Anatomy Tables - Pectoral Region & Breast http://www.med.umich.edu/lrc/coursepages/m1/anatomy2010/html/musc...

Anatomy Tables - Pectoral Region, Posterior Shoulder &

Breast

Topographical Anatomy of the Thorax

Structure/Space Description/Boundaries Significance

midaxillary line an imaginary vertical line passing used as a surface landmark for
(TG4-01) through the middle of the axilla descriptive purposes
midclavicular line an imaginary vertical line passing used as a surface landmark for
(TG4-01) through the midshaft of the clavicle descriptive purposes
deltopectoral a triangle in the upper chest region the deltopectoral triangle is pierced
triangle that is bounded medially by the by the cephalic vein on its course
(TG2-12) clavicle, superiorly by the deltoid m., from the upper limb to join the
and inferiorly by the pectoralis major axillary vein in the axilla
m.
nipple located superficial to the 4th location of the left nipple may be
(N182, TG2-10) intercostal space in the male and used to help locate the apex of
prepuberal female; areola is dark ring heart, which is approximately 8 cm
surrounding nipple from the midline in the left 5th
intercostal space; a surface
landmark used to place the
stethoscope for auscultation of the
bicuspid valve
suprasternal the notch located at the superior also known as: jugular notch
notch(N185, border of the manubrium of the
TG4-04) sternum, between the sternal ends of
the clavicles

Osteology of the Pectoral Region

Bone Structure Description Notes

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clavicle an "S" shaped bone it articulates medially with the manubrium of

(N419, located between the the sternum and laterally with the acromion
N420, sternum and the process of the scapula; it forms a strut that
TG2-03) scapula supports the upper limb; it is frequently
fractured; it is the first bone to begin
ossification during development (Latin,
clavicula = little key, this term was used to
refer to the catch that fastens a window as
well as to keys. Curved window fasteners
resemble the shape of this bone)
rib the bone forming the 12 pairs; several types are described: typical
(N185, lateral thoracic wall or "true" ribs, "false" ribs, "floating" ribs; all
TG4-04) three types of ribs have many features in
common: head, neck, tubercle, angle, body,
costal groove
sternum the broad flat bone it is formed by three parts: manubrium,
(N185, forming the anterior body, xiphoid process (Latin, sternum =
TG4-04) thoracic wall breastbone, sternere = spread out)
manubrium the superior part of (Latin, manubrium = handle)
the sternum
jugular a notch on the it is located between the clavicular notches
(suprasternal) superior border of the which articulate with the sternal ends of the
notch manubrium clavicles (Latin, jugulum = throat)
clavicular a notch on the it articulates with the sternal end of the
notch superolateral border clavicle
of the manubrium
sternal angle the junction of the it is an anterior projection located at the
manubrium and body level of the costal cartilage of rib 2; an
of the sternum important landmark for internal thoracic
anatomy
body the middle part of the it articulates with the manubrium superiorly
sternum and the xiphoid process inferiorly; laterally it
articulates with the costal cartilages of ribs
2-7
xiphoid the inferior part of the it is variable in size, shape & ossification; it
process sternum articulates with the body of the sternum
superiorly (Greek, xiphos = sword + eidos =
appearance)
scapula the bone of the the scapula floats in a sea of muscles, so it
(N420, shoulder is difficult to fracture; it articulates with the
TG2-03) axial skeleton through only one bone - the
clavicle at the coracoclavicular and
acromioclavicular joints

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coracoid a beak-like process
process that projects
(TG2-03) anteriorly from the
lateral end of the
superior border of the
scapula
humerus the bone of the arm
(N420, (brachium)
TG2-03)
greater the large projection
tubercle located lateral to the
head of the humerus
intertubercular the groove on the
groove anterior surface of
the humerus that is
located between the
crest of the greater
tubercle and the crest
of the lesser tubercle
crest of the the ridge of bone on
greater the anterior surface
tubercle of the humerus
extending inferiorly
from the greater
tubercle
crest of the the ridge of bone on
lesser tubercle the anterior surface
of the humerus
extending inferiorly
from the lesser
tubercle
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 (Greek, korax = crow + eidos =
appearance. The coracoid process of the
scapula is shaped like a crow's beak)
the humerus articulates proximally with the
scapula at the glenoid fossa; it articulates
distally with the radius and ulna at the elbow
joint
it is the attachment site of the
supraspinatus, infraspinatus & teres minor
mm.
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) (Latin, tuber = knobby process,
nodule)
it forms the lateral lip of the intertubercular
groove; it is the attachment site for the
transverse humeral ligament and the
pectoralis major m.
it forms the medial lip of the intertubercular
groove; it is the attachment site for the
transverse humeral ligament and the teres
major m.

Muscles of the Pectoral Region

Muscle Origin Insertion Action Innervation Artery Notes Image

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pectoralis medial 1/2 crest of flexes and medial and pectoral branch the deep
major of the the adducts the lateral of the fascia on
(N188, clavicle, greater arm, pectoral thoracoacromial its
TG2-12) manubrium tubercle medially nerves trunk anterior
& body of of the rotates the (C5-T1) surface
sternum, humerus arm should
costal not be
cartilages fused to
of ribs 2-6, the fascia
sometimes of the
from the mammary
rectus gland - if
sheath of it is, this
the upper is an
abdominal important
wall clinical
sign
indicating
breast
disease
(Latin,
pectus =
breast
bone)
pectoralis ribs 3-5 coracoid draws the medial pectoral branch branches
minor process scapula pectoral of the of medial
(N188, of the forward, nerve (C8, thoracoacromial pectoral
N189, scapula medialward, T1) trunk nerve
N428, and usually
TG2-12, downward pierce
TG4-07) pectoralis
minor to
reach the
pectoralis
major
muscle
(Latin,
pectus =
breast
bone)

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serratus ribs 1-8 or medial it draws the long lateral thoracic a lesion
anterior 9 border of scapula thoracic a. of long
(N188, the forward; the nerve (from thoracic
TG4-07) scapula inferior ventral rami nerve will
on its fibers rotate C5-C7) cause
costal the scapula winging
(deep) superiorly of the
surface scapula
(i.e., the
medial
border of
the
scapula
falls away
from the
posterior
chest wall
and looks
like an
angel's
wing)
(Latin,
serratus
= to saw)

Arteries

Artery Source Branches Supply to Notes

thoracoacromial axillary pectoral br., pectoralis major m., thoracoacromial trunk
(N188, N427, a., 2nd clavicular br., pectoralis minor m., pierces the
TG2-15, TG4-07) part acromial br., subclavius m., deltoid costocoracoid
deltoid br. m., shoulder joint membrane

Veins

Vein Tributaries Drains Regions Notes

Into Drained

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cephalic v. lateral side of the axillary superficial parts median cubital vein usually
(N424, N428, dorsal venous arch of vein of the lateral shunts some of the blood
N479, TG2-02, the hand; superficial hand and lateral collected by the cephalic v. to
TG2-12A, veins of the forearm forearm the basilic v. (Latin/Greek,
TG2-12B) kephale = head)

Lymphatics

Afferents Regions
Structure Location Efferents to Notes
from drained
axillary axilla cubital nodes; efferents upper limb, axillary nodes number
nodes lymphatic vessels form most of the from 20 to 30 and are
(N428, vessels from the mammary organized in five
TG2-11) the upper subclavian gland, some of groups based on their
limb, thoracic trunk, some the position within the
wall and drainage to anterolateral axilla: 1) pectoral
subscapular inferior deep chest wall, nodes, along the
region cervical posterior lateral border of the
nodes thoracic wall pectoralis major m.; 2)
and scapular lateral nodes, located
region along the distal axillary
v.; 3) 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 lateral anterior larger medial side of parasternal nodes
nodes border of phrenic lymphatic the mammary constitute an important
(N428, sternum, nodes, vessels in gland; medial drainage pattern in
TG2-11) along the lymphatic the root of part of the cases of cancer of the
course of vessels from the neck anterior chest mammary gland; one
the internal the anterior wall and or two parasternal
thoracic thoracic wall muscles nodes may be found in
vessels the anterior end of
intercostal spaces 1-6;
also known as: sternal
nodes

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pectoral along the lymphatic central anterolateral an important group of

nodes lateral vessels from axillary thoracic wall nodes to examine
(N428, border of the mammary nodes and muscles; during a breast
TG2-11) the gland and most of the physical exam; also
pectoralis anterolateral mammary known as: anterior
major m. thoracic wall gland axillary nodes
along the
course of
the lateral
thoracic
vessels

Nerves

Nerve Source Branches Motor Sensory Notes

intercostal n. ventral lateral & intercostal skin of the chest intercostal n. travels
(N180, N192, primary anterior muscles; and abdomen below the posterior
N257, rami of cutaneous abdominal anterolaterally; intercostal a. in the
TG1-17, spinal brs. wall muscles skin of the medial costal groove (Latin,
TG4-11) nerves (via T7-T11); side of the upper costa = rib)
T1-T11 muscles of limb (via T1-T2)
the forearm
and hand (via
T1)
long thoracic brachial no named serratus no cutaneous located on the
n. plexus branches anterior m. branches superficial surface of
(N429,N430, (ventral the serratus anterior
TG2-13, primary m.; lesion of this
TG2-14) rami of nerve causes
spinal scapular winging,
nerves hence the saying
C5-C7) "C5, 6, & 7 keep the
wings from heaven"
pectoral, lateral no named pectoralis no cutaneous lateral pectoral n.
lateral cord of branches major m. branches communicates with
(N428, the the medial pectoral
N429,N430, brachial n. anterior to the
TG2-13, plexus axillary a.; it pierces
TG2-14, the clavipectoral
TG2-15) fascia

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pectoral, medial no named pectoralis no cutaneous medial pectoral n.

medial cord of branches minor m., branches communicates with
(N428, the pectoralis the lateral pectoral n.
N429,N430, brachial major m. anterior to the
TG2-13, plexus axillary a.; it pierces
TG2-14, the pectoralis minor
TG2-15) m.

Viscera/Fascia

Organ/Part
Location/Description Notes
of Organ
clavipectoral deep fascia attaching to clavicle, surrounding
fascia subclavius m., thickened below as costocoracoid
(N188,N428, ligament, extending inferiorly to pectoralis minor
TG2-12, as costocoracoid membrane (pierced by cephalic
TG4-07) v., lateral pectoral n., thoracoacromial a.),
encloses pectoralis minor, extends inferolaterally
to attach to axillary fascia as suspensory ligament
of axilla
mammary located anterior to pectoralis major m. from rib 2/3 the breast, a modified sweat
gland to rib 6/7 gland, comprises glandular
(N182, tissue arranged in up to 20
TG2-10) lobules, surrounded by
subcutaneous connective
tissue and supported by
suspensory ligaments
lactiferous drain the lobules of the mammary gland at the beneath the nipple, the
ducts nipple ducts dilate to form
(N182, lactiferous sinuses
TG2-10A,
TG2-10B)
areola darkly pigmented skin surrounding the nipple
(N182,
TG2-10)

Clinical Terms

Term Definition

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anomalies/variations deviation or departure from the normal or common order, form, or

rule
gynecomastia excessive development of the male mammary glands, sometimes
secreting milk. This can be idiopathic, or as a result of an underlying
disease process. (Greek, gyn = female + mastos = breast)
axillary tail (of Spence) part of the mammary gland may extend along the inferolateral edge
of the pectoralis major toward the axilla (armpit), forming an axillary
tail (of Spence). This portion of breast tissue is in the upper-outer
quadrant of the breast which is important because 50% of breast
cancer is located in this quadrant and in the axillary tail
supernumerary nipples more than the normal number of nipples, may be on the breast or
(polythelia) other parts of the body-found along the "milk line" from axilla to
groin. These accessory nipples resemble raised nevi (commonly
called "moles").
supernumerary breasts a condition in which more than two breasts are present
(polymastia)
carcinoma any of the various types of malignant (invasive) neoplasm derived
from epithelial tissue in several sites, occuring more frequently in
skin, bronchi, stomach, and prostate gland in men, and in the
breast, cervix, and skin in women (Greek, carcino- = cancer + -oma
= tumor)
mastectomy/lumpectomy amputation of the breast or of an affected portion (Greek, mastos =
breast + -ectomy = excision)
inflammation of the mammary gland (Greek, mastos = breast + -itis
mastitis
= inflammation)
record indicating the intensity, location, and distribution of
scintigraphy radioactivity in tissue following the use of radioactive tracer
substances
special imaging examination of the breast to detect breast cancer.
The American Cancer Society currently recommends that screening
mammogram
should begin annually at the age of 40 (and earlier in those patients
with a family history of breast cancer).

The material presented in these tables is contained in the The excellent editorial assistance
book: of
MedCharts Anatomy by Thomas R. Gest & Jaye Dr. Pat Tank, UAMS
Schlesinger is gratefully acknowledged.
Published by ILOC, Inc., New York
Copyright © 1995, unauthorized use prohibited.

Updated: 21 Sep 2011

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Copyright© 2000 The University of Michigan. Unauthorized use prohibited.

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