6 The majority of the breast is in the superficial fascia, except the tail part (Tail of Spence) extends upward laterally into deep fascia at the lower border of pectoralis major.2/3 of the gland lies on pectoralis major1/3 of the gland lies on serratus anterior
8 Deltopectoral Triangle deep fascia separating deltoid and pectoralis muscles- Platysma = superficial muscle, thin plate, extends from the mandible to the clavicle
9 3. Muscles of pectoral region a. Pectoralis Majorb. Pectoralis Minorc. Serratus Anteriord. Subclavious
10 a. Pectoralis MajorO. middle ½ clavicle, sternum, rib 1-5I. lateral lip of bicipital groove of humerousA. adduction, medial rotation of armb. Pectoralis MinorO. rib 3-5I. coracoid process of scapularA. draw the scapular down / lift up the ribs
11 c. Serratus AnteriorO. half way of the anterior part of rib 1-8I. medial border (anterior surface) of the scapularA. pull scapular to chest wall / lift up the ribsd. SubclaviousO. 1st costal cartilageI. inferior surface of clavicleA. protecting structures underneath the clavicle
12 PectoralGirdle : clavicle, scapular, ribs Clavipectoral fascia / Costocoracoid membrane- deep fascia separating the pectoralis and the subclavious
14 Blood supply to the pectoral region 1. Axillary artery2. Perforating branches of the internal thoracic a.
15 1. Axillary artery :divided into 3 partsFirst part :Supreme thoracic a.Second part :1.Thoraco-acromial trunkAcromial branchPectoral branchClavicular branchDeltoid branch2. Lateral thoracic a.Third part :give branches to supply head of humerus and scapular regions
16 1. Deep veins - axillary v. <= from the muscles Venous drainage at the pectoral region1. Deep veins - axillary v. <= from the muscles
17 2. Superficial veinscephalic v. (from upper limb) at the deltopectoral triangle, it pierces the clavipectoral fascia (or infraclavicular fossa) into the axillary v.from mammary gland, it drains into deep veins => internal thoracic v. and lateral thoracic v.
18 1. Superficial 2. Deep Lymphatic drainage of the breast - around the mammary gland, lymphatic network is highly anastomosed / drainage is parallel the venous drainage.2. Deep- lymph nodes are formed along the lymphatic vessels.
19 A. from lateral side of the breast, drains into the anterior group of the axillary lymph node (the pectoral node).B. from medial side of the breast, drains into the parasternal node (the internal thoracic node)
20 Nerve Supply of the pectoral region 1. - medial & lateral pectoral nerve (terminal branches from the cords of the Brachial plexus (C5-8 & T1)- nerve to subclavius (a branch from upper trunk of the Brachial plexus)- long thoracic nerve (nerve roots from C5-6-7 of the Brachial plexus)
24 Clinical Relevance1. Chest wall – heart /lung sound2.Clavipectoral fascia- protection of the vessels and nerves underneathlimit spreading of the abscess from upper limb to the neck3. Fracture of clavicle- common site is at 1/3 from the lateral4. Breast cancer- structural abnormality- lymphatic drainage & metastasis- mastectomy
31 Muscles of Scapular region 1. DeltoideusO.lateral 1/3 of clavicle, acromion, spine of scapulaI. deltoid tuberosity of humerusA. abduct arm to 90 c, medial & lateral rotate armN. axillary n.
32 2. SubscapularisO. subscapular fossaI. lesser tubercle of humerusA. medially rotate armN. upper & lower subscapular nerves (C5,6)3. Teres MajorO. inferior 1/3 lateral border of scapularI. medial lip of bicipital grooveA. adduction & medial rotation of armN. lower subscapular nerve (branch of posterior cord)
33 4. SupraspinatusO.supraspinus fossaI. superior facet of greater tubercle of humerusA. abduction of armN. suprascapular nerve5. InfraspinatusO. infraspinus fossaI. middle facet of greater tubercle of humerusA. abduct & lateral rotate arm
34 3. Teres MinorO. superior 2/3 lateral border, dorsal surface of scapularI. inferior facet of greater tubercle of humerusA. lateral rotation of armN. axillary nerve
36 1. Axillary a. & branches 2. Axillary v. & tributaries Contents of the Axilla1. Axillary a. & branches 2. Axillary v. & tributaries3. Brachial plexusAxillary sheath – deep fascia that wrap around the axillary vessels and the brachial plexusformed by part of cervical fascia
38 1. Axillary a. & branches Third part : - anterior humeral circumflex a.- posterior humeral circumflex a.- subscapularis a.
39 2. Axillary v. & tributaries Superficial branch : cephalic v.Deep branch : venae comitant of brachial v.In the axilla vein lies medial to the atery. It is the most expandable structure in the axillary sheath (enlarge when the blood flow is high)
40 3. Brachial plexus- formed by anterior primary rami of spinal nerves level C5-8 & T1 - formed into trunk, division, cord and branchesUpper trunk = C5 + C6Middle trunk = C7Lower trunk = C8 + T1
41 Most of the the brachial plexus in the axilla are cords & branches -
42 1. Lateral cord & branches : - musculocutaneous n.- lateral head of median n.- lateral pectoral n.
43 2. Medial cord & branches : - medial head of median n.- ulnar n.- medial pectoral n.- medial cutaneous nerve of arm- medial cutaneous nerve of forearm
47 Node & Vessel Locations: 1. Anterior group– at the lower border of pectoralis minor- drinage parallel the lateral thoracic v.2. Posterior group– anterior to subscapularis m.- drainage parallel the subscapular v.3. Lateral group- at the lower border of teres major- drainage parallel medial side of axillary v.4. Central group- the outer border of 1st rib5. Apical group– at the apex of the axilla6. Subclavian lymph trunk
48 1. Nerve injury (lesion) at the axilla Lymph drainage :- anterior, posterior and lateral groups drain into the central group and then into the apical group-apical group drains into the subclavian lymph trunkClinical Correlation1. Nerve injury (lesion) at the axilla- long thoracic nerve- axillary nerve- lateral cord- medial cord2.Injury to the axillary a.- fracture & dislocation of bone