet blood and feces on the glove.

The stool is frequent and loose, which the patient associates with taking a laxative.

Urinary system:

Skin in the area of ​​the anatomical projection of the kidneys normal temperature and colors.

Urination is regular and painless.

The kidneys are not palpable on both sides.

The effleurage (Pasternatsky) symptom is negative on both sides.

The bladder is not percussed.

The ureteral points are painless.

Neurological status:

Intelligence and emotions are age appropriate. No pathology of the cranial nerves was identified according to the examination.

Physiological reflexes:

abdominal reflexes - present;

tendon reflexes from the arms and legs are present.

Endocrine system:

The proportions of the torso and limbs correspond to age.

The genitals are age appropriate. Exophthalmos and others eye symptoms are missing.

Preliminary diagnosis:

Taking into account complaints about:

Frequent, painful, bloody stools

Weakness

History of illness:

Examination at hospital No. 30 and exclusion of acute dysentery

Objective research data:

On rectal examination, there are traces of feces mixed with scarlet blood on the glove.

Cr of the rectosigmoid region

Related diseases:

Angina pectoris 2 f.kl.

Hypertension stage 2

Discussed

At a department meeting

"___" ______________2008

Protocol No.___________

METHODOLOGICAL DEVELOPMENT

To carry out practical classes with students III year FPIG

By operative surgery and topographic anatomy.

TOPIC: Topography of the chest (thorax). Walls chest cavity(cavum thoracalis): external landmarks, projections, layers and fascio-cellulosae spaces (spatium). Intercostal spaces: topography of intercostal neurovascular bundles and internal thoracic vessels (vasa thoracica interna). Mammary gland (glandula mammae): blood supply, innervation, features of lymphatic drainage as pathways for organ cancer metastasis. Thoracic cavity (cavum thoracalis): pleura, its sections, borders and sinuses. Lungs: (pulmon) zones, segments and topography of the roots (radix) of the right (dextra) and left (sinistra) lung (pulmon). Surgical anatomy of the diaphragm (diaphragma): topographic-anatomical formations passing through it, weak points. Topography of the mediastinum (mediastinum): classifications, surgical anatomy of the upper (superior), anterior (anterior) and middle (media) mediastinum (mediastinum) - fascia (fascii) and cellular spaces (spatium cellulosae), heart (cor) with the pericardium (pericard) , aortic arch (arcus aorticus) and its branches (rami), arterial ligament (ligamentum arteriosum), superior vena cava (v. cava superior), extracardial nerve plexuses. Topography of the trachea, lymph nodes, phrenic nerves (n.phrenicus) and pericardial-phrenic vessels (pericardiaco-phrenica). Topography of the posterior (posterior) mediastinum (mediastinum): descending aorta (aorta descendens), azygos and semi-gypsy veins (v.v., azygos et hemiazygos), thoracic lymphatic duct (ductus thoracicus), esophagus (oesophageus), vagus nerves (n.vagus), border sympathetic trunk (truncus sympaticus) and splanchnic nerves (n.n.splanchnici mayor et minor).

Students should independently study the features of the topographic anatomy of the chest organs in elderly people.

QUESTIONS TO PREPARE ANSWERS.

1. Walls of the chest cavity (cavum thoracalis).

2. Topography of intercostal (intercostalis) neurovascular bundles.

3. Topography of the internal thoracic vessels (vasa thoracica interna).

4. Topography of the mammary gland (glandula mammae).

5. Pleura, its sections, borders and sinuses (pleura, pars, recessus pleuralis).

6. Topography of the lungs (pulmon): zones, segments and topography of the roots (radix pulmon).

7. Surgical anatomy of the diaphragm.

8. Topography of the mediastinum (mediastinum): upper (superior), anterior (anterior) and middle (media).

9. Surgical anatomy of the heart (cor) with the pericardium (pericard).

10. Topography of the aorta (arcus aorticus) and its branches (rami).

11. Topography of the superior vena cava (v. cava superior) and azygos and semi-gypsy veins (v. v, azygos et hemiazygos).

12. Topography of the trachea, phrenic nerves (n.phrenicus) and pericardial-phrenic vessels (pericardiaco-phrenica).

13. Topography of the descending aorta (aorta descendens), thoracic lymphatic duct (ductus thoracicus) and border sympathetic trunk(truncus sympaticus).

14. Surgical anatomy of the esophagus (oesophageus), vagus nerves (n.vagus).

15. Heart-lung machine.

II. Find and be able to show on a corpse and skeleton:

1. Heart, lungs and its roots, trachea, esophagus and diaphragm (cor, pulmon et radix pulmonaris, traphea, oesophageus et diaphragma).

2. Mediastinum (mediastinum): upper, anterior, middle and posterior (superior, anterior, media et posterior).

3. The aortic arch and its branches (arcus aorticus et rami).

4. Pericardium and its sinuses (pericardii et recessus pericardialis).

5. Parietal pleura and its sinuses (pleura parietalis et recessus pleuralis).

6. The superior vena cava (v. cava superior) and the v. v. brachiocephalicae forming it.

7. Sternum, collarbone, ribs, grooves and heads of ribs (sternum, claviculae, costae, sulcus costae, caput costae).

8. Diaphragma and topographic-anatomical formations passing through it.

III. Be able to explain:

1. Draw conditional lines.

2. Formation of lung zones.

3. What is a lung segment.

4. Blood supply to the mammary gland.

5. Which fascia forms the capsule for the mammary gland.

6. Lymphatic drainage from the mammary gland, how possible way metastasis of the tumor.

7. Boundaries of the mediastinum (superior, anterior, middle and posterior).

8. Formation of the sinuses of the pleura and pericardium.

9. Borders of the pleura: upper, anterior, lower and posterior.

10. Why is puncture of the pleural cavity performed along the upper edge of the underlying rib?

11. Which pericardial sinus is punctured?

12. In which pleural sinus does pathological fluid accumulate?

13. Why can the left atrium be damaged when bougienaging the esophagus with its stenosis?

14. Topography of the intercostal neurovascular bundle.

15. The significance of deviations of the esophagus (oesophageus) for surgical access to the organ.

16. Meaning weak points diaphragm.

17. What topographic-anatomical formations pass through the diaphragm (diaphragma).

QUESTIONS.

Conditional lines.

They are carried out on the chest wall conditional lines to determine the projections of the organs of the thoracic and abdominal cavities.

Linia mediana anterior(anterior midline) is drawn from the middle of the jugular notch, along the middle of the sternum (sternum), through the navel (umbilicalis) - to the symphysis (symphisis).

Linia sterna is dextra et sinistra(right and left sternal or sternal lines) are drawn along the right or left edge of the sternum (sternum).

Linia parasternalis dextra et sinistra(right and left parasternal lines) are drawn in the middle of the distance between the sternum (sternum) and the midclavicular line (linia medio-clavicularis).

Linia medioclavicularis dextra et sinistra(right and left midclavicular lines) are drawn along the middle of the clavicle (clavicula).

Linia axillaris anterior dextra et sinistra(right and left anterior axillary lines) are drawn downwards (inferior) from the anterior edge (margo anterior) of the axillary fossa (fossa axillaris).

Linia axillaris media dextra et sinistra(right and left middle axillary lines) are drawn downwards (inferior) from the middle (media) of the axillary fossa (fossa axillaris).

Linia axillaris posterior dextra et sinistra(right and left posterior axillary lines) are drawn along the posterior edge (margo posterior) of the axillary fossa (fossa axillaris).

Linia scapularis dextra et sinistra(right and left scapular lines) are drawn through the lower angle of the scapula (angulus inferior scapulae), with the arm lowered.

Linia paravertebralis dextra et sinistra(right and left paravertebral or paravertebral lines) are drawn in the middle of the distance between the vertebral (linia vertebralis) and scapular (linia scapularis) lines.

Linia vertebralis dextra et sinistra(right and left vertebral or vertebral lines) are carried out through the transverse processes of the vertebrae (processus transversus vertebrae).

Linia mediana posterior(posterior midline) is carried out along the spinous processes of the vertebrae (processus spinosus vertebrae).

Topography of intercostal spaces.

The intercostal spaces are filled with external and internal intercostal muscles (m.m.intercostalis externi et interni), blood and lymphatic vessels and nerves and lymph nodes.

M. m.intercostalis externi do not fill the entire intercostal space; they reach the costal cartilages. At the level of the costal cartilages, the external intercostal muscles are replaced by the external intercostal membrane (membrane intercostalis externi).

M. m.intercostalis interni also does not perform the entire intercostal space. In front (anterior) they reach the sternum (sternum), and in the back (posterior) they reach the costal angles (angulus costae).

The internal intercostal muscles posterior to the costal angles are replaced by the internal intercostal membrane (membrane intercostalis interna). Thus, posterior to the angles of the ribs, the intercostal neurovascular bundle is not covered by muscles; it is separated from the parietal pleura only by a thin intercostal membrane and intrathoracic fascia. Therefore, when inflammatory diseases pleura, intercostal nerves may be involved in the pathological process with the occurrence of intercostal neuralgia.

Below the third rib inner surface The chest is lined by the transverse thoracic muscle (m.transversus thoracis). Deeper than this muscle lies the intrathoracic fascia (f.endothoracica).

The intercostal neurovascular bundle is located in the osteofibrous sheath formed by:

· above (superior) – costal groove on the lower edge of the rib (sulcus costalis, margo inferior

· front (anterior) – external intercostal muscles (m.m.intercostalis externi);

· behind (posterior) – internal intercostal muscles (m.m.intercostalis interni).

The intercostal neurovascular bundle includes:

* anterior and posterior intercostal veins (vena intercostalis anterior et posterior), forming a single

venous ring;

*anterior and posterior intercostal arteries (arteria intercostalis anterior et posterior), forming

single arterial ring;

* intercostal nerve (n. intercostalis).

In this case, the elements of the neurovascular bundle are located from top to bottom as follows: vein, artery and nerve (vena, arteria, nervus).

The intercostal veins and arteries are covered by the rib, and the nerve emerges from under the lower edge of the rib (margo inferior costae). For this reason, puncture of the pleural cavity (cavum pleuralis) is always carried out along the upper edge (margo superior) below the underlying rib, so as not to damage the intercostal nerve (n. intercostalis).

Intercostal nerves (n. intercostalis) are spinal nerves.

The anterior intercostal arteries (arteria intercostalis anterior) are branches of the internal thoracic artery (a.thoracica interna).

The posterior intercostal arteries (arteria intercostalis posterior) are branches of the thoracic aorta (aorta thoracica), with the exception of the first two, a.a. intercostalis suprema, extending from truncus costaecervicalis from a.subclavia.

The anterior intercostal veins flow into the internal thoracic veins (v.thoracica interna), and the posterior intercostal veins into the azygos, hemyazygos and accessory hemyazygos veins (v.v.azygos, hemyazygos et hemyazygos accessoria).

Due to the fact that the anterior and posterior intercostal arteries form a single ring, damage to the artery will lead to severe bleeding from both ends of the vessel. The bleeding will be massive, since the fascial sheath of the intercostal vessels is firmly connected to the periosteum of the ribs and the fascial sheaths of the intercostal muscles, so the vessels do not collapse (“gape”) and bleed profusely.

Such bleeding is difficult to stop, and ligation of the vessels will not stop the bleeding (the ligature will slip due to the connection of the adventitia of the vessels with the periosteum of the ribs and the fascial sheaths of the intercostal muscles), therefore only suturing of the vessels is used.

Anterior to the middle axillary artery, the intercostal neurovascular bundle emerges from under the edge of the rib and is located in the intermuscular tissue between the ribs (costar). Therefore, in order not to damage the intercostal neurovascular bundle, puncture of the pleural cavity (cavum pleuralis) is performed between the scapular and mid-axillary lines ( linea scapularis et linea axillaris media) in the VII – VIII intercostal spaces.

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Intercostal neuralgia is a lesion of the intercostal nerves, accompanied by intense pain. The pathology itself does not pose a threat to life, but the symptoms of intercostal neuralgia may mask serious illnesses, which include, first of all, cardiovascular pathologies, in particular myocardial infarction. In some cases, intercostal neuralgia indicates the presence of other diseases, such as neoplasms spinal cord or chest organs, pleurisy.

Intercostal neuralgia is one of the most common diseases of the human nervous system.

The intercostal nerves contain both sensory and motor fibers, as well as sympathetic fibers. In the human body, there are 12 pairs of nerves in the intercostal region, each of which passes below the edge of the corresponding rib in the intercostal space as part of the neurovascular bundle. Intercostal nerves innervate the skin and muscles of the peritoneum, costal and diaphragmatic parts of the pleura, anterior abdominal wall, mammary gland, and chest. Neuralgia occurs when the roots of the intercostal nerves are compressed at their exit from the spine, usually as a result of muscle spasm.

Intercostal neuralgia occurs equally often in men and women. Susceptibility to the disease increases with age.

Synonyms: neuralgia of the intercostal nerves, thoracic radiculitis.

Causes of intercostal neuralgia and risk factors

The most common causes of neuralgia of the intercostal nerves are:

• osteochondrosis, spondylitis, ankylosing spondylitis and other diseases thoracic spine;
• tumors of the thoracic spinal cord;
• sudden unsuccessful movement;
• chest injury;
• forced awkward body position;
• general hypothermia of the body, hypothermia of the chest and back;
• pathology upper section gastrointestinal tract;

In women, intercostal neuralgia can be caused by wearing tight underwear, as well as being underweight. In children and adolescents, intercostal neuralgia can occur during a period of intensive growth of the bone skeleton.

The contributing factors are:

• metabolic disorders (diabetes mellitus);
• age-related changes in blood vessels;
• diseases of the nervous system;
• infectious and inflammatory diseases;
• uncomfortable workplace.

Forms of the disease

There are two main forms of intercostal neuralgia:

• radicular - caused by irritation of the roots of the spinal cord and is accompanied by pain in the thoracic region, can masquerade as cardiac pathology;
• reflex – occurs due to muscle tension in the intercostal spaces.

Intercostal neuralgia occurs equally often in men and women. Susceptibility to the disease increases with age.

Depending on the location, intercostal neuralgia is classified into unilateral and bilateral. The latter often occurs against the background of immunodeficiency, radiation sickness, herpes infection and a number of other diseases.

Symptoms of intercostal neuralgia

The main symptom of intercostal neuralgia is paroxysmal piercing pain, which can be shooting, burning, stabbing, or resemble an electric shock. The pain intensifies when laughing, coughing, deep breathing, turning the body, getting up upper limbs. Besides, painful sensations increase upon palpation of the affected area and may become unbearable for the patient. The patient takes a forced body position (antalgic postures) to reduce or stop pain. The pain is long-lasting, often persisting day and night, although its intensity may vary.

The pain can have different localization. Women in the background hormonal changes in the menopausal and/or postmenopausal period, pain is often noted in the area of ​​​​the projection of the heart, pain can radiate to the mammary gland. In men, pain is more often localized at the level of the lower ribs, on the left side of the chest. Depending on the location of the lesion, the pain may radiate to the heart, scapula, and epigastrium. When pain is localized along one or two intercostal nerves, it can acquire a girdling character.

A characteristic sign of intercostal neuralgia is that pain does not decrease at night. In the early stages of the disease pain syndrome in the chest may be less intense, manifest as tingling, but increase with the progression of the pathology. Pain with intercostal neuralgia can be either unilateral or bilateral. During the first few days from the onset of the pathological condition, attacks of intercostal neuralgia can lead to sleep disturbances (including insomnia) and a deterioration in the patient’s general condition.

In children, intercostal neuralgia manifests itself as severe pain in the affected area and is accompanied by convulsions, sleep disturbances, increased excitability, and speech disorders.

IN clinical picture diseases may be present:

• muscle spasms in the affected area;
• numbness of the affected area;
• increased sweating (hyperhidrosis);
• pallor or redness of the skin;
• feeling of crawling sensations;
• shortness of breath (due to incomplete breathing during attacks of pain); etc.

Signs of intercostal neuralgia, which is caused by herpetic viral infection, are skin rashes and itchy skin, occurring even before the rash appears. Skin rashes represent pink spots, which transform into vesicles and dry out. The rash is localized on the skin of the intercostal space. Temporary hyperpigmentation of the skin is observed in place of the rash elements during convalescence.

Diagnosis of intercostal neuralgia

The primary diagnosis of intercostal neuralgia is carried out on the basis of complaints and anamnesis, as well as an objective examination of the patient. Often the data obtained is sufficient to diagnose the disease. In complex diagnostic cases, as well as for the purpose of differential diagnosis with other pathologies that have similar manifestations, additional examination, which, depending on the indications, includes:

• magnetic resonance and computed tomography (to exclude neoplasms, hernia);
• X-ray examination of the chest and spine in direct, lateral and oblique projections;
• electroneurography (if the consequences of injuries are suspected);
• electrocardiography (to exclude diseases of the cardiovascular system);
• ultrasound examination;
• contrasting discography;
• gastroscopy (to exclude pathologies of the gastrointestinal tract);
• general and biochemical blood test;
• serological blood test; etc.

Information content computed tomography increases when combined with X-ray contrast examination of the spinal cord fluid-conducting tracts (myelography).

In some cases, intercostal neuralgia indicates the presence of other diseases, for example, neoplasms of the spinal cord or chest organs, pleurisy.

Identify pathology on early stage, and also monitor the effectiveness of treatment using electrospondylography. The method allows you to assess the condition of the spine and determine the extent of damage.

Required differential diagnosis intercostal neuralgia with other diseases:

• cardiovascular pathologies (angina pectoris, coronary heart disease, myocardial infarction);
• intervertebral hernia;
• thoracic radiculitis;
• lung cancer and other chest tumors;
• diseases of the gastrointestinal tract (gastritis, acute pancreatitis, gastric ulcer);
• renal colic; etc.

Treatment of intercostal neuralgia

Indicated for patients with intercostal neuralgia bed rest lasting from several days to several weeks.

Acute pain syndrome accompanying intercostal neuralgia is relieved parenteral administration analgesics. If this is not enough, they resort to novocaine blockade of the intercostal nerves. After the pain intensity decreases, the patient is transferred to parenteral painkillers.

Treatment of intercostal neuralgia is complex. For increased muscle tone, muscle relaxants are used central action. Swelling in the affected area is eliminated using diuretics, as well as venotonics. In order to improve the functions of those involved in pathological process nerve shown parenteral use ascorbic acid and B vitamins. Non-steroidal anti-inflammatory drugs are used according to indications (for patients with heartburn, gastritis or peptic ulcer their purpose is supplemented with drugs from the group of organotropic gastrointestinal drugs), sedatives, antidepressants, vitamin complexes.

In case of development of intercostal neuralgia against the background of a herpetic infection, it is prescribed antiviral drugs, antihistamines. Treatment is supplemented local application antiherpetic drugs in the form of ointment.

In women, intercostal neuralgia can be caused by wearing tight underwear, as well as being underweight. In children and adolescents, intercostal neuralgia can occur during a period of intensive growth of the bone skeleton.

Physiotherapy and manual therapy applied after cupping acute symptoms intercostal neuralgia

In case of intercostal neuralgia due to displacement of the vertebrae or osteochondrosis, gentle manual therapy or traction of the spinal column can be performed. For intercostal neuralgia that has developed against the background of spinal pathologies, the main treatment is recommended to be supplemented with physical therapy, including a set of restorative exercises.

For intercostal neuralgia caused by a tumor, treatment is carried out in the oncology department.

Possible complications and consequences

In the absence of adequate treatment, intercostal neuralgia can have complications:

• circulatory disorders with subsequent development of pathologies of muscles and internal organs;
• chronic pain syndrome;
• exacerbation chronic diseases digestive system;
• increased blood pressure, hypertensive crisis;
• transient ischemic attack, stroke;
• angina attack accompanied by intense pain; etc.

Forecast

With timely treatment, the prognosis of the disease is favorable. In case of intercostal neuralgia caused by herpetic infection, relapses are common.

Prevention

Specific prevention of neuralgia of the intercostal nerves has not been developed; general strengthening measures will help prevent the development of pathology. Recommended:

• a healthy lifestyle that includes regular moderate physical activity and rational balanced nutrition;
• timely treatment of spinal diseases, chest injuries, pathologies of internal organs;
• measures to help prevent spinal curvature or treat an existing curvature;
• avoiding hypothermia;
• work in comfortable conditions, with prolonged forced body positions, take breaks for a short warm-up.

Video from YouTube on the topic of the article:

Breast

a complex area of ​​the human body containing vital organs: the heart and lungs.

The upper border of the chest is determined by a line drawn along the upper edge of the jugular notch, the clavicles, the humeral processes of the scapulae and the spinous process of the VII cervical vertebra.

The lower border is represented by a line running from the xiphoid process of the sternum, along the costal arches, along the free edges of the X-XII ribs and the spinous process of the XII thoracic vertebra. The chest is separated from the upper limbs by the deltoid grooves in front, and by the medial edge of the deltoid muscle behind.

The boundaries of the chest cavity do not correspond to the boundaries of the chest, since the dome of the pleura of the right and left lungs protrudes above the collarbones by 2-3 cm, and the 2 domes of the diaphragm are located at the level of the IV and V thoracic vertebrae.

The jugular notch is projected onto the lower edge of the II thoracic vertebra. Bottom corner scapula is projected onto top edge VIII ribs.

To determine the projection of the thoracic cavity organs onto the chest wall, the following lines are used:

Anterior midline

sternal line,

parasternal line,

midclavicular line,

Anterior axillary line

Mid axillary line

Posterior axillary line

Scapular line

Paravertebral line,

spinal line,

Posterior midline

Layers of the chest wall:

Skin, subcutaneous fat,

The superficial fascia, which forms the fascial sheath for the mammary gland, also gives off septa from the posterior layer to the anterior one, forming 15-20 lobules.

Proper fascia of the chest, which forms fascial sheaths for the pectoralis major and minor muscles on the anterior surface of the chest. On the posterior surface of the chest, the own fascia is divided into two sheets and forms fascial sheaths for the latissimus and dorsi muscles and the lower part of the trapezius muscle. And the deep layer of its own fascia limits the osteofibrous bed of the scapula with the muscles, vessels and nerves lying in them, and also forms cases for the rhomboid major and minor muscles of the back and the levator scapulae muscle.

Pectoralis major muscle

Superficial subpectoral cellular space,

pectoralis minor muscle,

Deep subpectoral cellular space,

Serratus anterior muscle.

Ribs with external and internal intercostal muscles,

Intrathoracic fascia

Prepleural fatty tissue,

Parietal pleura.

Limited to:

ribs above and below,

external intercostal muscle outside

internal intercostal muscle inside

Moreover, the relative position of the muscles is not the same throughout the entire interval from the vertebral lines to the sternal lines. Along the posterior surface, the internal pectoral muscles do not reach the vertebral line, and thus a gap remains between the muscles. And in front, at the level of the costal cartilages, the muscles are represented by an aponeurotic plate, tightly fixed to the sternum.

In the intercostal spaces there are intercostal neurovascular bundles, represented by intercostal arteries, intercostal veins and intercostal nerves.

There are anterior and posterior intercostal arteries. The anterior intercostal arteries begin from the internal thoracic arteries, which in turn are branches of the subclavian arteries. The posterior intercostal arteries are branches of the thoracic aorta.

Thus, it is formed arterial ring, the presence of which carries both benefit and danger.

The “+” of this anatomy is the presence of anastomoses between two main sources of blood circulation, which ensures adequate blood supply to the intercostal muscles responsible for our breathing even in the event of occlusion of one of the main sources.

“-” is that when the intercostal arteries are injured, the volume of blood loss doubles!!!

Intercostal veins, corresponding to arteries, are superior, inferior, anterior and posterior. Again, the main ones will be the front and rear. From the anterior intercostal arteries, blood flows into the anterior thoracic veins. And from the posterior intercostal veins, blood flows on the left into the hemizygos vein, and on the right into the azygos vein.

The intercostal nerves are branches of the sympathetic trunk.

The intercostal neurovascular bundle is located in the rib groove, and if viewed from top to bottom, the vein lies above all, the artery below it, and the nerve below the artery.

However, the SNP is located in the groove not along the entire length of the intercostal space, but only up to the midaxillary line, medial to which the neurovascular bundle exits the groove.

Thus, the indicated topographical and anatomical features of the location of the SNP determined certain rules for performing puncture of the pleural cavity.