By:Mohammed jamal mohammed
2nd G.m
S
Relationship of thorax to Neck,
Relationship of thorax to upper limb,
Relationship of thorax to abdomen,
Relationship of thorax to breasts ;
Pleural cavity - Pleura and Lungs
My goals
RELATIONSHIP BETWEEN
UPPER LIMB)،THORAX
TO (NECK
The Clavicle is a long bone
It is horizontally placed
The medial end of the Clavicle articulates with the
manubrium at the Sternoclavicular Joint
The lateral end of the Clavicle articulates with the
acromion of the scapula at the Acromioclavicular Joint
The Clavicle is divided into thirds along its length
Undersurface of Right Clavicle
Lateral Third
The lateral third is flattened and expanded
Undersurface of Right Clavicle
Medial Third
The medial third is rounded
Undersurface of Right Clavicle
The Clavicle is curved convex forwards at its medial end
Lateral
Medial
Posterior
Anterior
The Clavicle is concave forwards at its lateral end
Lateral
Medial
Posterior
Anterior
There are a number of impressions on the undersurface
Lateral
Medial
Posterior
Anterior
This area gives attachment to the Trapezoid ligament
Lateral
Medial
Posterior
Anterior
This is one of the two coracoclavicular ligaments that
stabilise the acromioclavicular joint
This area gives attachment to the Conoid ligament
Lateral
Medial
Posterior
Anterior
This is one of the two coracoclavicular ligaments that
stabilise the acromioclavicular joint
This area gives attachment to the costoclavicular ligament
that arises from the first costal cartilage and first rib
Lateral
Medial
Posterior
Anterior
It stabilises the sternoclavicular joint
Sternoclavicular Joint
Manubrium
Clavicle
Manubrium
1st Rib
Costoclavicular Ligament anterior fibres
Manubrium
Clavicle
Manubrium
1st Rib
Costoclavicular Ligament posterior fibres
Manubrium
Clavicle
Manubrium
1st Rib
Anterior Sternoclavicular Ligament
Manubrium
Clavicle
Manubrium
1st Rib
Interclavicular Ligament
Manubrium
Clavicle
Manubrium
1st Rib
Section through Sternoclavicular Joint
Manubrium
Clavicle
Manubrium
1st Rib
Section through Sternoclavicular Joint
Manubrium
Clavicle
Manubrium
1st Rib
Section through Sternoclavicular Joint
Articular Disc
Muscles that attach to the Clavicle
Muscles that attach to the Clavicle
Lateral
Medial
Posterior
Anterior
Deltoid
Muscles that attach to the Clavicle
Lateral
Medial
Posterior
Anterior
Pectoralis Major
Muscles that attach to the Clavicle
Lateral
Medial
Posterior
Anterior
Subclavius
Muscles that attach to the Clavicle
Lateral
Medial
Posterior
Anterior
Trapezius
Muscles that attach to the Clavicle
Lateral
Medial
Posterior
Anterior
Sternohyoid
Summary of Muscles that attach to Clavicle
Deltoid
Pectoralis Major
Subclavius
Sternohyoid
Sternocleidomastoid
Trapezius
Lateral Chest Wall
Deltoid
Origin Lateral third of clavicle,
acromion, and spine of scapula
Insertion Deltoid tuberosity on lateral
shaft of humerus
Action Anterior part: flexes and
internally rotates arm; Middle
part: abducts arm; Posterior
part: extends and externally
rotates arm
Nerve Supply Axillary nerve (C5 and C6)
Blood Supply Deltoid branch of
thoracoacromial artery
Anterior Chest Wall
Pectoralis Major
Origin Clavicular head: anterior surface
of medial half of clavicle;
Sternocostal head: anterior
surface manubrium & sternum,
superior 6 costal cartilages, and
aponeurosis of external oblique
muscle
Insertion Lateral lip of bicipital groove of
humerus
Action Clavicular head: flexes &
adducts arm
Sternal head: adducts &
internally rotates arm
Nerve Supply Lateral and medial pectoral
nerves (C5, C6, C7, C8, and T1)
Blood Supply pectoral branch of
thoracoacromial trunk
Subclavius
Origin Costochondral junction 1st
rib
Insertion Subclavian groove inferior
surface middle clavicle
Action Depresses clavicle
Nerve Supply Nerve to subclavius C5, 6
Blood Supply Clavicular branch of
thoraco-acromial artery
and suprascapular artery
Anterior Chest Wall
Posterior Chest Wall
Trapezius
Origin Medial third of superior nuchal
line; external occipital
protuberance, nuchal ligament,
and spinous processes of thoracic
vertebrae
Insertion Lateral third of clavicle, acromion,
and spine of scapula
Action superior fibers elevate, middle
fibers retract, and inferior fibers
depress scapula
Nerve Supply Spinal root of accessory nerve (CN
XI) (motor) and cervical nerves (C3
and C4) (pain and proprioception)
Blood Supply Transverse cervical artery
Relationship of thorax to
Abdomen
Abdominal Anatomy
The Abdominal
Cavity
Lies between the
diaphragm and
the pelvis
Bounded by the
lower ribs,
abdominal
muscles, and
vertebral column
Contains the
abdominal viscera
(internal organs)
Abdominal Anatomy
Solid Organs
~ more often & easily
injured
~ cause rapid death
due to large blood
supply which causes
internal bleeding
~ spleen, liver, kidneys,
pancreas
Hollow Organs
~ injuries are rare
because tubes are hollow
~ assist in transporting
substances from one
organ to another
~ stomach, gall bladder,
sm & lg intestines,
bladder
The Peritoneum
A continuous
sheath of
tissue which
covers the
entire
abdominal
cavity and all
visceral
organs
TheAbdominal
Quadrants
The abdomen is
divided into 4 regions –
or quadrants: RUQ
(right upper quadrant),
RLQ (right lower
quadrant), LUQ (left
upper quadrant), LLQ
(left lower quadrant)
This makes it easier to
locate organs in the
abdominal cavity
Right Upper
Quadrant
 Right lobe
of liver
 Gallbladder
 Right kidney
 Small
Intestine
 Large
Intestine
Right Lower Quadrant
 Small Intestine
 Large Intestine
 Appendix
 Right Ovary &
Uterus
(females)
 Prostate
(males)
 Ureters
Left Upper Quadrant
 Small
Intestine
 Stomach
 Spleen
 Left kidney
 Large
Intestine
 Part of liver &
pancreas
Left Lower Quadrant
 Small
Intestine
 Portion of
bladder
 Large
Intestine
 Left Ovary &
Uterus
(females)
 Prostate
(males)
the abdominal muscles
Rectus abdominis
Origin : crest of Pubis
Insertion : costal cartilages
of ribs 5-7 xiphoid process of
sternum
Artery : inferior epigastric
artery
Nerve : segmentally by
thoraco-abdominal nerves
(T11-T7)
Abdominal Internal obliquw
muscle
Origin : inguinal Ligament , iliac
crest and the lumbodorsal fascia
Insertion : linea alba , pecten
pubis (via Conjoint tendon) and
ribs 10-12
Artery : Sucostal Arteries
Nerve : thoracoabdominal nn
,(T6-T11) Subcostal n
(T12),lliohypogastric n . (L1) and
llioinguinal n (L1)
Action : Compresses abdomen
,unilateral contraction rotates
vertebral column to same side
The Obliquus externus
abdominis
Origin : Ribs 5-12
Insertion : lliac Crest , Puic
tubercle, linea alba
Nerve :Thoracoabdominal
Nerve (T7-T11) and subcostal
Nerve
Action : Contralateral rotation of
torso
transverse abdominis
Origin : lliac crest , inguinal
ligament , thoracolumbar
fascia , and costal
cartilages 7-12
Insertion : Xiphoid process,
linea aiba , pubic crest and
pecten pubis via conjoint
tendon
Artery : Subcostal arteries.
Nerve: thoracoabdominal
nn ,(T6-T11) Subcostal n
(T12),lliohypogastric n .
(L1) and llioinguinal n (L1)
Action : Compresses
abdominal contents
Anatomy - Thorax
Located between the
abdomen and the neck
Boney structures include:
12 pairs of Ribs
Costal cartilage
Sternum (breast bone)
Xiphoid process
Thoracic vertebrae
Thorax Anatomy
Internal Organs:
Heart
Pumps blood to the
body tissues
Lungs
Exchanges oxygen
and carbon dioxide
as blood passes
though the lungs
Major Arteries/Veins
Superior & Inferior
AORTA (arter)
Superior & Inferior
VENA CAVA (vein_
Pulmonary arteries
and veins carry blood
to/from the heart and
lungs
Thorax Anatomy
Heart
•Size of your fist
•Pumps blood to all parts of
the body
•Divided into 4 chambers
•Upper chambers – right
and left atrium
•Lower chambers – right
and left ventricles
•A muscular wall called the
septum separates the
right side from the left
side
Each chambers have valves.
The valves have different
names.
•the tricuspid valve is at the
exit of the right atrium
•the mitral valve is for the left
atrium
•the pulmonary valve is at the
exit of the right ventricle
•the aortic valve is at the exit
of the left ventricle.
Their purpose is to allow
Thorax Anatomy
Lungs
Right side has 3 lobes
Left has 2 lobes
Function
To exchange O2 and CO2
To dissipate heat from the
body
Thorax Anatomy
Trachea divides into two
bronchi
Bronchi divide into
bronchioles
Bronchioles end in alveoli
Alveoli are air
containing cells of the
lungs
O2 and CO2 are
exchanged here
Coughing & sneezing help
keep trachea and bronchi
clear and remove phlegm and
allergy-causing agents from
the lungs
Respiration Rate
oLung function and breathing
rate controlled by CO2 receptors
oIf there is too much CO2,
inhalation occurs to bring in
more O2
oExercise increases cell
metabolism
oCauses cells to need more
O2 and eliminate more CO2
oWith exercise lungs ability to
exchange air more efficiently
increases
oBreaths become more deeper
and more forceful
oReturn to normal breathing
quicker
Thorax Anatomy
Pleura
Thin lubricated tissue
Lines each half of thorax
Folded back over the
surface of the lung on
same side
Allow for smooth
movement of lungs as they
encounter the wall of ribs
during inhalation and
exhalation
Thorax anatomy
The Diaphragm
is a sheet of internal
skeletal muscle, that
extends across the bottom
of the rib cage.
The diaphragm separates
the thoracic cavity (heart,
lungs & ribs) from the
abdominal cavity
performs an important
function in respiration: as
the diaphragm contracts,
the volume of the thoracic
cavity increases and air is
drawn into the lungs.
Thorax Anatomy
Soft tissues include:
Major muscles
Pectoralis muscle
Adducts and
rotates the arm
Raises the ribs in
forced inspiration
Upper portion
flexes the arm
Intercostal muscles
Elevate and
depress ribs
Serratus posterior
Elevate ribs
during inhalation
Depress ribs
Pleural cavity - Pleura and
Lungs
Thoracic cavity Relationship
Thoracic cavity Relationship
Thoracic cavity Relationship
Thoracic cavity Relationship
Thoracic cavity Relationship
Q/Do men have mammary
gland ?
Yes  Or No 
Both men and women have mammary glands,
but these milk-producing glands are undeveloped
and typically nonfunctional in males.
Pleurae (Pleural cavity)
Each pleura consists of
two layers:
A visceral layer which is
adherent to the lung and a
parietal layer which lines
the inner aspect of the
chest wall, diaphragm and
sides of the pericardium
and mediastinum.
Pleurae (Pleural cavity)
• The parietal and visceral
layers of pleura are
separated from one
another by a slitlike
space, called pleural
cavity
• The pleural cavity contains a
small amount of pleural
fluid …which acts as a
lubricant decreasing
friction between the
pleurae.
Pleurae (Pleural cavity)
Pleurae (The parietal layer)
The costal pleura lines the
inner surfaces of the ribs,
the costal cartilages, the
intercostal spaces, the
sides of the vertebral
bodies, and the back of the
sternum
Pleurae (The parietal layer)
The
diaphragmatic
pleura covers
the thoracic
surface of the
diaphragm
The mediastinal pleura
covers and forms the lateral
boundary of the
mediastinum
Pleurae Blood Supply
Visceral pleura---
Artery supplied by
bronchial and
pulmonary arterial
systems.
The parietal
pleura--- Artery
supply is from
various systemic
arterial supply the
chest wall,
diaphragm, and
mediastinum.
Pleurae venous drainage
Visceral pleura--- Veins
drain is pulmonary vein.
The parietal pleura--- Vein
is to the superior vena
cava.
Pleurae Nerve Supply
The parietal pleura is
sensitive to pain,
temperature, touch, and
pressure
The parietal pleura is
innervated by both
somatic and
sympathetic and
parasympathetic fiber
via the intercostal
nerve.
Pleurae Nerve Supply
The parietal pleura
is supplied as
follows:
The costal pleura is segmentally
supplied by the intercostal
nerves.
The mediastinal pleura is
supplied by the phrenic nerve.
The diaphragmatic pleura is
supplied over the domes by the
phrenic nerve and around the
periphery by the lower six
intercostal nerves.
Pleurae Nerve Supply
The visceral pleura
covering the lungs is
sensitive to stretch
but is insensitive to
common sensations
such as pain and
touch.
It receives an
autonomic nerve
supply from the
pulmonary plexus.
Thoracic cavity Relationship

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Thoracic cavity Relationship

  • 2. Relationship of thorax to Neck, Relationship of thorax to upper limb, Relationship of thorax to abdomen, Relationship of thorax to breasts ; Pleural cavity - Pleura and Lungs My goals
  • 4. The Clavicle is a long bone It is horizontally placed
  • 5. The medial end of the Clavicle articulates with the manubrium at the Sternoclavicular Joint
  • 6. The lateral end of the Clavicle articulates with the acromion of the scapula at the Acromioclavicular Joint
  • 7. The Clavicle is divided into thirds along its length Undersurface of Right Clavicle
  • 8. Lateral Third The lateral third is flattened and expanded Undersurface of Right Clavicle
  • 9. Medial Third The medial third is rounded Undersurface of Right Clavicle
  • 10. The Clavicle is curved convex forwards at its medial end Lateral Medial Posterior Anterior
  • 11. The Clavicle is concave forwards at its lateral end Lateral Medial Posterior Anterior
  • 12. There are a number of impressions on the undersurface Lateral Medial Posterior Anterior
  • 13. This area gives attachment to the Trapezoid ligament Lateral Medial Posterior Anterior This is one of the two coracoclavicular ligaments that stabilise the acromioclavicular joint
  • 14. This area gives attachment to the Conoid ligament Lateral Medial Posterior Anterior This is one of the two coracoclavicular ligaments that stabilise the acromioclavicular joint
  • 15. This area gives attachment to the costoclavicular ligament that arises from the first costal cartilage and first rib Lateral Medial Posterior Anterior It stabilises the sternoclavicular joint
  • 23. Manubrium Clavicle Manubrium 1st Rib Section through Sternoclavicular Joint Articular Disc
  • 24. Muscles that attach to the Clavicle
  • 25. Muscles that attach to the Clavicle Lateral Medial Posterior Anterior Deltoid
  • 26. Muscles that attach to the Clavicle Lateral Medial Posterior Anterior Pectoralis Major
  • 27. Muscles that attach to the Clavicle Lateral Medial Posterior Anterior Subclavius
  • 28. Muscles that attach to the Clavicle Lateral Medial Posterior Anterior Trapezius
  • 29. Muscles that attach to the Clavicle Lateral Medial Posterior Anterior Sternohyoid
  • 30. Summary of Muscles that attach to Clavicle Deltoid Pectoralis Major Subclavius Sternohyoid Sternocleidomastoid Trapezius
  • 31. Lateral Chest Wall Deltoid Origin Lateral third of clavicle, acromion, and spine of scapula Insertion Deltoid tuberosity on lateral shaft of humerus Action Anterior part: flexes and internally rotates arm; Middle part: abducts arm; Posterior part: extends and externally rotates arm Nerve Supply Axillary nerve (C5 and C6) Blood Supply Deltoid branch of thoracoacromial artery
  • 32. Anterior Chest Wall Pectoralis Major Origin Clavicular head: anterior surface of medial half of clavicle; Sternocostal head: anterior surface manubrium & sternum, superior 6 costal cartilages, and aponeurosis of external oblique muscle Insertion Lateral lip of bicipital groove of humerus Action Clavicular head: flexes & adducts arm Sternal head: adducts & internally rotates arm Nerve Supply Lateral and medial pectoral nerves (C5, C6, C7, C8, and T1) Blood Supply pectoral branch of thoracoacromial trunk
  • 33. Subclavius Origin Costochondral junction 1st rib Insertion Subclavian groove inferior surface middle clavicle Action Depresses clavicle Nerve Supply Nerve to subclavius C5, 6 Blood Supply Clavicular branch of thoraco-acromial artery and suprascapular artery Anterior Chest Wall
  • 34. Posterior Chest Wall Trapezius Origin Medial third of superior nuchal line; external occipital protuberance, nuchal ligament, and spinous processes of thoracic vertebrae Insertion Lateral third of clavicle, acromion, and spine of scapula Action superior fibers elevate, middle fibers retract, and inferior fibers depress scapula Nerve Supply Spinal root of accessory nerve (CN XI) (motor) and cervical nerves (C3 and C4) (pain and proprioception) Blood Supply Transverse cervical artery
  • 36. Abdominal Anatomy The Abdominal Cavity Lies between the diaphragm and the pelvis Bounded by the lower ribs, abdominal muscles, and vertebral column Contains the abdominal viscera (internal organs)
  • 37. Abdominal Anatomy Solid Organs ~ more often & easily injured ~ cause rapid death due to large blood supply which causes internal bleeding ~ spleen, liver, kidneys, pancreas Hollow Organs ~ injuries are rare because tubes are hollow ~ assist in transporting substances from one organ to another ~ stomach, gall bladder, sm & lg intestines, bladder
  • 38. The Peritoneum A continuous sheath of tissue which covers the entire abdominal cavity and all visceral organs
  • 39. TheAbdominal Quadrants The abdomen is divided into 4 regions – or quadrants: RUQ (right upper quadrant), RLQ (right lower quadrant), LUQ (left upper quadrant), LLQ (left lower quadrant) This makes it easier to locate organs in the abdominal cavity
  • 40. Right Upper Quadrant  Right lobe of liver  Gallbladder  Right kidney  Small Intestine  Large Intestine
  • 41. Right Lower Quadrant  Small Intestine  Large Intestine  Appendix  Right Ovary & Uterus (females)  Prostate (males)  Ureters
  • 42. Left Upper Quadrant  Small Intestine  Stomach  Spleen  Left kidney  Large Intestine  Part of liver & pancreas
  • 43. Left Lower Quadrant  Small Intestine  Portion of bladder  Large Intestine  Left Ovary & Uterus (females)  Prostate (males)
  • 45. Rectus abdominis Origin : crest of Pubis Insertion : costal cartilages of ribs 5-7 xiphoid process of sternum Artery : inferior epigastric artery Nerve : segmentally by thoraco-abdominal nerves (T11-T7)
  • 46. Abdominal Internal obliquw muscle Origin : inguinal Ligament , iliac crest and the lumbodorsal fascia Insertion : linea alba , pecten pubis (via Conjoint tendon) and ribs 10-12 Artery : Sucostal Arteries Nerve : thoracoabdominal nn ,(T6-T11) Subcostal n (T12),lliohypogastric n . (L1) and llioinguinal n (L1) Action : Compresses abdomen ,unilateral contraction rotates vertebral column to same side
  • 47. The Obliquus externus abdominis Origin : Ribs 5-12 Insertion : lliac Crest , Puic tubercle, linea alba Nerve :Thoracoabdominal Nerve (T7-T11) and subcostal Nerve Action : Contralateral rotation of torso
  • 48. transverse abdominis Origin : lliac crest , inguinal ligament , thoracolumbar fascia , and costal cartilages 7-12 Insertion : Xiphoid process, linea aiba , pubic crest and pecten pubis via conjoint tendon Artery : Subcostal arteries. Nerve: thoracoabdominal nn ,(T6-T11) Subcostal n (T12),lliohypogastric n . (L1) and llioinguinal n (L1) Action : Compresses abdominal contents
  • 49. Anatomy - Thorax Located between the abdomen and the neck Boney structures include: 12 pairs of Ribs Costal cartilage Sternum (breast bone) Xiphoid process Thoracic vertebrae
  • 50. Thorax Anatomy Internal Organs: Heart Pumps blood to the body tissues Lungs Exchanges oxygen and carbon dioxide as blood passes though the lungs Major Arteries/Veins Superior & Inferior AORTA (arter) Superior & Inferior VENA CAVA (vein_ Pulmonary arteries and veins carry blood to/from the heart and lungs
  • 51. Thorax Anatomy Heart •Size of your fist •Pumps blood to all parts of the body •Divided into 4 chambers •Upper chambers – right and left atrium •Lower chambers – right and left ventricles •A muscular wall called the septum separates the right side from the left side Each chambers have valves. The valves have different names. •the tricuspid valve is at the exit of the right atrium •the mitral valve is for the left atrium •the pulmonary valve is at the exit of the right ventricle •the aortic valve is at the exit of the left ventricle. Their purpose is to allow
  • 52. Thorax Anatomy Lungs Right side has 3 lobes Left has 2 lobes Function To exchange O2 and CO2 To dissipate heat from the body
  • 53. Thorax Anatomy Trachea divides into two bronchi Bronchi divide into bronchioles Bronchioles end in alveoli Alveoli are air containing cells of the lungs O2 and CO2 are exchanged here Coughing & sneezing help keep trachea and bronchi clear and remove phlegm and allergy-causing agents from the lungs Respiration Rate oLung function and breathing rate controlled by CO2 receptors oIf there is too much CO2, inhalation occurs to bring in more O2 oExercise increases cell metabolism oCauses cells to need more O2 and eliminate more CO2 oWith exercise lungs ability to exchange air more efficiently increases oBreaths become more deeper and more forceful oReturn to normal breathing quicker
  • 54. Thorax Anatomy Pleura Thin lubricated tissue Lines each half of thorax Folded back over the surface of the lung on same side Allow for smooth movement of lungs as they encounter the wall of ribs during inhalation and exhalation
  • 55. Thorax anatomy The Diaphragm is a sheet of internal skeletal muscle, that extends across the bottom of the rib cage. The diaphragm separates the thoracic cavity (heart, lungs & ribs) from the abdominal cavity performs an important function in respiration: as the diaphragm contracts, the volume of the thoracic cavity increases and air is drawn into the lungs.
  • 56. Thorax Anatomy Soft tissues include: Major muscles Pectoralis muscle Adducts and rotates the arm Raises the ribs in forced inspiration Upper portion flexes the arm Intercostal muscles Elevate and depress ribs Serratus posterior Elevate ribs during inhalation Depress ribs
  • 57. Pleural cavity - Pleura and Lungs
  • 63. Q/Do men have mammary gland ? Yes  Or No 
  • 64. Both men and women have mammary glands, but these milk-producing glands are undeveloped and typically nonfunctional in males.
  • 65. Pleurae (Pleural cavity) Each pleura consists of two layers: A visceral layer which is adherent to the lung and a parietal layer which lines the inner aspect of the chest wall, diaphragm and sides of the pericardium and mediastinum.
  • 66. Pleurae (Pleural cavity) • The parietal and visceral layers of pleura are separated from one another by a slitlike space, called pleural cavity • The pleural cavity contains a small amount of pleural fluid …which acts as a lubricant decreasing friction between the pleurae.
  • 68. Pleurae (The parietal layer) The costal pleura lines the inner surfaces of the ribs, the costal cartilages, the intercostal spaces, the sides of the vertebral bodies, and the back of the sternum
  • 69. Pleurae (The parietal layer) The diaphragmatic pleura covers the thoracic surface of the diaphragm The mediastinal pleura covers and forms the lateral boundary of the mediastinum
  • 70. Pleurae Blood Supply Visceral pleura--- Artery supplied by bronchial and pulmonary arterial systems. The parietal pleura--- Artery supply is from various systemic arterial supply the chest wall, diaphragm, and mediastinum.
  • 71. Pleurae venous drainage Visceral pleura--- Veins drain is pulmonary vein. The parietal pleura--- Vein is to the superior vena cava.
  • 72. Pleurae Nerve Supply The parietal pleura is sensitive to pain, temperature, touch, and pressure The parietal pleura is innervated by both somatic and sympathetic and parasympathetic fiber via the intercostal nerve.
  • 73. Pleurae Nerve Supply The parietal pleura is supplied as follows: The costal pleura is segmentally supplied by the intercostal nerves. The mediastinal pleura is supplied by the phrenic nerve. The diaphragmatic pleura is supplied over the domes by the phrenic nerve and around the periphery by the lower six intercostal nerves.
  • 74. Pleurae Nerve Supply The visceral pleura covering the lungs is sensitive to stretch but is insensitive to common sensations such as pain and touch. It receives an autonomic nerve supply from the pulmonary plexus.