Shoulder Region & Anterior Arm | Gross HSB A ▪ Breast

1st Year – 1st Semester – 1st Prelims – 5th Week (Bañez, M.D.)
o Characteristic – part of two systems (endocrine & reproductive system)
Important muscles & structures (a checklist) ▪ Note: Acted upon by estrogen & progesterone hence it is part of the
✓ Pectoralis major reproductive system
✓ Pectoralis minor o Function – supplies nutrition to the baby
✓ Serratus anterior o Location – beneath the skin (more superficial than the pectoralis fascia)
✓ Subclavius ▪ Superior border – 2nd rib
✓ Female – breast ▪ Inferior border – 6th rib
✓ Neurovascular structures ▪ Lateral border – anterior axillary line
✓ Deltoid ▪ Medial border – parasternal line
✓ Intermuscular septa o Maturation – milk secretion imparts maturation
✓ Biceps brachii o Mammary line/ridge (5 pairs)
✓ Brachialis ▪ Axillary pair
✓ Coracobrachialis ▪ Upper pectoral pair – persists
✓ Basilic & cephalic veins ▪ Lower pectoral pair
✓ Brachial vein comitantes & its tributaries ▪ Abdominal pair
✓ Anterior & posterior humeral circumflex ▪ Inguinal pair
✓ Brachial artery & its branches o Hormones (only in females)
✓ Nerves in the anterior compartment of the arm ▪ Estrogen & progesterone
✓ Surface anatomy ▪ Prolactin & oxytocin – secreted when delivering a baby
Subregions of the shoulder region ▪ Note: In males, no hormones act on the breasts
▪ Pectoral side o Composition
▪ Scapular side ▪ Mammary gland
▪ Axillary area – most important (contains the brachial plexus) • Lobes – 16 to 20 per nipple
▪ Deltoid area – smallest subregion • Nipple – formed by ducts from 16 to 20 lobes
Topics of the shoulder region • Areola – highly-pigmented area around the nipple
▪ Surface anatomy o Montgomery gland – may impart smell in the areola due to
▪ Fascial covering (superficial & deep) being an apocrine gland located in the areolar area
▪ Muscle regions (pectoral, deltoid, and anterior arm) o Upper lateral quadrant – largest quadrant of the breast
Surface anatomy ▪ Description – extension of tissue of the breast into the axillary
▪ Sternum – divides right & left sides region via the tail of spence
▪ Clavicle – separates the thorax from the shoulder & the neck o Cooper’s ligament – supports the breast
o Note: Penetrating injuries above the clavicle also warrant a thorax o Superficial fascia (Camper’s & Scarpa’s)
examination since the apex of the lungs extends 1 ½ inches above the o Blood supply of the breast
clavicle → may cause pneumothorax ▪ Branches of internal thoracic artery
▪ Deltoid – common injection site ▪ Branches of the 2nd to 4th anterior intercostal arteries
▪ Pectoralis major ▪ Branches of the axillary arteries (highest thoracic, thoracoacromial,
▪ Cephalic vein – passes through the deltopectoral groove lateral thoracic, and subscapular arteries)
▪ Biceps brachii o Lymphatic drainage
o Note: Bicipital grooves are the passageways of the ▪ Note: Glandular epithelium whose preferred route of metastasis is
different neurovascular structures through the lymphatics
▪ Note: Deltopectoral groove – formed by the cephalic vein passing between ▪ Sappey – subareolar plexus
the deltoid & pectoralis major ▪ Axillary lymph node – chief lymph drainage
Superficial fascia ▪ Lymph node along the internal thoracic arteries
▪ Cutaneous innervations ▪ Contralateral breast & anterior abdomen
o Supraclavicular nerve Deep fascia
▪ Origin – superior trunk of brachial plexus (C5-C6) ▪ Pectoralis fascia
▪ Innervation – shoulder sensation o Importance – covers the pectoralis major
o Lateral cutaneous nerve o Cooper’s ligament – attaches to the pectoralis fascia
▪ Origin – intercostal nerves (T1-T2) o Note: Blends with the fascia of the deltoid & abdomen
o Medial cutaneous nerve o Attachment – clavicle & sternum
▪ Origin – terminal branches of intercostal nerve ▪ Clavipectoral fascia
▪ Blood vessels o Importance – covers the subclavius & pectoralis minor
o Branches of internal thoracic/mammary arteries o Note: Extension of the axillary fascia (which comes from the
▪ Description – branches of the subclavian artery prevertebral fascia)
• Note: Right subclavian artery is a branch of brachiocephalic o Cephalic vein – pierces the clavipectoral fascia in order to drain to the
artery which arises from the arch of aorta axillary vein
• Note: Left subclavian artery is a direct branch of the aortic arch ▪ Note: Also pierced by the thoracoacromial artery, lateral pectoral
▪ Supplies – pectoral area nerve, and lymph vessels of infraclavicular nodes
o Perforating branches of anterior intercostal arteries Muscles of the pectoral region
▪ Description – branches of the internal thoracic/mammary arteries ▪ Pectoralis major
▪ Note: Secondary branch of the subclavian artery (since it arises o Origin – medial half of the clavicle, sternum, & upper six costal cartilage
from a primary branch of the subclavian) o Insertion – lateral lip of bicipital groove of the humerus
▪ Supplies – pectoral area o Nerve supply – lateral pectoral nerve (clavicular part) & medial pectoral
o Branches of superior/highest thoracic arteries nerve (sternocostal part)
▪ Description – branch of the axillary artery o Action – adducts & medial rotation of the arm
▪ Supplies – pectoral area ▪ Pectoralis minor
o Branches of lateral thoracic arteries o Origin – 3rd to 5th rib
▪ Description – branch of the axillary artery o Insertion – coracoid process of the scapula
▪ Supplies – pectoral area o Nerve supply – medial pectoral nerve
o Thoracoacromial artery – supplies anterior chest wall o Action – pulls shoulder down & forward
▪ Clavicular branch of the thoracoacromial artery ▪ Also, can elevate ribs & assist in forceful respiration
▪ Acromial branch of the thoracoacromial artery ▪ Subclavius
▪ Humeral branch of the thoracoacromial artery o Origin – 1st rib
▪ Pectoral branch of the thoracoacromial artery o Insertion – lateral 3rd of the clavicle
o Branches of the subscapular artery o Nerve supply – nerve for subclavius
▪ Description – largest branch of the axillary artery o Action – depresses the clavicle; can also assist in forceful respiration
▪ Serratus anterior ▪ Arteries of the arm
o Origin – outer surface of upper 8 ribs o Some branches of the axillary artery (which supply the arm)
o Insertion – anterior surface of the medial border of the scapula ▪ Posterior circumflex humeral artery
o Nerve supply – long thoracic nerve (C5, C6, C7) ▪ Anterior circumflex humeral artery
o Action – protracts the scapula & rotates the scapula upward o Brachial artery – has muscular branches which supplies arm muscles
▪ Also, can elevate ribs during forceful respiration ▪ Branches of the brachial artery
o Note: Injury can cause winging of scapula • Profunda brachii artery
Muscle of the deltoid region o Characteristic – largest branch of the brachial artery
▪ Deltoid o Description – accompanies the radial nerve at the posterior
o Origins compartment of the arm
▪ Anterior fiber – lateral 3rd of the clavicle o Anastomosis – humeral circumflex artery
▪ Middle fiber – acromion process o Branches of the profunda brachii artery
▪ Posterior fiber – lower border of the spine of scapula ▪ Radial collateral artery
o Insertion – deltoid tuberosity of humerus (common insertion point) • Anastomoses with the radial recurrent artery
o Nerve supply – axillary nerve (from posterior cord) ▪ Interosseous collateral artery
o Action – primarily abducts the arm (16th degree to 180th degree) • Anastomoses with the interosseous recurrent
▪ Anterior fiber – flexes & medially rotates of the arm artery
▪ Posterior fiber – extensions & lateral rotation of the arm • Superior ulnar collateral artery – anastomoses with the
▪ Note: Supraspinatus primarily abducts the arm until the 15th degree posterior ulnar recurrent artery
Surface anatomy of the arm o Description – accompanies the ulnar nerve at the posterior
▪ Anterior & posterior fullness compartment of the arm
▪ Lateral and medial bicipital sulcus • Inferior ulnar collateral artery – anastomoses with the anterior
▪ Cutaneous nerves ulnar recurrent artery
o Lateral cutaneous nerve o Description – passes at the anterior compartment of the
o Posterior cutaneous nerve arm
o Median cutaneous nerve of arm & forearm ▪ Divisions of the brachial artery
Deep fascia of the arm • Radial artery
▪ Brachial aponeurosis o Branches of the radial artery
o Description – has an extension inward between two muscles which ▪ Radial recurrent artery – anastomoses with the radial
touches the medial & lateral sides of the humerus dividing it into two collateral artery
▪ Divisions of the compartments • Ulnar artery
• Lateral intermuscular septum – extends from the lateral surface o Branches of the ulnar artery
of the humerus to the lateral superficial fascia of the arm ▪ Anterior ulnar recurrent artery – anastomoses with the
• Medial intermuscular septum – extends from the medial surface inferior ulnar collateral artery
of the humerus to the medial superficial fascia of the arm ▪ Posterior ulnar recurrent artery – anastomoses with
▪ Compartments of the arm the superior ulnar collateral artery
• Anterior compartment – biceps brachii, brachialis, and ▪ Common interosseous artery
coracobrachialis • Anterior interosseous artery
o Also, contains the neurovascular structures • Posterior interosseous artery
o AKA. flexor compartment o Interosseous recurrent artery – anastomoses
• Posterior compartment – triceps brachii with the interosseous collateral artery
o AKA. extensor compartment ▪ Description – branch of the posterior
• Note: Compartment name reflects the action distal to it interosseous artery
o Function – covers the arm compartment ▪ Note: Grand total of four (4) anastomoses in the arm compartment
Muscles of the anterior compartment ▪ Veins of the arm
▪ Note: All muscles of the anterior compartment is innervated by the o Vena comites (brachial vein)
musculocutaneous nerve by piercing the coracobrachialis o Basilic & cephalic vein
o Since the musculocutaneous nerve is originates medially to the muscles ▪ Note: No arterial counterpart at all
of the anterior compartment, it must pierce the coracobrachialis in order
to gain access to the flexor muscles of the arm
▪ Biceps brachii
o Origins
▪ Long head – superior glenoid tubercle
▪ Short head – coracoid process
o Insertion – radial tuberosity & bicipital aponeurosis
o Action – supinates the arm when the elbow is flexed
▪ Also, flexes the arm & forearm
▪ Branchalis
o Origin – shaft of the humerus
o Insertion – coronoid process of the ulna
o Action – most powerful flexor of the elbow joint
▪ Coracobrachialis
o Origin – coracoid process of the scapula
o Insertion – shaft of the humerus
o Action – flexes & adducts the arm
▪ Note: Can never move the elbow since it attaches only to the
humerus bone & does not cross the elbow joint
Neurovascular structures of the arm
▪ Nerves associated with the brachial artery
o Median nerve – immediately anterior to the brachial artery
▪ Note: Never supplies any structures in the arm
o Ulnar nerve
▪ Note: Never supplies any structures in the arm & is also responsible
for painful sensation when the elbow is struck posteriorly
o Radial nerve – passes through the arm posteriorly (through the radial Ad astra per aspera
RICO2018 – FEU-NRMF SMT

groove) & appears anteriorly after the elbow AngeloBautista