Sternal angle

<h2 id="anatomy">Anatomy</h2>
The sternal angle forms an angle of about 162° in males.<a class="footnote-ref" id="fnref:8" href="#fn:8">8</a>

<h3>Relations</h3>
It marks the approximate<a class="footnote-ref" id="fnref:9" href="#fn:9">9</a> level of the 2nd pair of <a href="/facts/Costal_cartilage/c49rMqFC">costal cartilages</a>,<a class="footnote-ref" id="fnref:10" href="#fn:10">10</a><a class="footnote-ref" id="fnref:11" href="#fn:11">11</a>: 319  (sources differ) the level of the <a href="/facts/Intervertebral_disc/RTj5SrMo">intervertebral disc</a> between <a href="/facts/Thoracic_vertebra/WXBWDkfM">thoracic vertebra</a> T4-T5<a class="footnote-ref" id="fnref:12" href="#fn:12">12</a><a class="footnote-ref" id="fnref:13" href="#fn:13">13</a>: 319  or the lower border of the thoracic vertebra T4,<a class="footnote-ref" id="fnref:14" href="#fn:14">14</a>: 218  and the space between the <a href="/facts/Spinous_process/qAdLhD5H">spinous processes</a> of thoracic vertebrae T3-T4.<a class="footnote-ref" id="fnref:15" href="#fn:15">15</a>: 319  The horizontal plane that passes through the sternal angle and the articular disc between the 4th and 5th thoracic vertebrae represents the imaginary boundary between the <a href="/facts/Superior_mediastinum/mQUlFdhF">superior mediastinum</a> and <a href="/facts/Inferior_mediastinum/mQUlFdhF">inferior mediastinum</a>.
It is located approximately 7 cm inferior to the superior margin of the manubrium.
The sternal angle is used in the definition of the <a href="/facts/Thoracic_plane/mQUlFdhF">thoracic plane</a>.
The angle also marks the level of a number of features:

<ul><li>Boundary between the superior and inferior portion of the <a href="/facts/Mediastinum/mQUlFdhF">mediastinum</a></li>
<li>Passage of the thoracic duct from right to left behind esophagus</li>
<li><a href="/facts/Tracheal_bifurcation/z5gKXHrM">Tracheal bifurcation</a>.<a class="footnote-ref" id="fnref:16" href="#fn:16">16</a>: 387, 1039, 1060  The carina of the trachea is thus, present here. It is deep to the sternal angle.</li>
<li>The bifurcation of the <a href="/facts/Pulmonary_trunk/86j5Jc7D">pulmonary trunk</a><a class="footnote-ref" id="fnref:17" href="#fn:17">17</a>: 336 </li>
<li>The superior limit of the <a href="/facts/Fibrous_pericardium/ePd4gkeT">fibrous pericardium</a> surrounding the <a href="/facts/Ascending_aorta/shedA09L">ascending aorta</a><a class="footnote-ref" id="fnref:18" href="#fn:18">18</a>: 350 </li>
<li>Termination of the <a href="/facts/Azygos_vein/HQDk5Xjz">azygos vein</a> into the <a href="/facts/Superior_vena_cava/v4Ea6py0">superior vena cava</a><a class="footnote-ref" id="fnref:19" href="#fn:19">19</a>: 193 </li>
<li>Ligamentum arteriosum</li>
<li>Loop of left recurrent laryngeal nerve around aortic arch</li>
<li>The beginning and end of the <a href="/facts/Aortic_arch/JvSt61eK">aortic arch</a><a class="footnote-ref" id="fnref:20" href="#fn:20">20</a>: 383 <a class="footnote-ref" id="fnref:21" href="#fn:21">21</a>: 190 </li></ul>
<h2 id="clinical-significance">Clinical significance</h2>
The sternal angle is the most frequent site of <a href="/facts/Sternal_fracture/yz7t0GzX">sternal fracture</a> among elderly people.<a class="footnote-ref" id="fnref:22" href="#fn:22">22</a>: 303 

<h3>Surface anatomy and physical examination</h3>
The sternal angle marks the point at which the costal cartilage of either second rib articulates with the sternum. During <a href="/facts/Physical_examination/qzI0BK5P">physical examinations</a>, the readily palpated sternal angle is thus used as a landmark to identify the 2nd rib, and by extension, by counting, also the remaining ribs. Meanwhile, the first rib cannot be used for this purpose because it cannot be palpated.<a class="footnote-ref" id="fnref:23" href="#fn:23">23</a>: 321  Counting ribs is essential attempting to make a thoracic incision; an incision at the first or second rib interspace can result in damage to large, important blood vessels and the brachial plexus. Identification of the second rib and thus the second intercostal space inferiorly is useful when auscultating heart sounds. The optimal location for auscultation of the aortic valve is generally the right second intercostal space, whereas the optimal location for auscultation of the pulmonic valve is generally the left second intercostal space.
The sternal angle is used as the starting point in physical examinations of the heart since the sternal angle is located 5 cm superior to the right atrium.

<h2 id="history">History</h2>
The sternal angle is also called the angle of Louis, but the reason for that name was lost. Once thought to be after <a href="/facts/Antoine_Louis/G5hYVbJI">Antoine Louis</a> or <a href="/facts/Wilhelm_Friedrich_von_Ludwig/m2wbL5WS">Wilhelm Friedrich von Ludwig</a>, it is now believed to be after <a href="/facts/Pierre_Charles_Alexandre_Louis/U2fuBa3A">Pierre Charles Alexandre Louis</a>.<a class="footnote-ref" id="fnref:24" href="#fn:24">24</a>

<h2 id="see-also">See also</h2>
<ul><li><a href="/facts/Thoracic_plane/mQUlFdhF">Thoracic plane</a></li>
<li><a href="/facts/List_of_medical_mnemonics/XwvEEI9A">List of medical mnemonics</a></li></ul>

<h2 id="external-links">External links</h2>
<ul><li><a href="http://ect.downstate.edu/courseware/haonline/labs/l18/st0212.htm">Anatomy photo:18:st-0212</a> at the SUNY Downstate Medical Center - "Thoracic Wall: Bones"</li></ul>

<h2 id="references">References</h2>

<ol>
<li id="fn:1">Clinical Anatomy of the Spine, Spinal Cord, and Ans. Elsevier. 2014. p. 226. doi:10.1016/c2009-0-42801-0. ISBN 978-0-323-07954-9. <a href="978-0-323-07954-9" target="_blank">978-0-323-07954-9</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></li>
<li id="fn:2">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></li>
<li id="fn:3">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></li>
<li id="fn:4">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></li>
<li id="fn:5">Cramer, Gregory D.; Darby, Susan A. (2014). Clinical Anatomy of the Spine, Spinal Cord, and Ans (3rd ed.). Elsevier. p. 226. doi:10.1016/c2009-0-42801-0. ISBN 978-0-323-07954-9. <a href="978-0-323-07954-9" target="_blank">978-0-323-07954-9</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></li>
<li id="fn:6">Srebnik, Herbert H. (2012). Concepts in Anatomy. doi:10.1007/978-1-4615-0857-1. ISBN 978-1-4615-0857-1. <a href="978-1-4615-0857-1" target="_blank">978-1-4615-0857-1</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></li>
<li id="fn:7">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></li>
<li id="fn:8">Susan Standring; Neil R. Borley; et al., eds. (2008). "Chapter 54: Chest wall and breast". Gray's anatomy : the anatomical basis of clinical practice (40th ed.). London: Churchill Livingstone. p. 922. ISBN 978-0-8089-2371-8. <a href="978-0-8089-2371-8" target="_blank">978-0-8089-2371-8</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></li>
<li id="fn:9">Wilson, Herbert H. Srebnik ; illustrations by Genevieve M. (2002). Concepts in anatomy. Boston: Kluwer Academic Publishers. p. 70. ISBN 0792375394.{{cite book}}: CS1 maint: multiple names: authors list (link) <a href="0792375394" target="_blank">0792375394</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></li>
<li id="fn:10">Wilson, Herbert H. Srebnik ; illustrations by Genevieve M. (2002). Concepts in anatomy. Boston: Kluwer Academic Publishers. p. 70. ISBN 0792375394.{{cite book}}: CS1 maint: multiple names: authors list (link) <a href="0792375394" target="_blank">0792375394</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></li>
<li id="fn:11">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></li>
<li id="fn:12">Wilson, Herbert H. Srebnik ; illustrations by Genevieve M. (2002). Concepts in anatomy. Boston: Kluwer Academic Publishers. p. 70. ISBN 0792375394.{{cite book}}: CS1 maint: multiple names: authors list (link) <a href="0792375394" target="_blank">0792375394</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></li>
<li id="fn:13">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></li>
<li id="fn:14">Sinnatamby, Chummy S. (2011). Last's Anatomy (12th ed.). ISBN 978-0-7295-3752-0. <a href="978-0-7295-3752-0" target="_blank">978-0-7295-3752-0</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></li>
<li id="fn:15">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></li>
<li id="fn:16">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></li>
<li id="fn:17">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></li>
<li id="fn:18">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></li>
<li id="fn:19">Sinnatamby, Chummy S. (2011). Last's Anatomy (12th ed.). ISBN 978-0-7295-3752-0. <a href="978-0-7295-3752-0" target="_blank">978-0-7295-3752-0</a> <a href="#fnref:19" class="footnote-back-ref">↩</a></li>
<li id="fn:20">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:20" class="footnote-back-ref">↩</a></li>
<li id="fn:21">Sinnatamby, Chummy S. (2011). Last's Anatomy (12th ed.). ISBN 978-0-7295-3752-0. <a href="978-0-7295-3752-0" target="_blank">978-0-7295-3752-0</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></li>
<li id="fn:22">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></li>
<li id="fn:23">Moore, Keith L.; Dalley, Arthur F.; Agur, Anne M. R. (2017). Essential Clinical Anatomy (6th ed.). Lippincott Williams & Wilkins. ISBN 978-1496347213. <a href="978-1496347213" target="_blank">978-1496347213</a> <a href="#fnref:23" class="footnote-back-ref">↩</a></li>
<li id="fn:24">Alberto Coscione; L. Dixon; H. Ellis (2013). "The "Angle of Louis"" (PDF). Eur. J. Anat. 17 (3): 190–192. <a href="http://eurjanat.com/data/pdf/eja.130056ld.pdf" target="_blank">http://eurjanat.com/data/pdf/eja.130056ld.pdf</a> <a href="#fnref:24" class="footnote-back-ref">↩</a></li>
</ol>

Sternal angle open-in-new

Sternal angle