PECTORAL MUSCLES

The superficial fascia of the

anterior thoracic region
• Is continuous with that of the neck and
upper limb above, and abdomen below.
• It contains the mammary gland, sends
numerous septa between its lobes and
connects it, by fibrous mammary
suspensory ligaments, to the skin and
nipple.
• The pectoral fascia is the deep fascia that covers
pectoralis major and extends between its fasciculi.
• It is attached:
• Medially to the sternum,
• Above to the clavicle
• Is continuous inferolaterally with the fascia of the
shoulder, axilla and thorax.
• Is thin over pectoralis major,
• Is thicker between this muscle and latissimus
dorsi, to which it crosses, forming the floor of the
axilla.
• This axillary fascia divides at the lateral margin of
latissimus dorsi into two layers, which ensheathe
the muscle and are attached behind to the spines
of the thoracic vertebrae.
•
• As the fascia leaves the lower edge of
pectoralis major to cross the axilla, a layer
from it ascends under cover of the muscle;
this layer splits to envelop pectoralis minor,
at whose upper edge it becomes the
clavipectoral fascia
• The hollow of the armpit is produced mainly
by the action of this fascia in tethering the
skin to the floor of the axilla; it is sometimes
referred to as the suspensory ligament of the
axilla.
• Axillary fascia is pierced by the tail of the
mammary gland
• In the lower thoracic region the deep fascia
is well developed and continuous with the
fibrous sheath of rectus abdominis.
Pectoralis major is a thick,
fan-shaped muscle
Origin:
1. from the anterior surface of
the sternal half of the
clavicle,
2. from half the breadth of the
anterior surface of the
sternum down to the level of
the sixth or seventh costal
cartilage,
3. from the first to the seventh
costal cartilages

4. from the aponeurosis of

obliquus externus
abdominis.
5. The clavicular fibres are usually
separated from the sternal fibres
by a slight cleft
• The muscle
converges to a flat
tendon, about 5 cm
across,
• It is attached to the
lateral lip of the
intertubercular sulcus
of the humerus.
• The tendon of pectoralis major is bilaminar.

• The thicker anterior lamina is formed by fibres

from the manubrium, which are joined superficially
by clavicular fibres and deeply by fibres from the
sternal margin and second to fifth costal
cartilages.

• Clavicular fibres may be prolonged into the

deltoid tendon.

• The posterior lamina receives fibres from the sixth

(and often seventh) costal cartilages, sixth rib,
sternum, and aponeurosis of the obliquus
abdominis externus.
• Costal fibres join the lamina without twisting; fibres
from the sternum and aponeurosis curve around
the lower border, turning successively behind those
above them, this part of the muscle being so
twisted that the fibres that are lowest at their medial
origin are highest at their insertion on the humerus.

• The posterior lamina reaches higher on the

humerus than the anterior, and gives off an
expansion that covers the intertubercular sulcus
and blends with the capsular ligament of the
shoulder joint.

• An expansion from the deepest part of the lamina,

at its linear insertion, lines the intertubercular
sulcus; from its lower border another expansion
descends into the deep fascia of the upper arm.
• Blood Supply of pectoralis major
• 1. Pectoral and deltoid branches of the
thoraco-acromial artery
• 2. Perforating branches of the internal
thoracic arteries
• 3 Superior thoracic artery
• 4. Lateral thoracic artery
• Nerve Supply of Pectoralis major
• Medial pectoral nerves
• Lateral pectoral nerves.
• Fibres for the clavicular part are from
C5 and 6;
• Fibres for the sternocostal part are
from C6, 7, 8, and T1.
 Actions of pectoralis major
• The whole muscle assists adduction and medial
rotation of the humerus against resistance.
• It swings the extended arm forwards and medially,
its clavicular part acting with the anterior fibres of
deltoid and coracobrachialis; in this movement the
sternocostal part is relaxed.
• The opposite movement is usually aided by
gravity; when it is resisted the sternocostal part
acts together with latissimus dorsi, teres major
and the posterior fibres of deltoid, and the
clavicular part is relaxed.
• With the raised arms fixed, e.g.
gripping a branch, the same
combination of muscles draws the
trunk up and forwards in climbing.
• Pectoralis major is active in deep
inspiration.
• Electromyography suggests that the
clavicular part acts alone in medial
rotation.
•Pectoralis minor is a
thin, triangular
muscle lying
posterior (deep) to
pectoralis major.
• It arises from the
upper margins and
outer surfaces of the
third to fifth ribs
(frequently second to
fourth), near their
cartilages, and from
the fascia over
adjoining external
intercostals.
• Its fibres ascend laterally
under cover of pectoralis
major, converging in a flat
tendon attached to the
medial border and upper
surface of the coracoid
process of the scapula.
• Part or all of the tendon
may cross the process into
the coraco-acromial
ligament, or even beyond
to the coracohumeral
ligament, whereby it is
attached to the humerus.
Blood Supply of pectoralis minor:
• 1. Pectoral and deltoid branches of
the thoraco-acromial artery
• 2. Superior thoracic arteries
• 3. Lateral thoracic arteries
Nerve Supply of pectoralis minor:
• Medial and Lateral pectoral nerves,
C5, 6, 7, 8 and T1.
• Actions of pectoralis minor
• The muscle assists serratus anterior in
drawing the scapula forwards around the
chest wall.
• With levator scapulae and the rhomboids it
rotates the scapula, depressing the point
of the shoulder.
• Both pectoral muscles are
electromyographically quiescent in normal
inspiration, but are active in forced
inspiration.
•Subclavius is a small,
triangular muscle tucked
between the clavicle and
the first rib.
• It arises from the junction
of the first rib and its costal
cartilage, anterior to the
costoclavicular ligament, by
a thick tendon, which is
prolonged at its inferior
margin
•It passes upwards and
laterally to the groove on
the under surface of the
middle third of the clavicle,
where it is attached by
muscular fibres.
• Blood Supply of Subclavius
• Clavicular branch of the thoraco-
acromial artery & suprascapular artery
• Nerve Supply
• The subclavian branch of the brachial
plexus, containing fibres from C5 and
6
• Action
• Subclavius probably pulls the point of
the shoulder down and forwards and
braces the clavicle against the
articular disc of the sternoclavicular
joint,
• Clavipectoral fascia is a
strong fibrous sheet
behind the clavicular part
of pectoralis major.
• It fills the gap between
pectoralis minor and
subclavius,
• covers the axillary
vessels and nerves.
• It splits around
subclavius and is
attached to the clavicle
both anterior and
posterior to the groove
for subclavius;
• the posterior layer fuses
with the deep cervical
fascia that connects the
omohyoid to the clavicle
and with the sheath of
the axillary vessels.
• Medially it blends with
fascia over the first two
intercostal spaces and is
attached to the first rib,
medial to subclavius.
• Laterally, it is thick and
dense, and is attached to
the coracoid process,
blending with the
coracoclavicular ligament.
• Between the first rib and
coracoid process the fascia
often thickens to form a
band, the costocoracoid
ligament;
• below this it becomes thin,
splits around pectoralis
minor and descends to
blend with the axillary
fascia
• and laterally with the fascia
over the short head of
biceps.
• Structures
piercing the
clavipectoral
fascia: (CALL)
• The Cephalic vein,
• Thoraco-acromial
artery and vein,
• Lateral pectoral
nerve
• Lymphatics from
the upper lateral
quadrant of the
breast to the
apical axillary
lymph nodes