Pectoral Region

PECTORAL REGION
BY: HAROON BUTT, MAHRUKH MIRZA, AFSHAN UROOJ, ROHMA FATIMA, ZAYNAB FATIMA
CONTENTS
 introduction
 muscles of pectoral region (origin, insertion, nerve supply, nerve root, action)
 clinical anatomical problems of pectoral region
 Superficial fascia
 anatomy of the breast
INTRODUCTION
 located on the anterior aspect of the thorax

 contains muscles that connect the front of the human chest with the bones of the upper arm and shoulder
 breast lies in this region
MUSCLES OF THE
PECTORAL REGION
 PECTORALIS MAJOR
 PECTORALIS MINOR
 SERRATUS ANTERIOR
 SUBCLAVIUS
PECTORALIS MAJOR
ORIGIN
 CLAVICULAR HEAD:
i. from medial 2/3rds of the clavicle.
 STERNOCOSTAL HEAD:
i. from sternum.
ii. upper 6 costal, cartilages
iii. aponeurosis of external oblique.
INSERTION:
 lateral lip of bicipital groove
Nerve supply:
 Medial and lateral pectoral nerves
Nerve roots:
 C5, 6, 7, 8; T1
ACTION:
PECTORALIS MINOR
ORIGIN
 from 3rd, 4th, and 5th ribs close to their costal cartilages
INSERTION:
 medial border and upper surface of coracoid process
Nerve supply:
 medial and lateral pectoral nerves
Nerve roots:
 C6, 7, 8
ACTION:
 Depression of shoulder
SERRATUS ANTERIOR
ORIGIN
 OUTER BORDER UPPER EIGHT RIBS (1-8)
INSERTION:
 ventral aspect of the medial and inferior angle of the scapula
Nerve supply:
 long thoracic nerve
Nerve roots:
 C5 for 1st and 2nd digitations
 C6 for 3rd and 4th digitations
 C7 5th to 8th digitations
ACTION:
 draws the scapula forward to protract the upper limb
 rotates scapula outwards in raising the arm about 90 degree
SUBCLAVIUS
ORIGIN
 From 1st rib at its junction with the 1st costal cartilage
INSERTION:
 Subclavian groove at the interior surface of middle 1/3 of clavicle
 Upper surface of coracoid process
Nerve supply:
 Nerve to subclavius from upper trunk of brachial plexus
Nerve roots:
 C5, 6
ACTION:
 Steadies the clavicle during the movement of shoulder joint
CLINICAL ANATOMICAL PROBLEMS OF PECTORAL REGION
 Pectoralis major tendon rupture

 is a rare shoulder injury, most commonly seen in weightlifters.
 Pectoralis minor syndrome:
broad spectrum of clinical presentation with pain in the arm, shoulder, neck, chest etc.
wide age and gender ranges
 Damage to long thoracic nerve:
 Paralysis of the serratus anterior.
 neurogenic scapular winging
SUPERFICIAL FASCIA
 fascia (latin for “band”)

 visualization of pectoral region under the skin
 contains moderate amount of fat
 home to breast
 cutaneous nerves of pectoral region
 cutaneous vessels
 platysma
CUTANEOUS NERVES OF THE PECTORAL
REGION
 MEDIAL, INTERMEDIATE AND LATERAL SUPRACLAVICULAR NERVES:
supplying to:
i. skin over the upper half of deltoid
ii. skin from clavicle down to 2 nd rib
 ANTERIOR AND LATERAL INTERCOSTAL NERVE BRACNHES:
i. anterior cutaneous nerves (t2-t6)

ii. lateral cutaneous nerves (t3-t6)
iii. supply to skin below second rib
 INTERCOSTOBRACHIAL NERVES:
i. T2
ii. Supplies to skin on floor of axilla
CUTANEOUS VESSELS
 Anterior side accompanied by branches of internal thoracic artery

 Lateral side accompanied by branches of posterior intercostal artery
 Third to fourth of these branches largened in women
PLATYSMA
 Thin, broad subcutaneous muscle

 Supplied by facial nerves
 Protects the external jugular vein from pressure
BREAST
 Important accessory organ in female

 Provides nutrition to newborns via milk
 shape may be hemispherical, conical, pendulous, pyriform or
flat
 Lies in superficial fascia
 Deeper there are three muscles
i. Pectoralis major
ii. Serratus anterior
iii. External oblique muscle of abdomen
 Separated from pectoral fascia by retromammary space

BREAST CONT.
 Divided into four quadrants:
i. Upper medial (UM)

ii. Upper lateral (UL)
iii. Lower medial (LM)
iv. Lower lateral (LL)
 UL has a small extension called axillary tail of spence

 Extension passes through foramen of langer
 Foramen of Langer lies in axilla
BREASTS CONT.
 Lie Gradually enlarge at puberty

 get into shape through ovarian hormones
 Gland sizes increase due to fat deposition
 Base extends from second to sixth rib
 Axillary tail eventually extends laterally into axilla
STRUCTURE OF THE BREASTS
 SKIN:  AREOLA:
 NIPPLE: i. Pigmented skin around the base
i. Conical projection of nipple
ii. Present below the centre of the ii. Rich in modified sebaceous glands
breast iii. Enlargement during pregnancy and
iii. At level of 4th intercostal space lactation
iv. Pierced with 15-20 lactiferous iv. Tubercles of mongomery
ducts
v. contains sweat, and accessory
v. Contains circular and longitudinal
mammary glands
smooth muscle
vi. Lubrication during lactation
vi. Few modified glands
vii. Hairless skin
vii. Rich in nerve supply
viii. lactiferous sinus lie below it
STRUCTURE OF BREASTS CONT.
 MAMMARY GLANDS:
 Tubuloalveolar gland
 Secretes milk
 Modified sweat gland
 15-20 lobes
 STROMA:
 Partially fibrous
 Partially fatty
 Forms suspensory ligaments of cooper
 Fatty stroma distributed all over the breast
BLOOD SUPPLY TO
BREASTS
 Internal thoracic artery

 Lateral thoracic artery
 Superior thoracic artery
 Acromiothoracic artery
 Lateral branches of posterior intercostal arteries
converge on the breast
 Superficial veins drain into the internal thoracic vein

and veins on lower neck
 Deep veins drain into axillary and post. Intercostal
veins
NERVE SUPPLY TO THE BREASTS
 Anterior And lateral cutaneous branches of the 2nd to 6 th intercostal nerves

 Prolactin, secreted my ant. pituitary gland is responsible for milk secretion
LYMPHATIC DRAINAGE
OF THE BREASTS
 Great clinical importance due to

development of cancer
 75% to Axillary lymph nodes
 20% to Anterior thoracic nodes that lie
along mammary vessels
 5% to Supraclavicular, interpectoral,
infraclavicular (deltopectoral) nodes etc.
LYMPHATIC DRAINAGE
 Superficial lymphatics drain the skin to surrounding lymph nodes

 Deep lymphatics drain parenchyma, nipple, areola
 Anterior thoracic nodes drain the lymph from inner
and outer half of the breast

 Plexus of lymph vessels drain into anterior or pectoral group
of lymph nodes
 Lymphatics from the inner quadrants of the breasts may
communicate with diaphragmatic and subperitoneal lymph plexuses

after crossing the costal margin
 Anterior and central groups of nodes are commonly involved in
carcinoma breast
DEVELOPMENT OF THE BREAST
 MILK LINE:
 Breast develops from ectodermal thickening called milk line
 It extends from axilla to groin
 Mostly disappears and persists only in pectoral region
 Persisting part converts into mammary pit
 Secondary buds grow down from the floor of the pit and divide
 Nipple eversion at birth
 Growth of mammary glands caused by oestrogens at puberty
 Development of secretpry alveoli stimulated by prolactin and progesterone
DEVELOPMENTAL ANOMALIES OF THE BREAST
 Amastia (absence of breast)

 Athelia (absence of nipple)
 Polymasthia (supernumerary breasts)
 Polythelia (supernumerary nipples)
 Gynaecomasthia (development of breasts in a male) occurs in klinefelter’s syndrome
CLINICAL ANATOMY
OF BREASTS
 CARCINOMA:
 Most prevalent in upper and outer quadrant
 Nodes draining the tumor called sentinel
node
 points to note:
 Fixing of breast due to Cancer cells
infiltrating the suspensory ligaments
 Puckering of skin due to contraction of
ligaments
 retraction of nipple due to infiltration of
lactiferous ducts
 Oedema due to obstruction of superficial
lymph nodes
 Peau’d orange appearance of the breasts
 Spreading of cancer due to communication
between superficial lymphatics
 Potential cancer spread to brain and
vertebrae through veins
CLINICAL ANATOMY OF BREASTS
 CARCINOMA:
 Checking for cancer:

 Self inspection of nipples and breasts
 Any change in skin color
 Check for nipple retraction
 Check for discharge from nipple
 Note any lump in quadrants by palpating with palm
of hand
 Self examine to find any lymph nodes in axilla
 Get a mammogram
CLINICAL ANATOMY OF THE BREASTS
 CARCINOMA:
 Potential cures:
 Mastectomy
 Lumpectomy
 Radical mastectomy

Pectoral Region

Uploaded by

Copyright:

Available Formats

Pectoral Region

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Pectoral Region

Uploaded by

Copyright:

Available Formats

PECTORAL REGION

 located on the anterior aspect of the thorax

 Pectoralis major tendon rupture

 fascia (latin for “band”)

 MEDIAL, INTERMEDIATE AND LATERAL SUPRACLAVICULAR NERVES:

 ANTERIOR AND LATERAL INTERCOSTAL NERVE BRACNHES:

i. anterior cutaneous nerves (t2-t6)

 Anterior side accompanied by branches of internal thoracic artery

 Thin, broad subcutaneous muscle

 Important accessory organ in female

 Separated from pectoral fascia by retromammary space

 Divided into four quadrants:

i. Upper medial (UM)

 UL has a small extension called axillary tail of spence

 Lie Gradually enlarge at puberty

i. Conical projection of nipple

 Internal thoracic artery

 Superficial veins drain into the internal thoracic vein

 Anterior And lateral cutaneous branches of the 2nd to 6 th intercostal nerves

 Great clinical importance due to

 Superficial lymphatics drain the skin to surrounding lymph nodes

and outer half of the breast

communicate with diaphragmatic and subperitoneal lymph plexuses

 Amastia (absence of breast)

 Checking for cancer:

You might also like