This site needs JavaScript to work properly. M. Snosek, R. S. Tubbs, and M. Loukas, Sternalis muscle, what every anatomist and clinician should know, Clinical Anatomy, vol. I would honestly say that Kenhub cut my study time in half. L. Testut, Les Anomalies Musculaires Chez lHomme Expliques par lAnatomie Compare. The purpose of this report is to discuss an anomaly observed in the insertion of the tendon of the pectoralis major at the shoulder joint and to present the degenerative changes seen in the LHB. 5 suture, suture tape; (3) bone trough with No. Last reviewed: December 05, 2022 Should this pattern be present in females, it would be of clinical importance in cases of breast or transplant surgeries. -, Taylor SA, Fabricant PD, Bansal M, et al. No abnormality was observed in the nerve and blood supply either to the pectoralis major muscle or to the accessory tendon. Am J Sports Med. Medicine. Federal government websites often end in .gov or .mil. Morphometric characteristics of entry points of the neurovascular pedicles within the PM regarding, respectively, the parasternal line and the inferior border of the clavicle are presented in Tables 4 and 5. Therefore, in our case, the roof and both walls were formed by the tendon of the pectoralis major, and the floor was formed by the tendon of the latissimus dorsi and humerus (Fig. 14741477, 2017. Further studies should be carried out in this regard. For instance, Yamasaki [31] reported two cases of the congenital partial defect of pectoralis major and minor muscles. However, in our study the mean distance between the entry of the medial and lateral pectoral nerves into the PM was greater and varied between 31.2mm and 61.8mm. 2013 Jun;41(6):1395-9. doi: 10.1177/0363546513482297. Prior to the qualification of the cadavers for the research, the specimens with scars, traces of trauma, or deformations within pectoral, shoulder, and brachial regions were excluded. An official website of the United States government. 8790, 1991. J Surg Orthop Adv. Clipboard, Search History, and several other advanced features are temporarily unavailable. Qualitative and Quantitative Anatomy of the Humeral Attachment of the Pectoralis Major Muscle and Structures at Risk: A Cadaveric Study. The results of our measurements of the PM insertion are similar to the results cited above. The sub-branches of the lateral pectoral nerve were also distributed within the upper portion of the sternocostal part and they reached the height of approximately the upper half of the muscle (Figure 7). For instance, complicated axillary lymphadenectomy due to a pectoralis quartus muscle was described by Totlis et al. Posterior lamina (PL) of the pectoralis major muscle has been separated and reflected to expose the posterior view to the anterior lamina (AL) of the tendon. Abstract Rationale: Typically, the tendon of the pectoralis major inserts into the crest of the greater Which muscle is highlighted? Because the arteries were not injected by the resin, we were not able to trace detailed distribution of arterial branches within the PM. The PM plays an important role in the upper limb movements, especially during adduction and the medial rotation of the arm [35]. In general, the pectoralis major muscle originates from the medial end of the Rare cases of muscular anomalies involving the PM or its tendon have been presented. Samuel et al[5] reported that the bicipital tunnel is the extra-articular, fibro-osseous structure that encloses the LHB tendon in a normal case (Fig. Muscular System: Upper Limb > Lab Practical > Question 5. The site is secure. [27] demonstrated a case of anomalous accessory muscle confluent with the normal sternal head of PM. 3, pp. B. Perrin, Notes on some variations of the pectoralis major, with its associate muscles, Journal of Anatomy and Physiology, vol. Some error has occurred while processing your request. 423432, 1989. 15, no. The purpose of this study was to examine Philadelphia, PA: Saunders. WebOrigins of the pectoralis major include the clavicle, sternum, ribs, and external oblique fascia 3 as well as cartilage of the first six ribs. 22, no. [2] who noted the occurrence of the lateral pectoral nerve even with congenital PM deficiency. 26, no. The site is secure. On the right side, the entire pectoralis major muscle was absent and the pectoralis minor, deltoid, and coracobrachialis muscles were infiltrated with connective tissue and fat [24]. The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. Deficiency or absence of the sternocostal part is not uncommon. J. E. Hong, B. R. Kim, J. Kim, and S. P. Yoon, A cephalic vein drained into one of the double axillary veins through the pectoralis major muscle, Folia Morphologica, vol. The borderline between the two muscles, referred to in clinical jargon as the deltopectoral interval, remains an important topographical landmark during various medical procedures such as cephalic vein catheterization or deltopectoral approach for fractures or arthroplasty [912]. This anomaly is rare. Structure of the pectoralis major tendon tunnel. E. E. Beheiry, Innervation of the pectoralis major muscle: anatomical study, Annals of Plastic Surgery, vol. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. Graf, R. M., Bernardes, A., Rippel, R., et al. Bergman et al. 5, pp. The .gov means its official. Davimes et al. and transmitted securely. ACTIONS: Adducts the arm at the glenohumeral joint (entire muscle) The degree of separation of these two portions varied in different specimens from partial to almost total (Figure 1(b)). Here we report a unique case of unilateral four-head pectoralis major muscle in an 83 year-old cadaver (Figure 1), that was otherwise anatomically and functionally unremarkable. Variation of insertion of the pectoralis major in a cadaveric study. 655662, 2015. The tendon of the LHB adhered to this tunnel. However some patients present many months after the injury. The cited authors [26] classified this fusion as complete fusion into a deltopectoral complex muscle.. Bookshelf [5] To our knowledge, anatomical studies of the insertion of the pectoralis major have so far only reported on anomalies of insertion into the crest of the greater tubercle of the humerus. [26]. Typically, the tendon of the pectoralis major is inserted into the crest of greater tubercle. You may search for similar articles that contain these same keywords or you may Imbergamo C, Sequeira S, Bano J, Rate WR 4th, Gould H. Orthop J Sports Med. sharing sensitive information, make sure youre on a federal The pectoralis minor is encased in the clavipectoral fascia that Frontal view of the left shoulder showing the anatomy of the accessory tendon. Burkhead et al[10] reported that the width of the normal LHB intra-articularly was 6 to 7 mm. Segall HD. The authors wish to express their gratitude to all those who donated their bodies to medical science. [40] classification system. From these two origins, the fibers converge toward their insertions: those arising from the clavicle pass obliquely downward and laterally, and are usually separated from the rest by a slight interval; those from the lower part of the sternum, and the cartilages of the lower true ribs, run upward and laterally, while the middle fibers pass horizontally. Conclusions: The accessory tendon arises from the lateral aspect of the pectoralis major muscle. Posterior lamina (PL) of the pectoralis major muscle has been separated and reflected to expose the posterior view to the anterior lamina (AL) of the tendon. The main anatomical variations related to morphology of the pectoralis major muscle. However, the character of fibers provided to PM by intercostal nerves (motor or/and sensory) could not be determined basing on macroscopic methods. Learn more Frias JL, Felman AH. DM: deltoid muscle; LH: long head of the biceps brachii muscle; PMi: pectoralis minor muscle; SH: short head of the biceps brachii muscle. The Authors. On the left side of the same cadaver the unilateral presence of the sternalis muscle was noted (Figure 2(b)). 5, pp. Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review. (A) In the normal case, the structure of the tunnel is formed by the roof made by the tendon of the pectoralis major, and the floor formed is formed by the latissimus dorsi and humerus. Therefore, as in our case, the presence of the pectoral tendon tunnel on the outside of the shoulder joint may contribute to the stability of the LHB. Smaller Gap Formation With Suture Anchor Fixation Than Traditional Transpatellar Sutures in Patella and Quadriceps Tendon Rupture: A Systematic Review. We removed the fat and skin around the shoulder joint and upper extremity for observational purposes and carefully examined the structures during gross anatomy. Gray's Anatomy for Students. Copyright 2019 Robert Haadaj et al. Epub 2015 Aug 18. (d) Inferior view to the tendon of the left pectoralis major muscle. It inserts onto the greater tubercle of the humerus in the form of a single tendon. UBF/No. Epub 2018 Dec 13. Furthermore, rare cases of muscular anomalies involving the PM or its tendon have been presented. and transmitted securely. 44, no. WebThe humeral insertion of the pectoralis major was identied at its anatomic position, directly lateral to the bicipital groove. In one female cadaver (2 out of 80 = 2.5% of specimens) the hypotrophy of the clavicular portion of PM was observed (Figure 1(c)). Netter, F. (2014). Anatomical variations of the origin of PM concerned three main aspects: width of the clavicular part, width of the sternal insertion, and differences in number of costal cartilages involved in PM attachment. 2012 Aug;40(8):1887-94. doi: 10.1177/0363546512452849. 866884, 2014. Most of the reported pectoralis major abnormalities focused on its complete or partial absence due to congenital reasons (510), or as a result of diseases such as leukemia (11) and Poland's syndrome, where absence of the costosternal portion of the pectoralis major has been reported (12, 13). 205, no. The mean age of the cadavers was 69.3 11.8 years (range: 48-90 years), 69.6 13.8 years (range: 48-85 years) of male and 69.1 10.9 years (range: 53-90 years) of female cadavers. In 1.25% of specimens (1 of 80 specimens; one male cadaver on the left side) an atypical tendinous band connecting PM insertion with the coracoid process of the scapula was observed (Figure 6(a)). This type of origin was observed in 58.75% of specimens (47 of 80 specimens; bilaterally in 11 male cadavers, unilaterally in one male cadaver, and bilaterally in 11 female cadavers). 249, no. In addition, affected patients have visibly distorted breasts due to the aplasia of the pectoralis majormuscle, which is why a plastic-surgical reconstruction can be used therapeutically. Coracobrachialis muscle. The pectoralis major muscle adducts and medially rotates the 204207, 2018. (a) An atypical tendinous band (marked by white arrowheads) connecting tendon of the pectoralis major muscle (PMj) with the coracoid process of the scapula. Surg. Similar case was found in our study and was associated with the fusion between the clavicular part of the PM and the deltoid muscle. WebContext:: Pectoralis major tendon ruptures are becoming increasingly common due to the growing prevalence of active lifestyles. 1, pp. Pectoral Fascia Preservation in Oncological Mastectomy to Reduce Complications and Improve Reconstructions: A Systematic Review. [38]. Also intercostal nerves may participate in PM innervation. 4 This large muscle, located on the anterior Typical PM structure (Figure 1(a)) was observed in 51 specimens (63.75%), bilaterally in 13 male and 12 female cadavers, and unilaterally in one male cadaver. 2015 Oct;42(4):565-84. doi: 10.1016/j.cps.2015.06.016. Medicine. In the case of hypotrophy of the clavicular portion of the PM, normal and well-developed branches of the lateral pectoral nerve were observed. WebThe pectoralis major muscle is innervated by lateral (C5 and C6) and medial pectoral (C7, C8, and T1) nerves. However, to avoid altering of nerves staining and visualization, the study on distribution of arteries should be performed separately. C. D. Smith, S. J. Booker, H. S. Uppal, J. Kitson, and T. D. Bunker, Anatomy of the terminal branch of the posterior circumflex humeral artery: relevance to the deltopectoral approach to the shoulder, The Bone & Joint Journal, vol. http://creativecommons.org/licenses/by/4.0. 16, no. Accessibility Case Report. 2009 Jun;21(2):126-40. doi: 10.1007/s00064-009-1701-z. In 7.5% of specimens, the PM originated from the 2nd to 7th (6 of 80 specimens; in 2 male cadavers and 1 female cadaver bilaterally). The implications of such a finding are discussed. Armendares S. Letter: Absence of pectoralis major muscle in two sisters associated with leukemia in one of them. Publication of the article is funded by Medical University of Lodz. 5, pp. It also acts as an accessory muscle for inspiration. Epub 2022 Jan 20. R. Haadaj, M. Pingot, M. Polguj, G. Wysiadecki, and M. Topol, Anthropometric study of the piriformis muscle and sciatic nerve: a morphological analysis in a Polish population, Medical Science Monitor, vol. [42] pay attention to an unusual humeral insertion of the PM in that the clavicular and upper sternal fibers attach distally on the humerus, while the lower sternal and abdominal fibers cross above the former and insert uppermost on the shaft of the humerus. In turn, in the case of asymmetric deficiency of the pectoralis major muscle described by Mosconi and Kamath [24], on both sides, the lateral pectoral nerves were absent and the medial pectoral nerves were present. 227, no. 397-398, 2012. In the second cadaver, the fusion between the clavicular portion of PM and the deltoid muscle was bilaterally partial with the deltopectoral groove slightly marked. The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. This action is important in activities such as climbing. The procedure was modified, based on our earlier experience, for a large muscle mass [37]. However, a deviation from the described distribution of branches of the lateral pectoral nerve was observed in one male cadaver with a complete fusion between PM and the deltoid muscle. Yu J, Zhang C, Horner N, Ayeni OR, Leroux T, Alolabi B, Khan M. Sports Health. At the same time, the PM belongs to muscles demonstrating high anatomical variability, which may affect performing imaging-based evaluation and understanding the injury findings [4, 16]. On the left side, the sternal portion of the sternocostal head of the pectoralis major muscle was absent [24]. 5 suture/suture tape featured the lowest displacement superiorly (1.09 0.47 mm) and inferiorly (1.14 0.39 mm) with a significant difference compared with bone trough. They all end in a flat tendon, which is inserted into the lateral lip of the intertubercular sulcus of the humerus (1). 1A). Anatomy of the tendon of the pectoralis major muscle fused with the deltoid muscle. 1, pp. 11, pp. Therefore, further research on this topic is warranted. Before [40]. S. Standring, Ed., Grays Anatomy: The Anatomical Basis of Clinical Practice, Churchill Livingstone/Elsevier, Edinburgh, Scotland, 40th edition, 2008. However, anomalous insertion sites of the pectoralis major tendons have been noted. The complete absence of the pectoralis major is rare (1, 3). Three-dimensional study of. J Orthop Res. The right side is affected twice as often as the left side and there is a male preponderance. The R. Trbs, B. Gharavi, M. Neid, and G. Cernaianu, Chondroepitrochlearis musclea phylogenetic remnant with clinical importance, Klinische Pdiatrie, vol. This study is important for orthopedic and rehabilitation physicians in treating diseases of the long head of the biceps brachii tendon. Redler et al. 2, pp. The medial side of the insertion of the pectoralis major tendon was not into the humerus but had combined with the tendon of the latissimus dorsi, which then loosely inserted into the humerus. Katsuki, Shuji RPTa,b; Terayama, Hayato PhDb,; Tanaka, Ryuta RPTa,b; Qu, Ning PhD, MDb; Nomura, Hayato MDc; Kawakami, Satoshi PhDd; Umemoto, Kanae PhDb; Suyama, Kaori PhD, MDb; Yi, Shuang-Qin PhD, MDe; Suzuki, Takeshi PhD, MDc; Sakabe, Kou PhD, MDb, aDepartment of Rehabilitation, Kanto Rosai Hospital, Nakahara-ku, Kawasaki-si, cDepartment of Anesthesiology, Tokai University School of Medicine, dDepartment of Public Health, Tokai University School of Medicine and Nursing, Isehara-si, Kanagawa, Japan. 2017 Apr;45(2):112-115. doi: 10.5152/TJAR.2017.43815. Keywords: 3, pp. Most frequently, the PM originated from the 2nd to 6th costal cartilages. J. Please enable it to take advantage of the complete set of features! The authors declare that they have no conflicts of interest. Morphologie 2006;90:1579. In the first cadaver, the deltopectoral groove was absent and there was no visible borderline between clavicular portions of the pectoralis major and the deltoid muscles (Figure 1(d)). GT=greater tubercle, IG=intertubercular groove, LD=latissimus dorsi, LHB=long head of biceps brachii, LT=lesser tubercle, PM=pectoralis major. eCollection 2020 Apr. Perrin [32] already in 1871 suggested a useful and still valid classification of deviations from the average arrangement of the muscles, including, respectively, the presence of not typical muscles; duplication of muscles in whole or in part; fusion of muscles that are typically separate; presence of additional origins, supernumerary tendons or unusual insertions; segmentation (fission) of the muscle; and suppression (partial or complete). Federal government websites often end in .gov or .mil. The null hypothesis was that there would be no mechanical difference between repair techniques and no difference in the amount of footprint restoration. Almstead S. Congenital defects of the pectoral muscles. F. A. Cordasco, G. T. Mahony, N. Tsouris, and R. M. Degen, Pectoralis major tendon tears: functional outcomes and return to sport in a consecutive series of 40 athletes, Journal of Shoulder and Elbow Surgery, vol. Posterior lamina (PL) of the pectoralis major muscle tendon constitutes place of attachment for the lower fibers of the sternocostal (STC) part of the muscle. The clavicular head acts to flex the humerus, and the sternocostal head extends it from flexed position. The degree of asymmetry between the right and left side was assessed for the selected indices (i.e., percentage of total length of the clavicle covered by the origin of the clavicular part of the PM and width of the PM in the midclavicular line). Subfascial breast implant: A new procedure. Please enable it to take advantage of the complete set of features! 38, no. Butt, S. Mehta, L. Funk, and P. Monga, Pectoralis major ruptures: a review of current management, Journal of Shoulder and Elbow Surgery, vol. Branches of the intercostal nerves distributed within pectoralis major muscle were marked by black arrowheads. posterior wall: scapula, subscapularis muscle, teres major muscle, and latissimus dorsi muscle. The Chi-square test was applied to assess differences in the prevalence of anatomical variations between the sexes. The importance of PM in orthopedic surgery refers, among others, to the deltopectoral approach [912] or to the repair of PM injuries [6, 1315]. 21, pp. Samuel E. Congenital absence of the pectoralis major. The study was approved by the local Bioethics Committee (No: RNN/231/15/KE). Highlight selected keywords in the article text. Hangzhou, China: Zhejiang Science and Technology Press, 1999. (a) Small sub-branches of the lateral pectoral nerve (LPN) joined the clavicular portion of the deltoid muscle (DM). The pectoral fascias can be dissected bluntly along a subfascial plane with the pectoral fascia intact. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). E. M. Corten, P. P. Schellekens, R. L. Bleys, and M. Kon, The nerve supply to the clavicular part of the pectoralis major muscle: an anatomical study and clinical application of the function-preserving pectoralis major island flap, Plastic and Reconstructive Surgery, vol. Trignano E, Serra PL, Pili N, Trignano C, Rubino C. Gland Surg. 8600 Rockville Pike Morphometric characteristics of the anatomical variations of the clavicular part of PM are presented in Table 2. 268270, 2016. 85, no. 36, no. They also found that the mean distance from the apex of the upper edge of the PM tendon to the superomedial edge of the greater tubercle of the humerus was 42mm. The accessory tendon has approximately the same dimensions and position as the tendon of the long head of the biceps brachii muscle. Arican RY, Coskun N, Sarikcioglu L, et al. Fung L, Wong B, Ravichandiran K, et al. (A) The PM tendon appears to insert at the crest of the greater tubercle and the lesser tubercle of the humerus, and the tunnel is formed by the tendon of the PM. In one male cadaver, the atypical division of the PM into two almost completely separate portions was present on the left side at the level of the sternal angle (1 out of 80 specimens = 1.25%; Figure 2(a)). The anatomy of the pectoral fascia in Chinese female corpses was investigated to explore the possibility for a location of augmentation mammaplasty under the pectoral fascia. 2019 Jun;73(3):178-182. doi: 10.5455/medarh.2019.73.178-182. Hence, it appeared normal. The pectoralis major muscle occupies a large area on the anterior chest wall and its function consists basically of providing adduction and medial rotation of the In addition, the LHB tendon may adhere to the tunnel due to degenerative changes and it may be the limiting factor of shoulder motion. Conclusions. Would you like email updates of new search results? 5773, 2004. 34, no. Moreover, displacement after cyclic loading was by far smallest in the UBF/No. 5 suture/suture tape construct demonstrated 61% greater construct strength than a traditional bone trough technique. However, tested techniques have demonstrated diminished strength with inadequate restoration of the footprint and suture failure at relatively low loads. The lower half of PM and the abdominal portion, when present, were innervated by the branches of the medial pectoral nerve. We observed the accessory tendon of the pectoralis major muscle on the left side of this male cadaver. [28]. This is an open access article distributed under the, https://www.anatomyatlases.org/AnatomicVariants/MuscularSystem/Text/P/08Pectoralis.shtml. Morphometric characteristics of entry points of the neurovascular pedicles within the pectoralis major muscle (PM) regarding the inferior border of the clavicle. The width of the PM insertion ranged from 43.9 to 83.2mm (mean = 65.3mm 9.8mm; Table 3). Bookshelf 2, pp. T. Mosconi and S. Kamath, Bilateral asymmetric deficiency of the pectoralis major muscle, Clinical Anatomy, vol. 969975, 2003. 1, pp. 24, no. 100103, 2006. It is complex in that it has two separate muscular bellies and a dual nerve supply. Abstract Rationale: Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. 109, no. Loukas et al. Cortical button fixation with larger caliber suture and suture tape allows for a significantly better PM repair than more traditional techniques at the time of surgery, which may ultimately result in improved clinical outcomes if implemented in surgical practice. Sherman SL, Lin EC, Verma NN, Mather RC, Gregory JM, Dishkin J, Harwood DP, Wang VM, Shewman EF, Cole BJ, Romeo AA. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/. Additionally, supernumerary heads of muscles other than pectoralis major have been documented. The perforating point of the cephalic vein was in those cases located between the clavicular and sternal heads of the pectoralis major muscle. Outcomes: [47] drew attention to anatomical relationships within the deltopectoral triangle. If Orthopedics 2010;33:23. The muscle is supplied by the pectoral branch of the thoracoacromial trunk artery, and by branches of the lateral thoracic artery. Anatomy of the tendon of the pectoralis major muscle with a separate clavicular part. 3rd edPA: Churchill Livingstone/Elsevier; 2016. (b) An accessory head (AH) of the biceps brachii muscle inserted to the tendon of the pectoralis major muscle (place of this insertion is marked by grey arrowhead). Surgical anatomy of the pectoral nerves and the pectoral musculature. Clinical relevance: 2 suture; and (4) native PM tendon group; all groups were tested to failure. Bonastre V, Rodrguez-Niedenfhr M, Choi D, Saudo JR. Clin Anat. As part of management, the condition of the tendon of the pectoralis major should be confirmed using magnetic resonance imaging or echocardiography. WebStudy with Quizlet and memorize flashcards containing terms like Pectoralis major (cadaver), Pectoralis minor (cadaver), External oblique (cadaver) and more. 6, pp. A. Fogg, and T. Davis, A case of an anomalous pectoralis major muscle, Folia Morphologica, vol. A dedicated study of pectoralis muscle may be required and a typical shoulder MRI usually does not allow optimal visualization of the pectoralis major muscle 2. Please try again soon. Pectoralis major tear repair post operative X-Ray showing anchors in proximal humerus. The distance was also measured between the top of greater tubercle of the humerus and the upper border of PM tendon. Debeer P, Brys P, De Smet L, Fryns JP. 2C). government site. doi: 10.1097/PRS.0b013e31819055b5. [11]. The sternocostal origin is the most commonly missing part, lack of which causes weakness in the adduction and medial rotation of the shoulder joint (4). Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. The brachial segment of the cephalic vein is absent. ATTACHMENTS: The pectoralis major attaches from the medial clavicle, sternum, and the costal cartilages of ribs #1-7 to the lateral lip of the bicipital groove of the humerus. Anatomical variant of the lateral pectoral nerve innervating the anterior portion of the deltoid muscle was documented by Solomon et al. [2]. Patient concerns: Epub 2012 Jul 9. These authors found that the mean length of the PM insertion was 72mm. Mosconi T, Kamath S. Bilateral asymmetric deficiency of the pectoralis major muscle. [26] the cephalic vein and the deltoid branch of the thoracoacromial artery were lying under the fused muscles but had a typical drainage and distribution. 346349, 2003. 2010 Feb;34(1):29-32. doi: 10.1007/s00266-009-9443-8. As Bergman et al. Yoshikawa et al[11] suggested that all of the flattened LHB muscles in rotator cuff tears showed dense connective tissue with some degenerative changes which included failure of the collagen bundle, hyalinization, and myxoid changes. The presence of an accessory tendon to the pectoralis major muscle might stabilize the muscle origins (2). F. Barberini, The clavicular part of the pectoralis major: a true entity of the upper limb on anatomical, phylogenetic, ontogenetic, functional and clinical bases. The width of the origin of the clavicular portion of PM ranged from 42.5% to 79.2% of total length of the clavicle (mean = ). Please try after some time. In one of those cadavers, small sub-branches of the lateral pectoral nerve bilaterally joined the clavicular portion of the deltoid muscle. 2325, 2010. Study design: WebSix recently frozen cadaveric shoulder specimens from two women and one man were thawed to room temperature for 24 hr, then imaged using a 1.5-T MR magnet (General Electric Medical Systems, Milwaukee, WI). Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. 204204, 2011. The https:// ensures that you are connecting to the Because the clavicular part of PM develops from the same origin as deltoid muscle, it remains in close relation to the clavicular part of the deltoid; both parts are connected through fascial structures (deltopectoral fascia), especially in their distal part [46]. WebTerms in this set (44) abductor pollicis brevis. PMC Carey P, Owens BD. Cases are known of PM fusion with the deltoid muscle [1, 2, 28]. Black arrowheads show twisting of the lower fibers of the sternocostal part of the pectoralis major muscle. 2F). 2, pp. 463468, 2016. The three parts of the PM are attached to the anterior aspect of the medial half of the clavicle, the anterior part of the sternum, and the cartilages of all the true ribs (attachment to the first and/or seventh costal cartilage is often omitted) and to the aponeurosis of the external oblique, respectively [1]. Morphometric characteristics of entry points of the neurovascular pedicles within the pectoralis major muscle (PM) regarding the parasternal line. Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. 133-134, 2014. Therefore, repair constructs with larger caliber suture and suture tape provide a measurable improvement in construct strength versus traditional PM repair techniques in a biomechanical model and may be advantageous for repair. Controlled laboratory study. PMC Background: In Beheirys [53] study, the fourth intercostal nerve participated in supply of the inferolateral part of the PM in 4 out of 30 cases. Epub 2018 Nov 27. (b) The tendon of the pectoralis major muscle seen from behind. 38, no. 20, no. Christopher F. Congenital absence of the pectoral muscles. 5, pp. The pectoralis major is a paired, superficial muscle located on the anterior surface of the thoracic cage. 4, pp. Ann Plast Surg. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. The initial phase of Sihlers Stain (i.e., maceration and depigmentation) was extended to over 5 weeks due to the large mass of PM. In all specimens stained by Sihlers technique, the contribution of the intercostal nerves in PM innervation was confirmed (Figure 7). Edinburgh: Elsevier Churchill Livingstone. It is also a dynamic stabilizer of the shoulder joint; therefore, it is important in upper limb mobility, and the presence of supernumerary large heads may provide additional strength to the biceps brachii as described by Swieter and Carmichael (2). Therefore, it appeared to have sustained degenerative damage. [47] reported the absence of the cephalic vein in 5% of examined specimens. Introduction. Morphometric characteristics of the pectoralis major muscle (PM). This is particularly important during forced breathing in physical distress. White arrowheads show the insertion of the pectoralis major muscle. PMC legacy view Chiba S, Suzuki T, Kasai T. A rare anomaly of the. 1B). Standring, S. (2016). 8600 Rockville Pike Intervention: Perforating branches of vessels and nerves Aesthetic Plast Surg. Its humeral tendon insertion is just lateral to the bicipital groove and measures approximately 5 centimeters in length and 3 to 4 millimeters in width, with U-shape (anterior and posterior layers inferiorly continuous) [ 14 ]. Co-existence of the pectoralis quartus and pectoralis intermedius muscles. The clavicular part of the PM may also extend laterally on the clavicle as far as the deltoid muscle. 3, pp. external oblique internal oblique iliopsoas rectus abdominis. 26: 148, 2004. Transaxillary Subfascial Augmentation Mammaplasty with Anatomic Form-Stable Silicone Implants. In the case reported by Hong et al. Methods: In females, it is covered by the breast. Informed consent was obtained from the antemortem person by Tokai Daigaku Kentai No Kai. The medial side of the insertion of the pectoralis major tendon was not into the humerus but had combined with the tendon of the latissimus dorsi, which then loosely inserted into the humerus. The region was carefully dissected, clavicular part of deltoid and pectoralis major muscles were removed near their origin to expose pectoralis minor muscle. At this stage, the observed anatomical variations of the PM were evaluated. Clipboard, Search History, and several other advanced features are temporarily unavailable. NCI CPTC Antibody Characterization Program. In this case the clavicular portion of PM was fused with upper fibers (attached to the manubrium of the sternum) of the sternocostal portion of the PM, forming the upper head of the muscle. [23], who observed additional head of PM which fused with the fibers of the serratus anterior muscle. Surgeons should be aware of anatomic variations of the PM both in planning and in conducting surgeries of the pectoral region. Bethesda, MD 20894, Web Policies Biceps brachii. doi: 10.1097/GOX.0000000000002700. (b) A separate clavicular part (CL) of the pectoralis major muscle. In this article, we will discuss the anatomy and function of the pectoralis major muscle. Kenhub. ATTACHMENTS: The pectoralis major attaches from the medial clavicle, B. Wickham, J. M. Brown, and D. J. McAndrew, Muscles within muscles: anatomical and functional segmentation of selected shoulder joint musculature, Journal of Musculoskeletal Research, vol. sharing sensitive information, make sure youre on a federal In the first cadaver the brachial segment of the cephalic vein was absent; in the second case the cephalic vein pierced the clavicular part of PM to drain into axillary vein. A complete or partial absence of pectoralis major muscle is normally reported. Insertional footprint anatomy of the, [3]. Diagnosis: This nerve has a more variable course, piercing and supplying the pectoralis minor at the level of the third intercostal space, at a mean of 10.3cm from the margin of the sternum [56]. 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