Anatomy Tables - Pectoral Region & Breast

Topographical Anatomy of the Thorax

Structure/Space Description/Boundaries Significance
midaxillary line an imaginary vertical line passing through the
middle of the axilla
used as a surface landmark for descriptive purposes
midclavicular line an imaginary vertical line passing through the
midshaft of the clavicle
used as a surface landmark for descriptive purposes
deltopectoral
triangle
a triangle in the upper chest region that is bounded
medially by the clavicle, superiorly by the deltoid
m., and inferiorly by the pectoralis major m.
the deltopectoral triangle is pierced by the cephalic vein on its
course from the upper limb to join the axillary vein in the
axilla
nipple located superficial to the 4th intercostal space in
the male and prepuberal female; areola is dark ring
surrounding nipple
location of the left nipple may be used to help locate the apex
of heart, which is approximately 8 cm from the midline in the
left 5th intercostal space; a surface landmark used to place the
stethoscope for auscultation of the bicuspid valve
suprasternal notch the notch located at the superior border of the
manubrium of the sternum, between the sternal
ends of the clavicles
also known as jugular notch
steology of the Pectoral Region
Bone Structure Description !otes
cla"icle an !"! shaped bone located
between the sternum and the
scapula
it articulates medially with the manubrium of the sternum and
laterally with the acromion process of the scapula; it forms a strut that
supports the upper limb; it is fre#uently fractured; it is the first bone
to begin ossification during development $%atin, clavicula & little key,
this term was used to refer to the catch that fastens a window as well
as to keys. 'urved window fasteners resemble the shape of this bone(
rib the bone forming the lateral
thoracic wall
)* pairs; several types are described typical or !true! ribs, !false!
ribs, !floating! ribs; all three types of ribs have many features in
common head, neck, tubercle, angle, body, costal groove
sternum the broad flat bone forming the
anterior thoracic wall
it is formed by three parts manubrium, body, xiphoid process $%atin,
sternum & breastbone, sternere & spread out(
manubrium the superior part of the sternum $%atin, manubrium & handle(
jugular
$suprasternal(
notch
a notch on the superior border of
the manubrium
it is located between the clavicular notches which articulate with the
sternal ends of the clavicles $%atin, jugulum & throat(
clavicular notch a notch on the superolateral
border of the manubrium
it articulate with the sternal end of the clavicle
sternal angle the junction of the manubrium
and body of the sternum
it is an anterior projection located at the level of the costal cartilage of
rib *; an important landmark for internal thoracic anatomy
body the middle part of the sternum it articulates with the manubrium superiorly and the xiphoid process
inferiorly; laterally it articulates with the costal cartilages of ribs *+,
xiphoid process the inferior part of the sternum it is variable in si-e, shape . ossification; it articulates with the body
of the sternum superiorly $/reek, xiphos & sword 0 eidos &
appearance(
scapula the bone of the shoulder the scapula floats in a sea of muscles, so it is difficult to fracture; it
articulates with only one bone + the clavicle at the coracoclavicular
and acromioclavicular joints
coracoid process a beak+like process that projects
anteriorly from the lateral end of
the superior border of the scapula
it is the attachment site for the short head of the biceps brachii m., the
coracobrachialis m., the pectoralis minor m. and the coracoacromial
and coracoclavicular ligaments $/reek, korax & crow 0 eidos &
appearance. 1he coracoid process of the scapula is shaped like a
crow2s beak(
humerus the bone of the arm $brachium( the humerus articulates proximally with the scapula at the glenoid
fossa; it articulates distally with the radius and ulna at the elbow joint
greater tubercle the large projection located lateral
to the head of the humerus
it is the attachment site of the supraspinatus, infraspinatus . teres
minor mm.
intertubercular
groove
the groove on the anterior surface
of the humerus that is located
between the crest of the greater
tubercle and the crest of the lesser
tubercle
it is occupied by the tendon of the long head of the biceps brachii m.;
the transverse humeral ligament spans the intertubercular groove and
holds the biceps tendon in place; it is the attachment site for the
tendon of the pectoralis major $lateral lip(, teres major $medial lip(,
and latissimus dorsi $floor( $%atin, tuber & knobby process, nodule(
crest of the
greater tubercle
the ridge of bone on the anterior
surface of the humerus extending
inferiorly from the greater
tubercle
it forms the lateral lip of the intertubercular groove; it is the
attachment site for the transverse humeral ligament and the pectoralis
major m.
crest of the lesser
tubercle
the ridge of bone on the anterior
surface of the humerus extending
inferiorly from the lesser tubercle
it forms the medial lip of the intertubercular groove; it is the
attachment site for the transverse humeral ligament and the teres
major m.
#uscles of the Pectoral Region
#uscle rigin $nsertion Action $nner"ation Artery !otes
pectoralis
major
medial )3* of the
clavicle, manubrium .
body of sternum,
costal cartilages of ribs
*+4, sometimes from
the rectus sheath of the
upper abdominal wall
crest of the
greater
tubercle of
the humerus
flexes and
adducts the arm,
medially rotates
the arm
medial and
lateral pectoral
nerves $'5+1)(
pectoral branch of
the
thoracoacromial
trunk
the deep fascia on its
anterior surface should
not be fused to the fascia
of the mammary gland + if
it is, this is an important
clinical sign indicating
breast disease $%atin,
pectus & breast bone(
pectoralis
minor
ribs 5+5 coracoid
process of the
scapula
draws the scapula
forward,
medialward, and
downward
medial pectoral
nerve $'8, 1)(
pectoral branch of
the
thoracoacromial
trunk
branches of medial
pectoral nerve usually
pierce pectoralis minor to
reach the pectoralis major
muscle $%atin, pectus &
breast bone(
serratus
anterior
ribs )+8 or 6 medial border
of the scapula
on its costal
$deep(
surface
it draws the
scapula forward;
the inferior fibers
rotate the scapula
superiorly
long thoracic
nerve $from
ventral rami
'5+',(
lateral thoracic a. a lesion of long thoracic
nerve will cause winging
of the scapula $i.e., the
medial border of the
scapula falls away from
the posterior chest wall
and looks like an angel2s
wing( $%atin, serratus & to
saw(
Arteries
Artery Source Branches Supply to !otes
thoracoacromial axillary a.,
*nd part
pectoral br., clavicular br.,
acromial br., deltoid br.
pectoralis major m., pectoralis minor
m., subclavius m., deltoid m., shoulder
joint
thoracoacromial trunk pierces the
costocoracoid membrane
%eins
%ein Tributaries Drains
$nto
Regions Drained !otes
cephalic
v.
lateral side of the dorsal venous
arch of the hand; superficial veins
of the forearm
axillary
vein
superficial parts of the
lateral hand and lateral
forearm
median cubital vein usually shunts some of the
blood collected by the cephalic v. to the basilic v.
$%atin3/reek, kephale & head(
&ymphatics
Structure &ocation Afferents from 'fferents to Regions drained !otes
axillary
nodes
axilla cubital nodes;
lymphatic vessels
from the upper
limb, thoracic wall
and subscapular
region
efferents vessels
form the
subclavian trunk,
some drainage to
inferior deep
cervical nodes
upper limb, most of
the mammary gland,
some of the
anterolateral chest
wall, posterior
thoracic wall and
scapular region
axillary nodes number from *7 to 57
and are organi-ed in five groups based
on their position within the axilla )(
pectoral nodes, along the lateral border
of the pectoralis major m.; *( lateral
nodes, located along the distal axillary
v.; 5( central nodes, centrally located
along axillary v.; 4( subscapular nodes,
located along the subscapular v. and its
tributaries; 5( apical nodes, located at
the apex of axilla
parasternal
nodes
lateral border of
sternum, along
the course of the
internal thoracic
vessels
anterior phrenic
nodes, lymphatic
vessels from the
anterior thoracic
wall
larger lymphatic
vessels in the root
of the neck
medial side of the
mammary gland;
medial part of the
anterior chest wall
and muscles
parasternal nodes constitute an
important drainage pattern in cases of
cancer of the mammary gland; one or
two parasternal nodes may be found in
the anterior end of intercostal spaces )+
4; also known as sternal nodes
pectoral
nodes
along the lateral
border of the
pectoralis major
m. along the
course of the
lateral thoracic
vessels
lymphatic vessels
from the mammary
gland and
anterolateral
thoracic wall
central axillary
nodes
anterolateral thoracic
wall and muscles;
most of the mammary
gland
an important group of nodes to
examine during a breast physical
exam; also known as anterior axillary
nodes
!er"es
!er"e Source Branches #otor Sensory !otes
intercostal
n.
ventral primary
rami of spinal
nerves 1)+1))
lateral .
anterior
cutaneous
brs.
intercostal muscles;
abdominal wall
muscles $via 1,+1))(;
muscles of the forearm
and hand $via 1)(
skin of the chest and
abdomen anterolaterally;
skin of the medial side of
the upper limb $via 1)+1*(
intercostal n.travels below the
posterior intercostal a. in the costal
groove $%atin, costa & rib(
long
thoracic n.
brachial plexus
$ventral
primary rami of
spinal nerves
'5+',(
no named
branches
serratus anterior m. no cutaneous branches located on the superficial surface of
the serratus anterior m.; lesion of
this nerve causes scapular winging,
hence the saying !'5, 4, . , keep
the wings from heaven!
pectoral,
lateral
lateral cord of
the brachial
plexus
no named
branches
pectoralis major m. no cutaneous branches lateral pectoral n. communicates
with the medial pectoral n. anterior
to the axillary a.; it pierces the
clavipectoral fascia
pectoral,
medial
medial cord of
the brachial
plexus
no named
branches
pectoralis minor m.,
pectoralis major m.
no cutaneous branches medial pectoral n. communicates
with the lateral pectoral n. anterior
to the axillary a.; it pierces the
pectoralis minor m.
%iscera/(ascia
rgan/Part of
rgan
&ocation/Description !otes
clavipectoral
fascia
deep fascia attaching to clavicle, surrounding subclavius m., thickened below as costocoracoid ligament,
extending inferiorly to pectoralis minor as costocoracoid membrane $pierced by cephalic v., lateral pectoral
n., thoracoacromial a.(, encloses pectoralis minor, extends inferolaterally to attach to axillary fascia as
suspensory ligament of axilla
)linical Terms
Term Definition
anomalies3variations deviation or departure from the normal or common order, form, or rule
gynecomastia excessive development of the male mammary glands, sometimes secreting milk. 1his can be idiopathic,
or as a result of an underlying disease process. $/reek, gyn & female 0 mastos & breast(
axillary tail $of "pence( part of the mammary gland may extend along the inferolateral edge of the pectoralis major toward the
axilla $armpit(, forming an axillary tail $of "pence(. 1his portion of breast tissue is in the upper+outer
#uadrant of the breast which is important because 578 of breast cancer is located in this #uadrant and in
the axillary tail
supernumerary nipples
$polythelia(
more than the normal number of nipples, may be on the breast or other parts of the body+found along the
!milk line! from axilla to groin. 1hese accessory nipples resemble raised nevi $commonly called
!moles!(.
supernumerary breasts
$polymastia(
a condition in which more than two breasts are present
carcinoma any of the various types of malignant $invasive( neoplasm derived from epithelial tissue in several sites,
occuring more fre#uently in skin, bronchi, stomach, and prostate gland in men, and in the breast, cervix,
and skin in women $/reek, carcino+ & cancer 0 +oma & tumor(
mastectomy3lumpectomy amputation of the breast or of an affected portion $/reek, mastos & breast 0 +ectomy & excision(
mastitis inflammation of the mammary gland $/reek, mastos & breast 0 +itis & inflammation(
scintigraphy
record indicating the intensity, location, and distribution of radioactivity in tissue following the use of
radioactive tracer substances
mammogram
special imaging examination of the breast to detect breast cancer. 1he 9merican 'ancer "ociety
currently recommends that screening should begin annually at the age of 47 $and earlier in those patients
with a family history of breast cancer(.