PECTORAL REGION

JAYASHREE REDDY
 AS PER:
COMPETENCY BASED UNDERGRADUATE CURRICULUM

AT THE END OF THIS CHAPTER THE STUDENT SHOULD BE ABLE TO :

AN9.1: DESCRIBE ATTACHMENTS, NERVE SUPPLY AND ACTIONS OF
PECTORALIS MAJOR , PECTORALIS MINOR AND SUBCLAVIUS MUSCLES.
AN10.11: DESCRIBE AND DEMONSTRATE ATTACHMENT OF SERRATUS
ANTERIOR WITH ITS ACTIONS.
AN13.7: ………, TESTING OF MUSCLES: ………., PECTORALIS MAJOR,
SERRATUS ANTERIOR, ……..
. 2
 INTRODUCTION
Pectoral region lies in front of trunk anterior to the thoracic cage
(pector = breast or pectus = chest in Latin).
• It connects the upper limb and anterolateral part of thoracic wall.
•superficial fascia here is fibro-fatty , encloses mammary gland.
Platysma muscle sweeps forwards superficial to clavicle towards the neck
& arises from pectoral fascia.
The deep fascia known as pectoral-fascia attached to clavicle & sternum,
invests the pectoralis major & at the floor of axilla thickened to form axillary
fascia, splits & encloses lattismus dorsi.
 DEEP FASCIA
• Deep fascia of the pectoral region is called pectoral fascia.
• Extension:
– Superiorly: attaches to the clavicle
– Medially: attaches to the sternum
– Supero laterally: continues as deep fascia over deltoid
muscle
– Infero-laterally: turns to continue as axillary fascia (axilla =
armpit).
– Inferiorly: continue as fascia covering the lower part of
thoracic rage. 4
MUSCLES OF PECTORAL REGION
 PECTORALIS MAJOR MUSCLE

Nerve supply : medial & lateral pectoral nerves

 PECTORALIS MAJOR
Sternocostal head
• It has manubrial, sternal, and aponeurotic
fibers.
• Manubrial fibers arise from lateral half of
anterior surface of manubrium.
• Sternal fibers arise from lateral half of
anterior surface of sternum up to 6th costal
cartilage.
• Costal fibers arise from 2nd to 6th costal
cartilages.
• Aponeurotic fibers arise from aponeurosis
of external oblique muscle of abdomen.
Human Anatomy/Yogesh Sontakke 9
 CLINICAL INTEGRATION

• Pectoralis major is the most common

muscle to be congenitally absent.
• There may be a congenital complete or
partial absence of clavicular or
sternocostal heads.
• A separate cleft between clavicular and
sternocostal heads of pectoralis major may
be present. 10
ACCESSORY PECTORALIS MAJOR MUSCLE
POLAND SYNDROME
 RECTUS STERNALIS MUSCLE

It is an occasional muscle.

Disposed longitudinally along the side of
sternum, in front of pectoralis major.
It is derivative of superficial part of rectus
abdominus muscle .
Supplied segmentally by intercostal
nerves.
 PECTORALIS MINOR MUSCLE
• It is a triangular muscle, lies beneath pectoralis major, divides axillary artery
into 3 parts.
• Upper part gives attachment to clavipectoral fascia & lower border
suspensory ligament of axilla ,accompanied by lateral thoracic artery.
• ORIGIN: from 3-5th ribs (not cc’s) & from fascia covering external
• inter costal muscles.
• INSERTION : medial border & upper surface of coracoid process.
• Occasionally part of tendon may continuous with coraco-humeral ligament.
• NERVE SUPPLY : Medial & lateral pectoral nerves .
• ACTIONS : Assisted by serratus anterior , protracts the scapula.
• Depresses the shoulder , along with levator scapulae & rhomboids.
FLOW CHART OF PECTORALIS MINOR
 CLINICAL INTEGRATION
• Origin of pectoralis minor muscle is variable. It may be
Prefixed origin – arises from 2nd–5th rib.
Postfixed origin – arises from 3rd–6th rib.
It is the key muscle of axilla , because it crosses in front of axillary artery & divides it
into 3 parts.
• Poland syndrome
In this syndrome, muscles of one side of upper limb are under developed, which may
be due to loss of blood supply during embryonic development. It is a rare syndrome
(occurs in 1 in 20,000 new born) [sir alfred poland, british surgeon, 1822–72].
• Pectoral minimus muscle is an accessory muscle that is present in the pectoral
region. It originates from first costal cartilage and inserts on coracoid process. It lies
deep to the pectoralis major muscle.
 SUBCLAVIUS
It is a small triangular muscle that lies horizontally inferior to
the clavicle
• It lies within the clavipectoral fascia..
ORIGIN
• First rib at the costochondral junction.
DIRECTION
• The fibers run horizontally toward the under surface of clavicle
(supero laterally).
INSERTION
• Subclavius inserts on subclavian groove. Subclavian groove lies on the
inferior surface of middle-third of clavicle.
NERVE SUPPLY
• Nerve to subclavius (branch of upper trunk of brachial plexus, root 19

value: C5 & C6)

 SUBCLAVIUS

ACTIONS
• Protects the brachial plexus and
subclavian vessels by forming
cushion.
• Stabilizes the clavicle during
the movements of shoulder
joint.

20
 SERRATUS ANTERIOR
MUSCLE
• Serratus anterior muscle lies along the posterolateral wall of the chest (not the muscle of
pectoral region) (serrate = to saw, in latin) ,forms medial wall of axilla.
ORIGIN
• It originates by 8 digitations (slips) from upper eight ribs and fascia intervening intercostal muscles in the
mid axillary plane.
DIRECTION • The fibers curve around the thoracic wall to reach the medial border of scapula.
INSERTION

• Muscle is inserted on the costal surface of medial border of scapula as follows:

– 1st digitation at the superior angle
– 2nd and 3rd digitations along the entire medial border
– Remaining digitations on the triangular area at the costal surface of inferior angle
22
of
scapula.
 SERRATUS ANTERIOR MUSCLE
INNERVATION (NERVE SUPPLY)
• Long thoracic nerve (nerve to serratus anterior, nerve of bell )
• It arises from C5, C6, C7 roots of brachial plexus.
• Nerve lies on the superficial surface of the serratus anterior muscle in the midaxillary line.

ACTIONS
• Pushingand punching action (boxer’s muscle). Serratus anterior and pectoralis
minor together pulls the scapula forward around the chest wall for pushing and
punching action.
• Overhead abduction of arm serratus anterior (lower 4–5 digitations) and
trapezius (lower part) rotate the scapula and thus help in overhead abduction of
arm.
• Keeps the scapula in position.
Human Anatomy/Yogesh Sontakke 25
CLAVIPECTORAL FASCIA
30
 CUTANEOUS INNERVATION OF PECTORAL REGION
• BY THE FOLLOWING CUTANEOUS NERVES

• 1. The skin above the horizontal line

drawn at the level of sternal angle is
supplied by the supra clavicular
nerves.(C3 & C4).
• 2.The skin below this horizontal line is
supplied by the anterior & lateral
cutaneous branches of the 2nd -6th
intercostal nerves.(T1-T6).
PLATYSMA MUSCLE
 SERRATUS ANTERIOR MUSCLE
 THE EFFECTS OF PARALYSIS OF THE SERRATUS ANTERIOR MUSCLE:

1. It keeps the medial border of scapula in contact with chest wall.

2. It plays an important role in abduction of the arm & elevation of the arm above the head.
3. Pulls the scapula forwards in throwing, pushing & punching.
FUNCTIONS OF SERRATUS ANTERIOR ARE :
If serratus anterior muscle is paralysed due to injury of long thoracic nerve the effects will be as follows:
1. The medial border of the scapula stands out from chest wall , particularly when the patient is asked to press
against a wall in front of him, a condition known as winging of scapula.
2. The inability to raise the arm above head.
3. The inability to carry arm forward in the breast stroke of swimming a condition called ‘swimmer’s palsy’
The serratus anterior being the strongest protractor of the arm, it plays a key role in a forward punch during boxing.
Hence it is often termed Boxer’s muscle.
 QUESTIONS

• 1. Enumerate the structures piercing clavi-pectoral fascia.

• 2. Give the actions of pectoralis major muscle.
• 3. What is the action of serratus anterior muscle?
• 4. Name the muscles responsible for overhead abduction of arm.
THANK YOU………….

JAYASHREE REDDY