PECTORAL REGION

Mesole Samuel Bolaji (B.sc, M.sc PhD (in view))

course: Anatomy
Class: MBChB
 INTRODUCTION

• The pectoral region is located on the anterior chest

wall.
• It contains four muscles that exert a force on the
upper limb;
• These muscles include pectoralis major.
• pectoralis minor, serratus anterior and subclavius.

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 PECTORALIS MAJOR
• The pectoralis major is the most superficial muscle in the pectoral region.
• It is large and fan shaped, and is composed of a sternal head and a
clavicular head
• Attachments: The distal attachment of both heads is into the
intertubercular sulcus of the humerus.
• Clavicular head – originates from the anterior surface of the medial
clavicle.
• Sternocostal head – originates from the anterior surface of the sternum,
the superior six costal cartilages and the aponeurosis of the external
oblique muscle.
• Inserts into the lateral lip of the intertubercular groove and crest of the
greater tubercle.
ACTION, VASCULATURE AND INNERVATION
• Action: horizontal shoulder adduction, internal
rotation of the shoulder
• Flexion of an extended arm (Clavicular head)
• Extension of a flexed arm (sternocoastal head)
• Innervation: Lateral and medial pectoral nerves
(clavicular head (C5 and C6, sternocostal head (C7,
C8, and T1))
• Blood supply: pectoral branch of the
thoracoacromial trunk
 Clinical anatomy of Pectoralis Major
• Poland syndrome: Congenital absence of the
pectoralis major.
• the latissimus dorsi and teres major compensates
for the deficiencies.
• Lipomas: A lipoma is a benign tumor made of fat
tissue
• They are generally soft to the touch, movable, and
painless
 Pectoralis Minor
• The pectoralis minor lies underneath its larger counterpart
muscle, pectoralis major. Both of these muscles form part of
the anterior wall of the axilla region.
• The pectoralis minor muscle is covered anteriorly
(superficially) by the clavipectoral fascia.
• The pectoralis minor forms a 'bridge' - structures passing
into the upper limb from the thorax will pass directly
underneath
• Attachments: Originates from the 3rd-5th ribs, and inserts
into the coracoid process of the scapula.
Pectoralis Minor
ACTION, VASCULATURE AND INNERVATION
• Action : Stabilizes the scapula by drawing it inferiorly and anteriorly
against the thoracic wall, raises ribs in inspiration.
• Blood supply: Pectoral branch of the thoracoacromial trunk
• Innervation: Lateral and medial pectoral nerves
 SUBCLAVIUS
• The subclavius is small muscle, which is located directly
underneath the clavicle, running horizontally.
• The subclavius protects the underlying brachial plexus and
subclavian vessels from a broken clavicle
• It affords some minor protection to the underlying
neurovascular structures (e.g in cases of clavicular fracture
or other trauma).
• Attachments: Originates from the junction of the 1st rib
and its costal cartilage
• inserting into the inferior surface of the middle third of the
clavicle.
SUBCLAVIUS MUSCLE
ACTION INNERVATION AND VASCULATURE
• Action: Anchors and depresses the clavicle.
• The subclavius depresses the shoulder, carrying it downward and
forward.
• Nerve: Nerve to the subclavius or Subclavvian nerve
• Blood supply: clavicular branch of the thoracoacromial trunk
 CLAVIPECTORAL FASCIA
• strong fascia situated under cover of the clavicular portion of the
pectoralis major.
• occupies the interval between the pectoralis minor and subclavius, and
protects the axillary vein and artery, and axillary nerve.
• Medially, it blends with the fascia covering the first two intercostal
spaces, and is attached also to the first rib medial to the origin of the
subclavius.
• Laterally, it is very thick and dense, and is attached to the coracoid
process.
• Pierced by Cephalic vein, Thoracoacromial artery, Lateral pectoral nerve
and Lymphatics.
Clavipectoral fascia with the P- Major removed
 Serratus Anterior
• The serratus anterior is located more laterally in the chest
wall, and forms the medial border of the axilla region.
• Originates on the surface of the 1st to 8th ribs on the lateral
aspect of the thoracic wall.
• Inserted on the costal aspect of medial margin of the scapula
• It is divided to different parts depending on the points of
insertions.
• serratus anterior superior is inserted near the superior angle
• the serratus anterior intermediate is inserted along the
medial border
• the serratus anterior inferior is inserted near the inferior
angle.
Serratus Anterior
ACTION, VASCULATURE AND INNERVATION
• Action: Rotates the scapula, allowing the arm to be raised over 90
degrees. It also holds the scapula against the ribcage.
• Blood supply: lateral thoracic artery, superior thoracic artery (upper
part), thoracodorsal artery (lower part).
• Nerve supply:long thoracic nerve (from roots of brachial plexus C5, 6, 7)
 CLINICAL SIGNIFICANCE
• long thoracic nerve is highly affected during surgery of the anterolateral
thorax
• for example, during axillary dissection or radical mastectomy
• Typical symptoms for this injury are scapular winging and loss of ability
to raise the affected arm overhead
• Another causes for injury of long thoracic nerve are trauma and a
compression due to carrying heavy loads (e.g. backpack) and trauma.
winged scapular