Anatomy of the Pectoral

Region

By

DR. OJEWALE A.O

1
 Outlines
• Intro’
• Lines of orientation
• Muscles of the pectoral region
• Cutaneous innervation
• Fasciae
• Applied Anatomy
 Pectoral Region
• The pectoral region is the anterior aspect of
the thorax (chest).
• The important structures are present in this
region are:
 Muscles that connect the upper limb with the
anterolateral chest wall.
 Breasts (mammary glands) which secrete milk
(in female).

3
Skeletal framework and surface landmarks of the pectoral
4
region
 LINES OF ORIENTATION
• The following lines are often used to describe
the surface features on the anterior chest wall:
• Midsternal line: It runs vertically downwards in
the median plane on the front of the sternum

• Midclavicular line: It runs vertically downwards

from the midpoint of the clavicle to the
midinguinal point.

• Anterior axillary line: It runs vertically

downwards from the anterior axillary fold 5
• Midaxillary line: It runs vertically downwards
from a point located midway between the
anterior and posterior axillary folds.

• Posterior axillary line: It runs vertically

downwards from the posterior axillary fold.

6
 MUSCLES OF THE PECTORAL
REGION
• Pectoralis major.
• Pectoralis minor.
• Subclavius

7
 PECTORALIS MAJOR
• It is the largest muscle of the pectoral region

 Origin
 Pectoralis major muscle is thin fan shaped
and arises by two heads, namely small
clavicular head and large sternocostal head.
 Clavicular head arises from the medial half of
the anterior aspect of the clavicle.

8
 Cont’d
• Sternocostal head arises from the (a) lateral
half of the anterior surface of the sternum, up
to 6th costal cartilage, (b) medial parts of 2nd-
6th costal cartilages, and (c) aponeurosis of the
external oblique muscle of the abdomen.

9
Bony attachments of the pectoralis major and minor muscles
10
Origin and insertion of the pectoralis major muscle 11
 Insertion:
• Pectoralis major is inserted by a U-shaped
(bilaminar) tendon on to the lateral lip of the
bicipital groove. The anterior lamina of the
tendon is formed by the clavicular fibres, while
posterior lamina is formed by sternocostal
fibres. The two laminae are continuous with
each other inferiorly. The lower sternocostal
and abdominal fibres in their course to
insertion are twisted in such a way that fibres,
which are lowest are inserted highest. This
twisting of fibres forms the rounded axillary
fold 12
 Nerve supply
• Lateral (C5 to C7) and medial pectoral (C8 and
T1) nerves.

 Actions
• The clavicular head flexes the arm, whereas
sternocostal head adducts and medially
rotates the arm.

13
 PECTORALIS MINOR
 It is the small triangular muscle that lies deep to
the pectoralis major muscle.

 Origin
• It arises from 3rd, 4th, and 5th ribs, near their
costal cartilages.
 Insertion
• It is inserted by a short thick tendon into the
medial border and upper surface of the coracoid
process of the scapula. 14
Origin and insertion of the pectoralis minor muscle 15
 Cont’d
 Nerve Supply
• By medial and lateral pectoral nerve

 Actions
 Assists the serratus anterior in drawing the
scapula forward (protraction) for punching
action.
 Depresses the point of shoulder
 Acts as an accessory muscle of respiration,
during forced inspiration. 16
 Subclavius
• It is the small rounded muscle that lies
horizontally inferior to the clavicle.

 Origin
• It arises from the first rib at the costochondral
junction.
 Insertion
• It is inserted into the subclavian groove on the
inferior surface (middle-third) of the clavicle.
17
Origin and insertion of the subclavius muscle
18
 Nerve Supply
• It is by nerve to subclavius, which arises from
the upper trunk of the brachial plexus.

 Actions
• The subclavius stabilizes the clavicle by
pulling it inferiorly and medially, during
movement at the shoulder joint.

19
 SERRATUS ANTERIOR
• It is a broad sheet of muscle that clothes the
side wall of the thorax. It is not a muscle of
the pectoral region, it is usually described
with the muscles of the pectoral region for
convenience and surgical significance.

20
Origin and insertion of the Serratus anterior muscle
21
 Origin
• It arises by a series of 8 digitations from upper
eight ribs. The first digitation arises from the 1st
and 2nd ribs, whereas all other digitations arise
from their corresponding ribs.
 Insertion
• It is inserted into the costal surface of the
scapula along its medial border. (The first 2
digitations are inserted into the superior angle,
next 2 digitations into the medial border and the
lower 4 or 5 digitations into the inferior angle of
the scapula). 22
 Nerve Supply
• It is by long thoracic nerve/nerve to serratus
anterior (C5, C6, and C7).
 Actions
• It is a powerful protractor of the scapula, i.e., it
pulls the scapula forward around the chest wall for
pushing and punching movements as required
during boxing.
• It keeps the medial/vertebral border of scapula in
firm contact with the chest wall.
• Its lower 4 or 5 digitations along with lower part of
the trapezius rotate the scapula laterally and
upwards during overhead abduction of the arm. 23
 CUTANEOUS INNERVATION
 The skin of the pectoral region is supplied by
the following cutaneous nerves:
• The skin above the horizontal line drawn at
the level of sternal angle is supplied by
supraclavicular nerves (C3 and C4).
• The skin below the horizontal line is supplied
by anterior and lateral cutaneous branches of
the 2nd–6th intercostal nerves (T2–T6).

24
Cutaneous nerves of the pectoral region 25
 FASCIAE
 PECTORAL FASCIA
• It is the deep fascia covering the anterior
aspect of the pectoralis major muscle. It is
thin and anchored firmly to the muscle by
numerous fasciculi.

26
 Cont’d
 Extent
• Superiorly, it is attached to the clavicle.
• Inferiorly, it is continuous with the fascia of
anterior abdominal wall.
• Superolaterally, it passes over the
deltopectoral groove to become continuous
with the fascia covering the deltoid muscle.
• Inferolaterally, it curves round the
inferolateral border of the pectoralis major to
become continuous with the axillary fascia.
The axillary fascia is a dense fibrous sheet 27
 CLAVIPECTORAL FASCIA
• The clavipectoral fascia is a strong fascial
sheet deep to the clavicular head of the
pectoralis major muscle, filling the space
between the clavicle and the pectoralis minor
muscle. It encloses two muscles, subclavius
and pectoralis minor.

28
 Extent

• Vertically, it extends from clavicle above to the

axillary fascia below. Its upper part splits into two
laminae to enclose the subclavius muscle. The
posterior lamina becomes continuous with the
investing layer of deep cervical fascia and gets
fused with the axillary sheath. The anterior lamina
gets attached to the clavicle.
• Its lower part splits to enclose the pectoralis minor
muscle. Below, this muscle it extends downwards as
the suspensory ligament of axilla, which is attached
to the dome of the axillary fascia. The suspensory
ligament keeps the dome of axillary fascia pulled29
 Cont’d
• Medially, clavipectoral fascia is attached to the
first rib and costoclavicular ligament and blends
with external intercostal membrane of the
upper two intercostal spaces.
• Laterally, it is attached to the coracoid process
and blends with the coracoclavicular ligament.
The thick upper part of the fascia extending
from first rib near costochondral junction to the
coracoid process is called costocoracoid
ligament
30
Clavipectoral fascia: as seen from front
31
Structures Piercing the Clavipectoral
Fascia
• Lateral pectoral nerve.
• Thoraco-acromial artery.
• Lymphatics from the breast to the apical
group of axillary group of lymph nodes.
• Cephalic vein. The first two structures pass
outwards, whereas the lower two structures
pass inwards.

32
Structures piercing the clavipectoral fascia
33
 APPLIED ANATOMY
• Clinical testing: On lifting a heavy rod, the
clavicular head becomes prominent and
when one attempts to depress the rod, the
sternocostal head becomes prominent.
• Congenital anomaly of pectoralis major:
Sometimes, a part of the pectoralis major,
usually the sternocostal part, is absent at
birth. This causes weakness in adduction and
medial rotation of the arm.
34
 Cont’d
 Paralysis of serratus anterior: The paralysis of
serratus anterior muscle following an injury to
long thoracic nerve by stab injury or during
removal of the breast tumour leads to the
following effects:
• Protraction of scapula is weakened.
• Winging of the scapula: Inferior angle and
medial border of scapula become unduly
prominent particularly when patient places his
hands against the wall.
35
The winging of right scapula
36