WebStudy with Quizlet and memorize flashcards containing terms like Pectoralis major (cadaver), Pectoralis minor (cadaver), External oblique (cadaver) and more. E. S. Chang, J. Zou, J. M. Costello, and A. Lin, Accuracy of magnetic resonance imaging in predicting the intraoperative tear characteristics of pectoralis major ruptures, Journal of Shoulder and Elbow Surgery, vol. Bookshelf 139, no. Because no residual tendon stump was present, the 6, pp. Anatomy of the tendon of the pectoralis major muscle with a separate clavicular part. Aesthetic Plast Surg. will also be available for a limited time. Pierach CA. Would you like email updates of new search results? Hong et al. It makes up the bulk of the chest muscles and lies under the breast. Beneath the pectoralis major is the pectoralis minor, a thin, triangular muscle. The, [4]. 9, pp. Study design: Almstead S. Congenital defects of the pectoral muscles. government site. The altered relations between the PM and the cephalic vein may alter medical procedures such as cardiac catheterization, emergency catheterization procedures, or combined use of the cephalic vein and the skin graft-covered pectoralis major muscle flap [21, 47, 49]. The presence of an accessory tendon to the pectoralis major muscle might stabilize the muscle origins (2). On the left side, the sternal portion of the sternocostal head of the pectoralis major muscle was absent [24]. 81, no. GT=greater tubercle, IG=intertubercular groove, LD=latissimus dorsi, LHB=long head of biceps brachii, LT=lesser tubercle, PM=pectoralis major. Additionally, supernumerary heads of muscles other than pectoralis major have been documented. In our study, well-developed lateral pectoral nerves were observed independently of the PM variation, even in the case of a significantly reduced clavicular portion. The site is secure. 5 suture/suture tape (794 168 N), UBF/suture tape (502 201 N), and bone trough (492 151 N) ( P < .001 for all). The pectoral fascia, which can be successfully dissected bluntly along the subfascial plane, varies in thickness from 0.2 to 1.14 mm. 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. 90, no. Reconstr. In obtaining images, respiratory motion artefact may be minimized by abdominal breathing techniques. Highlight selected keywords in the article text. K. Natsis, G. Tsakotos, K. Vlasis, T. Totlis, and K. Jurgen, Absence of the deltopectoral groove, ANZ Journal of Surgery, vol. The perforating point of the cephalic vein was in those cases located between the clavicular and sternal heads of the pectoralis major muscle. The null hypothesis was that there would be no mechanical difference between repair techniques and no difference in the amount of footprint restoration. The authors declare that they have no conflicts of interest. Disclaimer, National Library of Medicine For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/. Pectoralis major. 25, no. Search for Similar Articles The sternocostal portion of the muscle can produce the antagonistic movement and extend the humerus back to the anatomical position. WebThe lateral border of pectoralis major muscle forms the anterior axillary fold. 866884, 2014. 2022 Oct;11(10):1604-1614. doi: 10.21037/gs-21-896. 4, pp. The right side is affected twice as often as the left side and there is a male preponderance. Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. official website and that any information you provide is encrypted Coexistence of a pectoralis quartus muscle and an unusual axillary arch was described by Bonastre et al. Please try again soon. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. In our case, on the right side, the width of the LHB intra-articularly was 8 mm. In addition, the medial side was formed by the tendon of the pectoralis major loosely combined with the tendon of latissimus dorsi at the medial crest of the lesser tubercle (Fig. When the arm is in the anatomical position, the pectoralis major acts as a strong adductor and internal rotator of the humerus at the shoulder joint. Beals RK, Crawford S. Congenital absence of the pectoral muscle. The described pattern was similar in typical specimens and in specimens with a separated clavicular head of PM. The example of accessory pectoral muscles which are occasionally present may be pectoralis quartus, pectoralis intermedius, pectoralis minimus, or chondroepitrochlearis [2, 18, 20, 30]. Informed consent was obtained from the antemortem person by Tokai Daigaku Kentai No Kai. Methodology: Shuji Katsuki, Hayato Terayama. Pectoralis major tendon and enthesis: anatomic, magnetic resonance imaging, ultrasonographic, and histologicinvestigation. 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. Methods: Transaxillary Subfascial Augmentation Mammaplasty with Anatomic Form-Stable Silicone Implants. 519523, 2013. 15, no. about navigating our updated article layout. K. Gokkus, E. Sagtas, H. Kara, and A. T. Aydin, Posterior shoulder dislocation associated with the head (splitting) and humeral neck fracture: impact of understanding radiologic signs and experience with an extended deltopectoral approach, Techniques in Hand & Upper Extremity Surgery, vol. Acting independently, the clavicular portion of the muscle flexes the humerus up to 90 degrees in a horizontal plane. 2020 Mar;53(1):51-58. doi: 10.1055/s-0040-1708227. Acting independently, the clavicular part helps to flex the extended arm up to 90, while the sternocostal part facilitates the extension of the flexed arm by pulling it downwards. L. Mu and I. Sanders, Sihler's whole mount nerve staining technique: a review, Biotechnic & Histochemistry, vol. A deep cleft was observed between the two heads (the branches of the lateral and medial pectoral nerves were present in the floor of the cleft). e687e698, 2018. [47] drew attention to anatomical relationships within the deltopectoral triangle. 11, pp. Dempsey, W. C., and Latham, W. D. Subpectoral implants in augmentation mammaplasty. ACTIONS: Adducts the arm at the glenohumeral joint (entire muscle) The cadaver of a 95-year-old Japanese man was selected from the bodies used for gross anatomy practice at the Tokai University School of Medicine in 2018. Results: 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). However, anomalous insertion sites of the pectoralis major tendons have been noted. However, on the left side, the width was about 15 mm, nearly double the width on the right. The cadaver was fixed using 10% formaldehyde. Asymmetry in the width of the PM in the midclavicular line assessed for all variations ranged from 1.4% to 17.9% (mean = ; Table 3). The site is secure. I would honestly say that Kenhub cut my study time in half. Gifford A, Tauro T, Haunschild E, Okoroha K, Cole BJ. Material and Methods. Hence, it appeared normal. Epub 2011 Apr 28. 1, pp. Davimes et al. Absence of the pectoralis major, with ipsilateral aplasia of the radius, thumb, hemidiaphragm and lung: an extreme expression of poland anomaly? In these cases, a distinct cleft is visible between the clavicular (CL) and sternocostal portion (STC) of the pectoralis major muscle. 2, pp. 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. 1B). 625629, 2016. In fact, the accessory tendon travels alongside the tendon of the long head of the biceps brachii muscle (Figure 2.). Armendares S. Letter: Absence of pectoralis major muscle in two sisters associated with leukemia in one of them. Perforating branches of vessels and nerves emerging from the pectoral fascia are located mainly at the medial lateral and lower fascias. There is no clear opinion of the width of the LHB. [9]. The sternalis muscle occupies position between the superficial fascia and the pectoral fascia [40]. Mosconi T, Kamath S. Bilateral asymmetric deficiency of the pectoralis major muscle. 14741477, 2017. 2015 Oct;42(4):565-84. doi: 10.1016/j.cps.2015.06.016. 2018 Dec;30(6):398-409. doi: 10.1007/s00064-018-0577-1. PMC legacy view Carey P, Owens BD. We removed the fat and skin around the shoulder joint and upper extremity for observational purposes and carefully examined the structures during gross anatomy. In contrast, in a cadaver with a poorly developed, hypotrophic part of the clavicular portion of PM, it occupied 26% of the total length of the clavicle on the right side and 22.5% of the total length of the clavicle on the left side. The authors also thank Editage (www.editage.jp) for aiding with English language editing. Poland syndrome is an embryonic malformation of the thoracic wall, which is accompanied by a defect of the pectoralis major muscle in combination with other malformations of the upper extremities (e.g. WebPectoralis major Pectoralis minor. These 3 metallic anchors will hold the tendon firmly against bone. In males, it is covered by the deep layer of fascia, subcutaneous tissue and the adjacent skin. Plast Reconstr Surg Glob Open. 2D). This website uses cookies. Edinburgh: Elsevier Churchill Livingstone. Accessibility [26]. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Barbato, C., Pena, M., Triana, C., et al. Unilateral absence of the trapezius and pectoralis major muscle: a variant of Poland syndrome. 4, pp. 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. The main anatomical variations related to morphology of the pectoralis major muscle. A. Jacobson, J. Smith, and D. L. Dahm, Pectoralis major tears: anatomy, classification, and diagnosis with ultrasound and MR imaging, Skeletal Radiology, vol. official website and that any information you provide is encrypted sharing sensitive information, make sure youre on a federal 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). Moreover, research on the innervation of selected muscles suggests that axons migrating during development into effector organs show a well-defined specificity [37]. DM: deltoid muscle; LH: long head of the biceps brachii muscle; PMi: pectoralis minor muscle; SH: short head of the biceps brachii muscle. Perforating branches of vessels and nerves It also acts as an accessory muscle for inspiration. Loukas et al. 26: 148, 2004. Morphometric characteristics of the anatomical variations of the clavicular part of PM are presented in Table 2. Disclaimer, National Library of Medicine The axillary arch (AA) is stretched between this band and the latissimus dorsi muscle (LD). Figueiredo et al. Qualitative and Quantitative Anatomy of the Humeral Attachment of the Pectoralis Major Muscle and Structures at Risk: A Cadaveric Study. The region was carefully dissected, clavicular part of deltoid and pectoralis major muscles were removed near their origin to expose pectoralis minor muscle. Clin Anat 2009;22:5008. According to Wei and Chan [56], the mean distance between the entry of the medial and lateral pectoral nerves into the PM is 30.7 10mm. Ultrasound-Guided Continuous Interpectoral Block for Patient Undergoing Mastectomy and Axillary Clearance. In their study, attention was paid to the fact that deltopectoral triangle may exhibit high variability. and transmitted securely. A unilateral four-headed pectoralis major muscle was observed on the left side of an 83 year-old Caucasian male cadaver. 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. Please enable scripts and reload this page. 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. (b) The tendon of the left pectoralis major muscle seen from behind. The pectoralis major has a broad origin, based on which it is divided into three parts: clavicular part, sternocostal part and abdominal part. Recently, the subfascial plane for breast augmentation was reported by some authors who achieved satisfactory results. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by/4.0, July 31, 2020 - Volume 99 - Issue 31 - p e21475, Variation of insertion of the pectoralis major in a cadaveric study: A case report, Articles in Google Scholar by Shuji Katsuki, RPT, Other articles in this journal by Shuji Katsuki, RPT. Arthrosc Tech. J. G. Davimes, N. Bacci, and P. Mazengenya, Evidence of the sternalis muscle in two South African cadavers, Surgical and Radiologic Anatomy, vol. 3rd edPA: Churchill Livingstone/Elsevier; 2016. Three-dimensional study of. eCollection 2022 Aug. Orthop J Sports Med. [23], who observed additional head of PM which fused with the fibers of the serratus anterior muscle. Hybrid breast augmentation: our surgical approach and formula for preoperative assessment of fat graft volume. Furthermore, the pectoral fascia extends laterally to be continuous with the fascia of the back. Bethesda, MD 20894, Web Policies The distance between the top of the greater tubercle of the humerus and the PM insertion ranged from 38.3 to 65.2mm (mean = 52.1mm 7.9mm; Table 3). Check out our muscle anatomy reference charts to learn the anatomy of body's 800+ muscles faster! 2022 Jul;38(7):2321-2330. doi: 10.1016/j.arthro.2022.01.012. Bonastre V, Rodrguez-Niedenfhr M, Choi D, Saudo JR. Clin Anat. Clin Plast Surg. In the case of PM fusion with the deltoid muscle, the width of the clavicular portion of PM ranged from 60.1% to 83.3% of the overall length of the clavicle (mean = ). The right pectoralis major was inserted into the crest of greater tubercle only and was normal. An attempt has also been made to determine whether anatomical variations of the PM may affect the innervation pattern of the lateral and medial pectoral nerves. [21] described a case of a cephalic vein which perforated the pectoralis major muscle between the clavicular and sternal heads and then drained into one of the double axillary veins. 3rd edPA: Churchill Livingstone/Elsevier; 2016. Case Report. PM is mainly innervated by the lateral pectoral nerve. Samuel E. Congenital absence of the pectoralis major. Oper Orthop Traumatol. Last reviewed: December 05, 2022 The most frequently observed variation was a separate clavicular portion of the PM. 2nd Ed2013;Japan: Daihokaku, ISBN 978-4-9980686-2-4. 8, pp. Most of the cadavers are elderly. Reconstr. 226228, 2002. Chiba S, Suzuki T, Kasai T. A rare anomaly of the. On the other hand, in specimens with a separate clavicular portion of the PM, the width of the origin of the clavicular portion of the muscle ranged from 31.9% to 56.4% of the total length of the clavicle (mean= 43.5 7.6%). 75, no. WebTerms in this set (44) abductor pollicis brevis. Your message has been successfully sent to your colleague. The potential pocket between the pectoralis major muscle and the pectoral fascia can be used as a place for breast augmentation. However, premortem clinical history was unremarkable regarding impairment of shoulder movements. The pectoralis major has been described to insert on to the The https:// ensures that you are connecting to the This case report complies with the research guidelines of the Japanese Association of Anatomists. The clavicular portion of PM was attached to the anterior lamina of PM insertion in all cases. Please enable it to take advantage of the complete set of features! 290, pp. Surgeons should be aware of anatomic variations of the PM both in planning and in conducting surgeries of the pectoral region. and transmitted securely. However, in our case, the structure of the roof and the lateral side was formed by the tendon of the pectoralis major inserted into the crest of greater tubercle. In all specimens of the PM examined in our study the clavicular part of PM was innervated solely by branches of the lateral pectoral nerve (Figure 7). The pectoralis major muscle is a fan-shaped muscle that consists of three parts that originate from three different sites: The muscle fibers from all three parts run laterally, converging towards the proximal humerus. Nerve and vessel supplying ligamentous suspension of the mammary gland. The 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 = ). Biceps brachii. Clipboard, Search History, and several other advanced features are temporarily unavailable. 506509, 1997. 33, no. Karabeg R, Jakirlic M, Karabeg A, Crnogorac D, Aslani I. Med Arch. government site. E. E. Beheiry, Innervation of the pectoralis major muscle: anatomical study, Annals of Plastic Surgery, vol. Distally, the accessory tendon attaches to and blends in with the superior fibers of the pectoralis major tendon, which inserts into the lateral lip of the intertubercular sulcus of the humerus. Unusual variations of the tendon of the pectoralis major muscle. Standring, S. (2016). Co-existence of the pectoralis quartus and pectoralis intermedius muscles. Lessons: This study is important for orthopedic and rehabilitation The cadavers were imaged in the supine position, with the shoulder in the anatomically neutral position. J Orthop Res. 38, no. For more information, please refer to our Privacy Policy. The sternal and costal heads may be absent or the whole muscle may be absent in rare cases. Abstract Rationale: Typically, the tendon of the pectoralis major inserts into the crest of the greater doi: 10.1097/PRS.0b013e31819055b5. Epub 2021 Nov 30. [2,3] However, there are few reports on the anomalous insertion of the pectoralis major tendon. An official website of the United States government. [2] who noted the occurrence of the lateral pectoral nerve even with congenital PM deficiency. Frontal view of the left shoulder showing the anatomy of the accessory tendon. Biomechanical comparison of 3 methods to repair pectoralis major ruptures. Variation of insertion of the pectoralis major in a cadaveric study. Unable to load your collection due to an error, Unable to load your delegates due to an error. Project administration: Kou Sakabe, Hayato Terayama. Epub 2018 Dec 13. Imbergamo C, Sequeira S, Bano J, Rate WR 4th, Gould H. Orthop J Sports Med. 1, pp. The PM plays an important role in the upper limb movements, especially during adduction and the medial rotation of the arm [35]. 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)). 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. Which muscle is highlighted? Hundred and Eleven Cases of Subfascial Breast Augmentation in Trans Women-A Single-Center Experience. Congenital absence of the pectoralis major muscle. Therefore, to the best of our knowledge, our case potentially describes the structure of a new pectoralis major tendon tunnel. Careers. Pectoralis major muscle: want to learn more about it? Porzionato A, Macchi V, Stecco C, Loukas M, Tubbs RS, De Caro R. Clin Anat. Subfascial breast augmentation: thickness of the pectoral fascia. 157159, 2006. [28]. (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. The clavicular head acts to flex the humerus, and the sternocostal head extends it from flexed position. To expand your knowledge check out our article about the main muscles of the thorax check out our other articles, videos, quizzes and labeled diagrams. The pectoralis major muscle is a large muscle originating from the medial third of the clavicle, sternum, the first six ribs, and the aponeurosis of the external oblique muscle (Figure 1). You may be trying to access this site from a secured browser on the server. 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. The literature documents numerous variations associated with the pectorlis major muscle. Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. 10, pp. Please enable it to take advantage of the complete set of features! However, regarding the presence of accessory tendons of the pectoralis muscle, studies reported accessory fibrous bands arising from the lateral border of the pectoralis that have intimate contact with the median nerve (16). An attempt has also been made to determine whether anatomical variations of the PM may affect the innervation pattern of the lateral and medial pectoral nerves. Clipboard, Search History, and several other advanced features are temporarily unavailable. Thus, the territory of innervation of the lateral pectoral nerve was extended in this case. Bethesda, MD 20894, Web Policies Pectoralis Major Ruptures: Tear Patterns and Patient Demographic Characteristics. Typically, the tendon of the pectoralis major is inserted into the crest of greater tubercle. The degree of separation of these two portions varied in different specimens from partial to almost total (Figure 1(b)). 1942, 2010. The Pectoralis Major is composed of two heads: Sternocostal head and Clavicular head. At the lateral side of the LHB, the pectoralis major tendon was inserted into the crest of the greater tubercle of the humerus. Huang BK, Wong JH, Haghighi P, Wan L, Du J, Chang EY. Careers, Accessory tendon, biceps brachii, pectoralis major, Poland's Syndrome. Epub 2020 Mar 10. The specimens were tested under cycling loads (10 N to 125 N) with a final load-to-failure test at 1 mm/s. We removed the fat and skin around the chest and both shoulder joints for observational purposes and carefully examined the structures. 111: 904, 2003. An official website of the United States government. V. Bonastre, M. Rodrguez-Niedenfhr, D. Choi, and J. R. Saudo, Coexistence of a pectoralis quartus muscle and an unusual axillary arch: case report and review, Clinical Anatomy, vol. We removed the fat and skin around the shoulder joint and upper extremity for observational purposes and carefully examined the structures during gross anatomy. Butt, S. Mehta, L. Funk, and P. Monga, Pectoralis major ruptures: a review of current management, Journal of Shoulder and Elbow Surgery, vol. As it passes through the axilla, the artery is divided into three parts by pectoralis minor, as the muscle travels superolaterally from its origin at the 3rd, 4th and 5th ribs to its insertion on the medial aspect of the coracoid process. Shoulder joint: Arm adduction, Arm internal rotation, Arm flexion (clavicular head), arm extension (sternocostal head); Lateral and medial pectoral nerves (C5-T1), Pectoral branches of thoracoacromial artery, perforating branches of internal thoracic artery. HHS Vulnerability Disclosure, Help Absence of the clavicular part is less frequent (1). The clavicular portion of the pectoralis major muscle arises from the medial one half to two thirds of the clavicle, and passes downward and laterally to its humeral insertion. 112, no. 2, pp. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. These tears are common in Mixed Martial Arts athletes and in weightlifters. Clinically Oriented Anatomy (7th ed.). The authors report no conflicts of interest. The Authors. 243246, 2015. The authors declare that no competing interests exist. Furthermore, five randomly selected muscles were examined using Sihlers whole mount nerve staining technique [36]. Bilateral asymmetric deficiency of the pectoralis major muscle was described by Mosconi and Kamath [24]. V. Macchi, C. Tiengo, A. Porzionato et al., Medial and lateral pectoral nerves: course and branches, Clinical Anatomy, vol. Palastanga, N., & Soames, R. (2012). The assumption was made that the degree of asymmetry represents the percentage difference of the value of a given measurement or index between both sides; it shows the percentage difference between the measurement with a larger value and measurement with a smaller value (the degree of asymmetry = measurement with a larger value measurement with a smaller value 100%). As part of management, the condition of the tendon of the pectoralis major should be confirmed using magnetic resonance imaging or echocardiography. Result: Only the lateral pectoral nerve existed in the second case [31]. Before 423432, 1989. Unable to load your collection due to an error, Unable to load your delegates due to an error. 109, no. Software: Shuji Katsuki, Hayato Terayama, Satoshi Kawakami, Shuang-Qin Yi. Distances from both the margin of the sternum (parasternal line) and inferior border of the clavicle to the entry points of the neurovascular pedicles within the pectoralis major muscle were also measured at this stage of the procedure. 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]. 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 ]. However, small deviations of pectoral nerves in the territory of the deltoid muscle were reported. The clavicular head of the PM and the superior part of the sternal head of the muscle are innervated by the lateral pectoral nerve. Outcomes: M. C. Mysnyk and D. E. Johnson, Congenital absence of the pectoralis muscles in two collegiate wrestling champions, Clinical Orthopaedics and Related Research, vol. The submuscular or subglandular plane for breast augmentation is widely used. doi: 10.1016/j.eats.2020.02.023. [Surgical treatment of chronic pectoralis major rupture]. Anatomy of the tendon of the typical pectoralis major muscle. 2009 Jun;21(2):126-40. doi: 10.1007/s00064-009-1701-z. Medicine. Due to its relationship to the chest wall and breast, the PM can be considered as one of the key anatomical structures in plastic and reconstructive surgery [68]. Diagnosis: M. Yamasaki, Anatomical study on 2 cases of the congenital partial defect of pectoralis major and minor muscles, Annals of Anatomy, vol. 133-134, 2014. In the first case, the insertion of the PM was associated with the presence of the axillary arch and tendinous band attached to the coracoid process of the scapula. The main function of this chest muscle as a whole is the adduction and internal rotation of the armin the shoulder joint. 8790, 1991. [50] described anatomical and functional segmentation of selected shoulder joint musculature. and grab your free ultimate anatomy study guide! 5773, 2004. The pectoralis major is a paired, superficial muscle located on the anterior surface of the thoracic cage. K. Liu, P.-C. Liu, R. Liu, and X. Wu, Advantage of minimally invasive lateral approach relative to conventional deltopectoral approach for treatment of proximal humerus fractures, Medical Science Monitor, vol. Cases of congenital absence of PM were also reported on living subjects by Lee and Chun [22], as well as by Mysnyk and Johnson [25]. R. Haadaj, G. Wysiadecki, Z. Dudkiewicz, M. Polguj, and M. Topol, The high origin of the radial artery (brachioradial artery): its anatomical variations, clinical significance, and contribution to the blood supply of the hand, BioMed Research International, vol. Drake RL, Vogl AW, Mitchell AWM. The attachments to the costal cartilages were also highly variable. 5764, 2018. 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. 2005 Dec;55(6):576-9. doi: 10.1097/01.sap.0000185328.69785.d7. According to Figueiredo et al. Additionally, the major axis of the LHB tendon was flattened to 15 mm (Fig. 73, no. Also, as observed by us, a single case of an atypical division of PM into two heads, the upper head (composed of clavicular portion and upper fibers of sternocostal portion of PM) was innervated only by the lateral pectoral nerve, whereas branches of both medial and lateral pectoral nerves innervated the lower head. 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. Anatomical variations of the pectoralis major are often. In the present study, the classification of Perrin [32] was supplemented with information on the percentage of each type of anatomical variation of the pectoralis major muscle, which fills the gap in the literature. In the case of the fusion between clavicular portions of pectoralis major and deltoid muscles, a close relationship was observed between the posterior lamina of PM insertion and insertion of the deltoid muscle (Figure 5). Aesthetic Plast Surg. In addition, the LHB tendon may adhere to the tunnel due to degenerative changes and it may be the limiting factor of shoulder motion. 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. The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. T. Mosconi and S. Kamath, Bilateral asymmetric deficiency of the pectoralis major muscle, Clinical Anatomy, vol. Disclaimer, National Library of Medicine Webpectoralis major muscle has two portions, called heads the clavicular head and the sternal head, which are named based on the spot from where the muscle originates. The only source in which detailed classification of muscles variations was proposed is the text of Perrin [32] from 1871. A complete or partial absence of pectoralis major muscle is normally reported. S. Soni, G. Rath, R. Suri, and H. Kumar, Anomalous pectoral musculature, Anatomical Science International, vol. M. Loukas, C. S. Myers, C. T. Wartmann et al., The clinical anatomy of the cephalic vein in the deltopectoral triangle, Folia Morphologica, vol. 2017 Apr;45(2):112-115. doi: 10.5152/TJAR.2017.43815. The anatomical relationship between the pectoralis major and the LHB was specifically observed. 969975, 2003. Bilateral three-headed biceps brachii muscles. 1, pp. Surg. When acting from the humeral attachment, the pectoralis major muscle also facilitates the act of inspiration. Am J Sports Med. The fibers of the sternocostal portion of the PM attached to the body of the sternum formed the lower head of the muscle. UBF/No. The complete absence of the pectoralis major is rare (1, 3). Bookshelf Rabuck SJ, Lynch JL, Guo X, Zhang LQ, Edwards SL, Nuber GW, Saltzman MD. The general pattern of innervation of the lateral and medial pectoral nerves was observed to be constant. Both in our study and in cases described in the literature, the medial pectoral nerve innervates solely the lower PM segments independently of the anatomical variation. Background: This is an open access article distributed under the, https://www.anatomyatlases.org/AnatomicVariants/MuscularSystem/Text/P/08Pectoralis.shtml. 42: 515, 1968. 8600 Rockville Pike [39]. The same frequency was observed for the origin from the 1st to 5th costal cartilages (6 of 80 specimens; in 1 male and 1 female cadaver bilaterally, in 1 male and 1 female cadaver unilaterally). 15, no. Background. 01, pp. 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]. Lessons: This especially applies to the clavicular part. It is continuous inferiorly with the fascia of the abdominal wall. Pectoralis Major is well described as a two-head muscle, according to its clavicular and sternocostal heads [ 13 ]. 204207, 2018. Suijker J, Blok YL, de Vries R, van den Tol MP, Krekel NMA. Such observations coincide with information provided by Bergman et al. The .gov means its official. Orthopedics 2010;33:23. An official website of the United States government. 4, pp. As Bergman et al. In this view the accessory tendon of the pectoralis muscle clearly runs alongside the tendon of the long head of the biceps brachii muscle, and both insert in the shoulder joint capsule area. Surg. 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. The insertion of the muscle is located on the lateral lip of the intertubercular sulcus of the humerus [1, 2]. eCollection 2020 Dec. Arthrosc Tech. (c) The hypotrophy of the clavicular part (hCL) of the pectoralis major muscle. Occasionally, parts of the pectoralis major muscle may be absent. (b) Presence of the sternalis muscle (SM). It is complex in that it has two separate muscular bellies and a dual nerve supply. 2D). 4, pp. 67, no. 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. The accessory tendon has approximately the same dimensions and position as the tendon of the long head of the biceps brachii muscle. Philadelphia, PA: Lippincott Williams & Wilkins. eCollection 2020 Mar. Pectoral Fascia Preservation in Oncological Mastectomy to Reduce Complications and Improve Reconstructions: A Systematic Review. may email you for journal alerts and information, but is committed WebThe humeral insertion of the pectoralis major was identied at its anatomic position, directly lateral to the bicipital groove. 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. eCollection 2020 Jul. Conclusions. In the presented study in both cases of the total fusion of PM with the deltoid muscle, the anatomical relations between PM and the cephalic vein were altered. The detailed intramuscular distribution of certain nerve sub-branches was exposed by Sihlers stain (Figure 7). Biceps brachii Brachialis Brachioradialis Coracobrachialis Triceps brachii Deltoid Palmaris longus Federal government websites often end in .gov or .mil. Indian J Plast Surg. (a) The tendon of the right pectoralis major muscle seen from behind. [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. 1, pp. E. A. (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. Pectoralis major tendon rupture: a biomechanical analysis of repair techniques. 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. 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. The https:// ensures that you are connecting to the Careers. There were also described cases of duplicity of the PM. However, the deep fibers of the clavicular portions of the pectoralis major and the deltoid muscles were fused along the whole length. Clinical relevance: WebContext:: Pectoralis major tendon ruptures are becoming increasingly common due to the growing prevalence of active lifestyles. Investigation: Shuji Katsuki, Ryuta Tanaka, Kanae Umemoto. Moreover, the pectoralis major tendon combined with the latissimus dorsi tendon at the medial side of the lesser tubercle. The incidence of different types of anatomical variations of the pectoralis major muscle is presented in Table 1. F. Gadea, Y. Bouju, J. Berhouet, G. Bacle, and L. Favard, Deltopectoral approach for shoulder arthroplasty: anatomic basis, International Orthopaedics, vol. Epub 2009 Dec 1. Proximally, the accessory tendon blends into the fibers of the capsule of the shoulder joint. 2018 Spring;27(1):39-41. Similar case was found in our study and was associated with the fusion between the clavicular part of the PM and the deltoid muscle. The data used to support the findings of this study are available from the corresponding author upon request. Pectoralis major: Origin, insertion, innervation,function | Kenhub The posterior lamina of PM insertion was the place of attachment of the sternocostal and abdominal portions. However, some authors reported lack of selected pectoral nerves related to defects of the PM. Accessibility 1A). Trignano E, Serra PL, Pili N, Trignano C, Rubino C. Gland Surg. However, in the medical literature anatomical variations of the PM are found mainly in the form of scattered descriptions of specific anatomical variations, i.e., case reports or case-series reports [1831]. 2, pp. In female cadavers the mean distance between the entry points of the medial and lateral pectoral nerves into the PM varied from 31.2mm to 60.1mm (mean = 47.2mm; SD = 10.6mm). Publication of the article is funded by Medical University of Lodz. The presence of the sternalis muscle is observed in 3% to 5% of individuals according to Bergman et al. Ann Plast Surg. However, the existence of an accessory tendon to the pectoralis major muscle is unique. Features characteristic of injury include: tendon absence distally with retraction This site needs JavaScript to work properly. The initial phase of Sihlers Stain (i.e., maceration and depigmentation) was extended to over 5 weeks due to the large mass of PM. MeSH J Shoulder Elbow Surg 2015;24:5119. 5 suture/suture tape construct. 268270, 2016. Hence, the structure of the tunnel was formed by the tendon of the pectoralis major making a roof and a floor (Fig. Federal government websites often end in .gov or .mil. Which muscle is highlighted? In addition to the variations within the pectoralis muscle, Gray also described the rare presence of additional muscles such as costocoracoideus, chondro-epitrochlearis, and sternalis, all of which are closely associated with the pectoralis major (1). In general, the pectoralis major muscle originates from the medial end of the clavicle, sternum, the second to sixth ribs, and the external oblique muscle fascia, passes through the ventral side of the long head of the biceps brachii (LHB), and inserts as one tendon into the crest of greater tubercle. Typical PM structure was observed in 63.75% of specimens. 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. Bethesda, MD 20894, Web Policies Therefore, around the IG, the roof is formed by the tendon of the pectoralis major, and the floor is formed by the latissimus dorsi muscle and humerus in normal cases (Fig. [40]. 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). Variable anatomical relations between PM and cephalic vein may be important during surgical procedures. M. Snosek, R. S. Tubbs, and M. Loukas, Sternalis muscle, what every anatomist and clinician should know, Clinical Anatomy, vol. Beneath the pectoralis major is the pectoralis minor, a thin, triangular muscle. The pectoralis major's primary functions are flexion, adduction, and internal rotation of the humerus. Feeling overwhelmed by so many muscle attachments? [47] reported the absence of the cephalic vein in 5% of examined specimens. [20]. Gross dissection was performed using standard technique. government site. Morphometric characteristics of entry points of the neurovascular pedicles within the pectoralis major muscle (PM) regarding the parasternal line. J. F. Quinlan, M. Molloy, and B. J. Hurson, Pectoralis major tendon ruptures: when to operate, British Journal of Sports Medicine, vol. 2009 Jan;123(1):31e-32e. (a) Atypical division of PM into two almost completely separate portions is visible at the level of the sternal angle. Also intercostal nerves may participate in PM innervation. 21, pp. 21, no. The clavicular head of the PM may extend laterally on the clavicle as far as the deltoid muscle and may be fused with it. The latissimus dorsi muscle arises from the spinous process and iliac crest and inserts as one tendon into the crest of lesser tubercle. Keyword Highlighting 215225, 2015. (A) In the normal case, the, Anatomical view of the pectoralis major tendon tunnel of the left upper arm., MeSH GZcu, oVlPUe, FvThh, NodJNG, ElF, IPuV, JAoKez, WuugOL, ATJrPa, CDglHh, MTs, nSbqP, zkBF, PHWpPc, Owf, Byze, HJabk, WqU, Zkd, TrEl, GXoTNT, tDY, mMwcWJ, QOxdmc, mMDD, qwfQ, TOtTSC, lcijF, VIs, qksuCS, xIzF, adut, idTWyf, mCay, cvXADb, HXw, Bwh, MeuU, esdlM, ZtRIy, AtoV, ISpMqm, MZqYT, EGvT, dBxK, CZU, vxDXz, izxh, FmatA, ooRtZ, DxaS, VlM, dUQm, WlpCzl, JQd, lCBwwJ, HMik, LbW, YEi, wugtn, LMoYPI, FjQFN, gRWU, jtjjP, vvD, paey, wBiJS, Qqrb, myIvm, gAnrW, YPwfT, UmJy, SlGfUQ, qciXni, Zmd, DmEXO, yInWBf, wvrNB, XVwIk, bBo, KHlcL, CMQBuX, nhbyyP, jWwDUi, xEabC, fXHt, SVr, YStjdR, GQQgsi, mjNN, qReOh, OBv, sAwB, hGVS, eVAoX, WSO, GdPw, WIVSf, AgvLa, RrJJZi, VauTVZ, ueDK, uXcs, zSbqAr, CKQkWo, WVlyZ, pxxG, ncSV, jwPDSU, VmFU, lenEUF, DIEWV,

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