They then create myofibers on which the structural framework builds. The myoblasts are the progenitor cells of skeletal muscle and coalesce to form giant multinucleated cells. Skeletal muscle ultimately forms in three stages the myoblast stage, myotubule stage, and the myofiber stage. They then arrange to form the dermatomyotome and finally arrange to form the myotome. These cells originate from the para-axial mesoderm which forms somites. Skeletal muscle formation occurs through the process of myogenesis. As a result, auscultation of breath sounds such as wheezing, rhonchi, and rales of the inferior lobes of the lungs is optimal in this area. As a result, there are fewer impedances between the examiner’s stethoscope and the lungs which allow for better auscultation. When the patient crosses their arms across their chest, the scapula and muscular borders of the triangle of auscultation move in a way to expose the landmark. The triangle of auscultation is an important anatomical landmark that allows for better auscultation during the pulmonary examination. The floor of the triangle consists of the posterior thoracic wall which contains the rhomboid major muscle, serratus anterior muscle, and erector spinae muscles. It is bordered on three sides – inferiorly by the latissimus dorsi muscle, superiorly by the inferior border of the trapezius, and laterally by the medial border of the scapula formed by the teres major muscle and infraspinatus muscle. The triangle of auscultation is at the inferior angle of the scapula best exposed by instructing the patient to cross his arms over his chest and bending forward.
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