The diaphragm arises from the inner surface of ribs 7-12 via muscular and tendinous slips, with the tendinous portions attaching to the costal cartilages and ribs. These costal slip tendons radiate toward the central tendon and represent the peripheral tendinous framework of the diaphragm.
Costal slip tendon avulsion from rib fractures disrupts diaphragm continuity and may produce a traumatic diaphragmatic hernia if multiple ribs are fractured. The costal slips interdigitate with the transversus abdominis origin, explaining why diaphragmatic hernia repair requires addressing both the diaphragm and the abdominal wall. Rib-spreading during thoracotomy stresses the costal slip tendons and may produce post-thoracotomy pain syndrome.
Rupture of costal slip tendons from severe chest-abdominal blunt trauma allowing abdominal viscera to herniate into the chest through the diaphragmatic defect, diagnosed on CT and repaired surgically.
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