Pectoralis major. In our case, the left pectoralis major tendon appeared to insert at the crest of the greater tubercle and lesser tubercle of the humerus, forming a tunnel (Fig. Coracobrachialis muscle. 176189, 2017. F. Bussu, R. Gallus, V. Navach et al., Contemporary role of pectoralis major regional flaps in head and neck surgery, Acta Otorinorhinolaryngologica Italica, vol. Carey P, Owens BD. 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. 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]. 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. The pectoral fascia may provide the breast implant with more soft-tissue coverage. The pectoralis major muscle is innervated by lateral (C5 and C6) and medial pectoral (C7, C8, and T1) nerves. The procedure was modified, based on our earlier experience, for a large muscle mass [37]. 2020 Aug;29(8):1590-1598. doi: 10.1016/j.jse.2019.12.020. Rabuck SJ, Lynch JL, Guo X, Zhang LQ, Edwards SL, Nuber GW, Saltzman MD. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. In those cases, the PM and the deltoid muscle may be fused to varying degrees [2]. Partial duplicity of the PM was reported by Loukas et al. The fibers of the sternocostal portion of the PM attached to the body of the sternum formed the lower head of the muscle. Mosconi T, Kamath S. Bilateral asymmetric deficiency of the pectoralis major muscle. 2011 Nov;29(11):1783-7. doi: 10.1002/jor.21438. The New Method of Pocket Forming for Breast Implant Placement in Augmentation Mammaplasty: Dual Plane Subfascial. 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. 42: 515, 1968. 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. 463468, 2016. In the second, the accessory head of the biceps brachii was attached to the anterior lamina of the PM insertion. In another study, Kawakami et al[9] reported that only the tendon of the pectoralis major formed the tunnel. Highlight selected keywords in the article text. E. E. Beheiry, Innervation of the pectoralis major muscle: anatomical study, Annals of Plastic Surgery, vol. Variations of the clavicular part of the PM may be explained and understood based on embryology and phylogeny. In the case of hypotrophy of the clavicular portion of the PM, normal and well-developed branches of the lateral pectoral nerve were observed. Writing original draft: Shuji Katsuki, Hayato Terayama. In contrast, the lateral pectoral nerve is involved in the innervation of the clavicular portion and the upper segments of the sternocostal portion. Anatomy of the tendon of the pectoralis major muscle with a separate clavicular part. The structure of the floor was the IG of the humerus and latissimus dorsi. Project administration: Kou Sakabe, Hayato Terayama. 10, pp. HHS Vulnerability Disclosure, Help 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. Copyright 2013 Jun;41(6):1395-9. doi: 10.1177/0363546513482297. 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]. We removed the fat and skin around the chest and both shoulder joints for observational purposes and carefully examined the structures. 98-B, no. Federal government websites often end in .gov or .mil. Smaller Gap Formation With Suture Anchor Fixation Than Traditional Transpatellar Sutures in Patella and Quadriceps Tendon Rupture: A Systematic Review. Would you like email updates of new search results? [20]. Please try again soon. Material and Methods. Drake RL, Vogl AW, Mitchell AWM. 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). The main anatomical variations related to morphology of the pectoralis major muscle. Pectoralis major: Origin, insertion, innervation,function | Kenhub Three-dimensional study of. Abstract Rationale: Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. 15, no. malformations of the fingers). Data curation: Hayato Nomura, Kaori Suyama. 2022 Sep 21;10(9):23259671221121333. doi: 10.1177/23259671221121333. 5, pp. Typical PM structure was observed in 63.75% of specimens. R. Y. Arican, N. Coskun, L. Sarikcioglu, M. Sindel, and N. Oguz, Co-existence of the pectoralis quartus and pectoralis intermedius muscles, Morphologie, vol. WebStudy with Quizlet and memorize flashcards containing terms like Pectoralis major (cadaver), Pectoralis minor (cadaver), External oblique (cadaver) and more. The pectoralis major muscle in humans is a large fan shaped muscle situated at the anterior upper part of the chest. 2427, 2018. 2019 Jun;73(3):178-182. doi: 10.5455/medarh.2019.73.178-182. 2020;99:31(e21475). Porzionato A, Macchi V, Stecco C, Loukas M, Tubbs RS, De Caro R. Clin Anat. 21, no. In both cases described by Yamasaki [31], the PM was defected, with the clavicular portion and a small part of sternocostal portion only persisting. Results. Clin Anat 2009;22:5008. 4, pp. If youre a gym lover, youll hear these muscles also being referred to as the pecs muscles. 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. 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. Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space, Clavicular part: anterior surface of medial half of clavicle. 2002 Aug;15(5):366-70. doi: 10.1002/ca.10053. -, de Figueiredo EA, Terra BB, Cohen C, et al. Conclusions. The pectoralis major is a paired, superficial muscle located on the anterior surface of the thoracic cage. Epub 2018 Dec 13. Last reviewed: December 05, 2022 In 2.5% of cases (bilaterally in 1 male cadaver), the PM originated from the 1st to 7th costal cartilages. 3, 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. The region was carefully dissected, clavicular part of deltoid and pectoralis major muscles were removed near their origin to expose pectoralis minor muscle. eCollection 2020 Mar. 111: 904, 2003. 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]. The degree of separation of these two portions varied in different specimens from partial to almost total (Figure 1(b)). 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. The authors wish to express their gratitude to all those who donated their bodies to medical science. Insertional footprint anatomy of the, [3]. In addition, the LHB tendon may adhere to the tunnel due to degenerative changes and it may be the limiting factor of shoulder motion. The muscle can be partly or completely missing. Moreover, the pectoralis major tendon combined with the latissimus dorsi tendon at the medial side of the lesser tubercle. 215225, 2015. The literature documents numerous variations associated with the pectorlis major muscle. The sternocostal portion of the muscle can produce the antagonistic movement and extend the humerus back to the anatomical position. Careers. However, tested techniques have Our study, supplemented by using Sihlers stain technique, is in accordance with previous reports on the segmented innervation pattern of the pectoral nerves [19]. Mini-open Subpectoral Biceps Tenodesis Using All-Suture Anchor. 2E), and the left LHB tendon showed more intra-articular degenerative changes at gross anatomy than the right LHB tendon. Can the pectoral fascia integrity be preserved during subfascial breast augmentation through the axillary approach? We removed the fat and skin around the shoulder joint and upper extremity for observational purposes and carefully examined the structures during gross anatomy. The accessory tendon has approximately the same dimensions and position as the tendon of the long head of the biceps brachii muscle. Study design: Hence, it appeared normal. Clinical relevance: Gray's Anatomy for Students. The deltoid muscle has been reflected. Epub 2015 Aug 18. 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. In two male cadavers (4 out of 80 = 5% of specimens) fusion between the clavicular portion of PM and the deltoid muscle was observed (Figure 1(d)). Clipboard, Search History, and several other advanced features are temporarily unavailable. Additionally, supernumerary heads of muscles other than pectoralis major have been documented. WebOrigins of the pectoralis major include the clavicle, sternum, ribs, and external oblique fascia 3 as well as cartilage of the first six ribs. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. According to those authors, the nerve courses on the deep surface of the PM for a mean of 55 7mm and is visible under the muscle [56]. Learn more Gross dissection was performed using standard technique. Anatomic Pectoralis Major Repair With Intramedullary Anchor Fixation. 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. 310313, 2008. Surgical anatomy of the pectoral nerves and the pectoral musculature. Our case may be classified as a simple type according to Snosek et al. Anatomy of pectoral fascia in relation to subfascial mammary augmentation. Case report and review of the literature, Italian Journal of Anatomy and Embryology, vol. 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. 33, no. 68, pp. The most frequent variation was a separate clavicular portion of PM. Acting together with the latissimus dorsi muscle, the pectoralis major muscle pulls the trunk forwards or upwards when its humeral attachment is fixed. Only the lateral pectoral nerve existed in the second case [31]. F. Gadea, Y. Bouju, J. Berhouet, G. Bacle, and L. Favard, Deltopectoral approach for shoulder arthroplasty: anatomic basis, International Orthopaedics, vol. For instance, complicated axillary lymphadenectomy due to a pectoralis quartus muscle was described by Totlis et al. 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. It is continuous inferiorly with the fascia of the abdominal wall. Surg. [11]. 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). The complete absence of the pectoralis major is rare (1, 3). How to cite this article: Katsuki S, Terayama H, Tanaka R, Qu N, Nomura H, Kawakami S, Umemoto K, Suyama K, Yi SQ, Suzuki T, Sakabe K. Variation of insertion of the pectoralis major in a cadaveric study: a case report. PMC Aesthetic Plast Surg. 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%). Rare cases of muscular anomalies involving the PM or its tendon have been presented. In Rockwood: CA Jr, Matsen FA III, Wirth MA, Lippitt SB (eds) PA: Saunders; 2004: p1062. A unilateral four-headed pectoralis major muscle was observed on the left side of an 83 year-old Caucasian male cadaver. The https:// ensures that you are connecting to the However, in the present case, the tendon of the pectoralis major appeared to insert into the crest of the greater tubercle and the crest of the lesser tubercle, and a tunnel was being formed by the insertion of the pectoralis major. The thicknesses of the pectoral fascias were measured. Morphometric characteristics of the pectoralis major muscle (PM). Benito-Ruiz J, Raigosa M, Manzano M, Salvador L. Plast Reconstr Surg. Almstead S. Congenital defects of the pectoral muscles. The AL is a place of attachment for the clavicular part (CL), as well as for the upper and middle fibers of the sternocostal (STC) part of the pectoralis major muscle. The AL is a place of attachment for the clavicular part (CL), as well as for the upper and middle fibers of the sternocostal (STC) part of the pectoralis major muscle. The width of the attachment of the sternocostal portion of PM ranged from 133mm to 215mm (mean = 172mm 22mm; Table 3). The Pectoralis Major is composed of two heads: Sternocostal head and Clavicular head. GT=greater tubercle, IG=intertubercular groove, LD=latissimus dorsi, LHB=long head of biceps brachii, LT=lesser tubercle, PM=pectoralis major. 4, pp. The clavicular portion of the PM is usually separated from the sternocostal portion of the PM by a slight cleft. 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]. J. sharing sensitive information, make sure youre on a federal Dempsey, W. C., and Latham, W. D. Subpectoral implants in augmentation mammaplasty. As part of management, the condition of the tendon of the pectoralis major should be confirmed using magnetic resonance imaging or echocardiography. 8600 Rockville Pike Surg. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Medicine. Depending on the degree of severity, the adduction and internal rotation of the shoulder joint are more or less difficult to perform (for example, the crossing of the raised arms). 24, no. 16, no. The latissimus dorsi muscle arises from the spinous process and iliac crest and inserts as one tendon into the crest of lesser tubercle. 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. WebThe lateral border of pectoralis major muscle forms the anterior axillary fold. [45] suggested that the muscle belly of the PM consisted of an architecturally uniform clavicular head and a segmented sternal head, while the PM tendon consisted of longer anterior and shorter posterior layers that were continuous inferiorly. Disclaimer, National Library of Medicine Hangzhou, China: Zhejiang Science and Technology Press, 1999. [1]. 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. Wei, W. Plastic Surgery. 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. Epub 2012 Jul 9. WebThe humeral insertion of the pectoralis major was identied at its anatomic position, directly lateral to the bicipital groove. The pectoralis minor is encased in the clavipectoral fascia that 2018, Article ID 1520929, 11 pages, 2018. The triangular depression between the pectoralis major muscle, deltoid muscle and clavicle is called infraclavicular fossa (Mohrenheims fossa) which serves as an important landmark in the surgical procedures on the subclavian artery. There were also described cases of duplicity of the PM. 67, no. The medial pectoral nerve, in turn, supplies the posterolateral parts of the sternal head of the PM. Bethesda, MD 20894, Web Policies During the further stage of the dissection, the insertion of the PM was cut along the lateral lip of the intertubercular sulcus and reflected to expose the neurovascular bundles and attachment to the costal cartilages. Publication of the article is funded by Medical University of Lodz. 2012 Aug;40(8):1887-94. doi: 10.1177/0363546512452849. Davimes et al. [Surgical treatment of chronic pectoralis major rupture]. Author: The initial phase of Sihlers Stain (i.e., maceration and depigmentation) was extended to over 5 weeks due to the large mass of PM. Wringer, E., Mader, N., Posch, E., et al. The purpose of this study was to examine On both sides of the described body the cephalic vein had a typical course; however its terminal segment pierced the muscle fibers to empty into the axillary vein. (b) The tendon of the pectoralis major muscle seen from behind. 15, no. eDepartment of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Tokyo, Japan. 5 suture/suture tape (794 168 N), UBF/suture tape (502 201 N), and bone trough (492 151 N) ( P < .001 for all). In females, it is covered by the breast. The presented study attempts to classify individual anatomical variants of PM, including rare and unusual findings. Samilson R L. Congenital and developmental anomalies of the shoulder girdle. 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). ; This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. [27] demonstrated a case of anomalous accessory muscle confluent with the normal sternal head of PM. 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. 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). 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). 73, no. 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. [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. Data is temporarily unavailable. Taylor SA, Fabricant PD, Bansal M, et al. In their study, attention was paid to the fact that deltopectoral triangle may exhibit high variability. 1, pp. to maintaining your privacy and will not share your personal information without Would you like email updates of new search results? M. Loukas, C. S. Myers, C. T. Wartmann et al., The clinical anatomy of the cephalic vein in the deltopectoral triangle, Folia Morphologica, vol. Methods: The submuscular or subglandular plane for breast augmentation is widely used. The incidence of different types of anatomical variations of the pectoralis major muscle (PM). M. M. Maclin, O. The deltopectoral groove is absent and there is no visible borderline between clavicular portion (CL) of the pectoralis major muscle and the deltoid muscle (DM). Leur Importance en Anthropologie, Masson, Paris, France, 1884. Surgeons should be aware of anatomic variations of the PM both in planning and in conducting surgeries of the pectoral region. 2010 Feb;34(1):29-32. doi: 10.1007/s00266-009-9443-8. Moreover, research on the innervation of selected muscles suggests that axons migrating during development into effector organs show a well-defined specificity [37]. Epub 2012 Jun 7. 5, pp. 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. Y. H. Lee and S. I. Chun, Congenital absence of pectoralis major: a case report and isokinetic analysis of shoulder motion, Yonsei Medical Journal, vol. However, anomalous insertion sites of the pectoralis major tendons have been noted. Standring, S. (2016). The authors report no conflicts of interest. Background: 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. 1A). Segall HD. 2 suture; and (4) native PM tendon group; all groups were tested to failure. In another case (1 of 80 specimens; one male cadaver on the left side), the accessory head of the biceps muscle was inserted to the PM tendon (Figure 6(b)). Features characteristic of injury include: tendon absence distally with retraction No reports exist regarding the relationship between degenerative changes of the LHB and the structure of the tendon of the pectoralis major. Search for Similar Articles 204207, 2018. MeSH In extreme cases, the deltopectoral triangle may not exist as in the case of PM fusion with deltoid muscle, which can potentially cause issues during surgery. 27, no. 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)). 38, no. S. Standring, Ed., Grays Anatomy: The Anatomical Basis of Clinical Practice, Churchill Livingstone/Elsevier, Edinburgh, Scotland, 40th edition, 2008. Clin Plast Surg. Indian J Plast Surg. 2022 Oct;11(10):1604-1614. doi: 10.21037/gs-21-896. In the case reported by Hong et al. Butt, S. Mehta, L. Funk, and P. Monga, Pectoralis major ruptures: a review of current management, Journal of Shoulder and Elbow Surgery, vol. e687e698, 2018. The site is secure. Please enable it to take advantage of the complete set of features! 22, no. Particular attention has been paid to the variability of attachments and the variability in the shape of the clavicular portion of this muscle. The presence of the sternalis muscle is observed in 3% to 5% of individuals according to Bergman et al. The anatomy and histology of the bicipital tunnel of the shoulder. sharing sensitive information, make sure youre on a federal Different variations of the PM represent all six classes of anatomical variability of muscles described by Perrin [32]. R. Trbs, B. Gharavi, M. Neid, and G. Cernaianu, Chondroepitrochlearis musclea phylogenetic remnant with clinical importance, Klinische Pdiatrie, vol. 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. Results: The importance of PM in orthopedic surgery refers, among others, to the deltopectoral approach [912] or to the repair of PM injuries [6, 1315]. Epub 2011 Apr 28. 496504, 2015. The right side is affected twice as often as the left side and there is a male preponderance. 14741477, 2017. Moreover, displacement after cyclic loading was by far smallest in the UBF/No. 2, pp. doi: 10.1097/GOX.0000000000002700. Copyright 2019 Robert Haadaj et al. 412422, 2012. CL: clavicular part of the pectoralis major muscle; LPN: branches of the lateral pectoral nerve; MPN: branches of the medial pectoral nerve; STC: sternocostal part of the pectoralis major muscle. The anatomy and histology of the bicipital tunnel of the shoulder. CL: clavicular part of the pectoralis major muscle; DM: deltoid muscle; STC: sternocostal part of the pectoralis major muscle. Conclusion: and transmitted securely. [23], who observed additional head of PM which fused with the fibers of the serratus anterior muscle. It is complex in that it has two separate muscular bellies and a dual nerve supply. 506509, 1997. 205, no. Because no residual tendon stump was present, the The data used to support the findings of this study are available from the corresponding author upon request. However, at the medial side of the LHB, the pectoralis major tendon combined loosely with the tendon of the latissimus dorsi and was not inserted to the crest of the lesser tubercle of the humerus (Fig. L. B. Solomon, N. Ravindranath, B. Vidic, and M. Dym, Anatomical variant of the lateral pectoral nerve innervating the anterior portion of the deltoid muscle: a case report, Anatomical Record, vol. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/. 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. Similar case was found in our study and was associated with the fusion between the clavicular part of the PM and the deltoid muscle. J. G. Davimes, N. Bacci, and P. Mazengenya, Evidence of the sternalis muscle in two South African cadavers, Surgical and Radiologic Anatomy, vol. 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. Medicine. 2009 Jun;21(2):126-40. doi: 10.1007/s00064-009-1701-z. 290, pp. Variation of insertion of the pectoralis major in a cadaveric study. Reading time: 6 minutes. 36, no. Sherman SL, Lin EC, Verma NN, Mather RC, Gregory JM, Dishkin J, Harwood DP, Wang VM, Shewman EF, Cole BJ, Romeo AA. 20, no. The posterior lamina of PM insertion was the place of attachment of the sternocostal and abdominal portions. posterior wall: scapula, subscapularis muscle, teres major muscle, and latissimus dorsi muscle. http://creativecommons.org/licenses/by-nc-nd/3.0/. http://creativecommons.org/licenses/by/4.0. The site is secure. G. W. Hoffman and L. F. Elliott, The anatomy of the pectoral nerves and its significance to the general and plastic surgeon, Annals of Surgery, vol. Bookshelf It is likely that your cadaver does not have any appreciable mammary tissue. Transaxillary Subfascial Augmentation Mammaplasty with Anatomic Form-Stable Silicone Implants. government site. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). [45] stated that there is little consensus regarding the complex musculotendinous architecture of the PM. The biceps tendon. Read more. Failure modes were classified by location and cause of rupture based on optical markers, while tendon footprint length was measured to determine amount of footprint restoration. The sternalis muscle occupies position between the superficial fascia and the pectoral fascia [40]. Result: In our study, the mean width of the insertion of PM was 65.3mm (range: 43.9-83.2), while the mean distance between the top of the greater tubercle and upper border of PM tendon was 52.1mm (range: 38.3-65.2). 2005 Dec;55(6):576-9. doi: 10.1097/01.sap.0000185328.69785.d7. WebThe pectoralis major muscle is innervated by lateral (C5 and C6) and medial pectoral (C7, C8, and T1) nerves. An official website of the United States government. The deep surface of the muscle covers the pectoralis minor and serratus anterior muscles and the anterior surface of the upper six ribs. 65, no. WebThe pectoral fascia, which can be successfully dissected bluntly along the subfascial plane, varies in thickness from 0.2 to 1.14 mm. 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]. FOIA Epub 2018 Nov 27. 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. J. Black arrowheads show twisting of the lower fibers of the sternocostal part of the pectoralis major muscle. 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. It also acts as an accessory muscle for inspiration. Epub 2020 Apr 17. 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. 866884, 2014. Lafrance R, Madsen W, Yaseen Z, Giordano B, Maloney M, Voloshin I. 5, pp. and grab your free ultimate anatomy study guide! The pectoralis major (PM) is a large, fan-shaped muscle, typically composed of a clavicular, sternocostal, and abdominal part. Edinburgh: Elsevier Churchill Livingstone. Augmentation mammaplasty using the retrofascia approach. Qualitative and Quantitative Anatomy of the Humeral Attachment of the Pectoralis Major Muscle and Structures at Risk: A Cadaveric Study. sharing sensitive information, make sure youre on a federal Investigation: Shuji Katsuki, Ryuta Tanaka, Kanae Umemoto. Carey and Owens [44] also proved that it was not possible to differentiate between the two layers of the PM tendon in the region of the insertion in the humerus. (a) Atypical division of PM into two almost completely separate portions is visible at the level of the sternal angle. 8, pp. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. One presumably very rare variation is During the routine dissection of the right upper extremity of an adult male cadaver a distinct separate tendinous insertion into the shoulder joint capsule was identied. The pectoralis major footprint; an anatomical study. Reconstr. Rev Bras Ortop 2013;48:51923. (d) Fusion between the clavicular part (CL) of the pectoralis major muscle and the deltoid muscle (DM). Pectoralis Major is well described as a two-head muscle, according to its clavicular and sternocostal heads [ 13 ]. 8600 Rockville Pike WebAbstract Background: Pectoralis major (PM) ruptures are increasingly common, and a variety of surgical techniques have been described. 2, pp. Subfascial breast augmentation: thickness of the pectoral fascia. 16931705, 2010. 5, pp. 969975, 2003. (d) Inferior view to the tendon of the pectoralis major muscle. Hence, the structure of the tunnel was formed by the tendon of the pectoralis major making a roof and a floor (Fig. Anatomical variant of the lateral pectoral nerve innervating the anterior portion of the deltoid muscle was documented by Solomon 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. government site. 233420.19, 1871. 5, pp. Christopher F. Congenital absence of the pectoral muscles. A. W. ElMaraghy and M. W. Devereaux, A systematic review and comprehensive classification of pectoralis major tears, Journal of Shoulder and Elbow Surgery, vol. [10]. This stage allowed observing possible differences in PM innervation depending on its anatomical variations. SK and HT contributed equally to this work. Burkhead WZ, Arcand MA, Zeman C, et al. The total length of tunnel was about 2.5 cm (Fig. 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. (a) The right pectoralis major muscle and the deltoid muscle seen from behind. The insertion of the muscle is located on the lateral lip of the intertubercular sulcus of the humerus [1, 2]. Before The axillary arch (AA) is stretched between this band and the latissimus dorsi muscle (LD). Additionally, the fact that we found this unique case in a male cadaver raises the question whether it is sex-specific, and encourages a more thorough search to find out if a similar pattern of variation exists in females. By continuing to use this website you are giving consent to cookies being used. Which muscle is highlighted? In obtaining images, respiratory motion artefact may be minimized by abdominal breathing techniques. Fung L, Wong B, Ravichandiran K, et al. 42, no. M. M. Chiavaras, J. Y. K. Lee, M. R. Skalski, E. A. 26: 148, 2004. Barbato, C., Pena, M., Triana, C., et al. [2] who noted the occurrence of the lateral pectoral nerve even with congenital PM deficiency. 1, pp. The specimens were tested under cycling loads (10 N to 125 N) with a final load-to-failure test at 1 mm/s. According to Figueiredo et al. Quinlan et al. Gifford A, Tauro T, Haunschild E, Okoroha K, Cole BJ. The pectoral fascias can be dissected bluntly along a subfascial plane with the pectoral fascia intact. The mean distance between the entry points of the medial and lateral pectoral nerves into the PM varied from 38.6mm to 61.8mm in male cadavers (mean = 49.7mm; SD = 11.2mm). 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. 101: 1086, 1998. This study is important for orthopedic and rehabilitation physicians in treating diseases of the long head of the biceps brachii tendon. [2,3] However, there are few reports on the anomalous insertion of the pectoralis major tendon. Nerve and vessel supplying ligamentous suspension of the mammary gland. 32, no. A complete or partial absence of pectoralis major muscle is normally reported. WebThe pectoralis major is surrounded by a thin layer of deep fascia that is continuous with the fascia of the axilla. In our study all specimens stained by Sihlers technique showed the contribution of the intercostal nerves in PM innervation. The highlighted muscle originates from which bone? 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). Methods: S. Miyamoto, S. Kayano, M. Fujiki, and M. Sakuraba, Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction, Microsurgery, vol. 4, pp. (b) A separate clavicular part (CL) of the pectoralis major muscle. 2nd Ed2013;Japan: Daihokaku, ISBN 978-4-9980686-2-4. This website uses cookies. Careful dissection of the neurovascular bundles was performed in accordance with previously described anatomic dissection techniques [3335]. This study is important for orthopedic and rehabilitation physicians in treating diseases of the long head of the biceps brachii tendon. 2022 Case Report. 1, pp. (c) The hypotrophy of the clavicular part (hCL) of the pectoralis major muscle. 209214, 2012. 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). Epub 2013 Apr 5. The width of the origins of clavicular and sternocostal portions, the width of the PM insertion, and the width of the PM in the midclavicular line were measured. Careers. The right pectoralis major was inserted into the crest of greater tubercle only and was normal. 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. Morphometric characteristics of entry points of the neurovascular pedicles within the pectoralis major muscle (PM) regarding the inferior border of the clavicle. In this case, the brachial segment of the cephalic vein was absent bilaterally. 100103, 2006. NCI CPTC Antibody Characterization Program. The accessory tendon arises from the lateral aspect of the pectoralis major muscle. Intervention: Keywords: Writing review & editing: Hayato Terayama, Ning Qu, Shuang-Qin Yi, Kou Sakabe. The, [4]. L. Mu and I. Sanders, Sihler's whole mount nerve staining technique: a review, Biotechnic & Histochemistry, vol. Abstract Rationale: Typically, the tendon of the pectoralis major inserts into the crest of the greater HHS Vulnerability Disclosure, Help 1, pp. K. Natsis, G. Tsakotos, K. Vlasis, T. Totlis, and K. Jurgen, Absence of the deltopectoral groove, ANZ Journal of Surgery, vol. (a) Small sub-branches of the lateral pectoral nerve (LPN) joined the clavicular portion of the deltoid muscle (DM). 9, pp. Disclaimer, National Library of Medicine The detailed intramuscular distribution of certain nerve sub-branches was exposed by Sihlers stain (Figure 7). When the arteries are injected by the resin, the initial part of Sihlers method (destaining) may be used to trace detailed intramuscular arterial pattern. The clavicular head acts to flex the humerus, and the sternocostal head extends it from flexed position. 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]. For instance, Yamasaki [31] reported two cases of the congenital partial defect of pectoralis major and minor muscles. Pectoralis major. Below (deep to) the pectoralis major is the pectoralis minor, a thin, triangular muscle. In sports as well as bodybuilding, the pectoral muscles may colloquially be referred to as " pecs ", " pectoral muscle " or " chest muscle " due to its being the larger and most superficial muscle in the chest area. These 3 metallic anchors will hold the tendon firmly against bone. WebThe pectoralis major muscle is subject to various morphologies. WebSubcoracoid transfer of the pectoralis major has recently been described as a reconstruction for subscapularis insufficiency. The general pattern of innervation of the lateral and medial pectoral nerves was observed to be constant. De Figueiredo, B. All these parts may be more or less separable [2]. 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]. Bookshelf In this cadaver, the left side of the pectoralis major tendon appeared to insert at the crest of the greater tubercle and lesser tubercle of the humerus, forming a tunnel measuring 2.5 cm in total length. Epub 2011 Nov 28. Feeling overwhelmed by so many muscle attachments? 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. The authors report no conflicts of interest. The https:// ensures that you are connecting to the All content published on Kenhub is reviewed by medical and anatomy experts. [9]. 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. 3, pp. Conceptualization: Shuji Katsuki, Hayato Terayama, Ryuta Tanaka. 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). Would you like email updates of new search results? 8600 Rockville Pike The procedure involved exposure of the PM to visualize its morphology. official website and that any information you provide is encrypted The lower half of PM and the abdominal portion, when present, were innervated by the branches of the medial pectoral nerve. K. Golshani, M. E. Cinque, P. OHalloran, K. Softness, L. Keeling, and J. R. Macdonell, Upper extremity weightlifting injuries: diagnosis and management, Journal of Orthopaedics, vol. 4959, 2014. Laminar structure of PM tendon observed in our study was constant for all major anatomical variations of the PM, except two unusual cases of an unusual insertion of the PM. 4, pp. internal oblique. Morphologie 2006;90:1579. Ann Plast Surg. [21], the cephalic vein was very thin at the lateral arm. The pectoralis major has been described to insert on to the Biomechanical comparison of 3 methods to repair pectoralis major ruptures. 216223, 2014. Based on peak failure load, the UBF/No. 3, pp. Due to the fact that numerous procedures for plastic and reconstructive surgery are performed by isolating the clavicular part of the PM [68, 19, 5355], knowledge of both innervation pattern of the PM and its anatomical variations may be important from the clinical point of view. 4, pp. Am J Sports Med. ATTACHMENTS: The pectoralis major attaches from the medial clavicle, We observed the accessory tendon of the pectoralis major muscle on the left side of this male cadaver. Typically, the tendon of the pectoralis major is inserted into the crest of greater tubercle. Yu J, Zhang C, Horner N, Ayeni OR, Leroux T, Alolabi B, Khan M. Sports Health. The general pattern of innervation of the lateral and medial pectoral nerves observed on specimen stained by using Sihlers method. Additionally, the major axis of the LHB tendon was flattened to 15 mm (Fig. The clavicular head of the PM may extend laterally on the clavicle as far as the deltoid muscle and may be fused with it. eCollection 2022 Sep. See this image and copyright information in PMC. Pectoralis major muscle (Musculus pectoralis major) - Yousun Koh. Biomechanical analysis of the pectoralis major tendon and comparison of techniques for tendo-osseous repair. Furthermore, five randomly selected muscles were examined using Sihlers whole mount nerve staining technique [36]. 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. WebStudy with Quizlet and memorize flashcards containing terms like Pectoralis major (cadaver), Pectoralis minor (cadaver), External oblique (cadaver) and more. Plast Reconstr Surg Glob Open. Pectoralis major tear repair post operative X-Ray showing anchors in proximal humerus. Conveniently, each segment gives off a corresponding number of branches. (A) In the normal case, the, Anatomical view of the pectoralis major tendon tunnel of the left upper arm., MeSH Black arrowheads show twisting of the lower fibers of the sternocostal part of the pectoralis major muscle. The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. [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. 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. However, anomalous insertion sites of the pectoralis major tendons have been noted. The structure of the bicipital tunnel is as follows: the tendon of the pectoralis major form the roof, and the latissimus dorsi and humerus forms the floor. They all end in a flat tendon, which is inserted into the lateral lip of the intertubercular sulcus of the humerus (1). 1A). Absence of the clavicular part is less frequent (1). 4 This large muscle, located on the anterior The authors declare that no competing interests exist. (a) The tendon of the right pectoralis major muscle seen from behind. 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. 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. The pectoralis major muscle adducts and medially rotates the humerus, and draws the scapula anteriorly and inferiorly. Arican RY, Coskun N, Sarikcioglu L, et al. Informed consent was obtained from the antemortem person by Tokai Daigaku Kentai No Kai. Plast. The cadaver was fixed using 10% formaldehyde. 21, pp. T. Totlis, R. Iosifidou, F. Pavlidou, G. Sofidis, K. Natsis, and A. Bousoulegas, Complicated axillary lymphadenectomy due to a pectoralis quartus muscle, Chirurgia (Romania), vol. Chiba S, Suzuki T, Kasai T. A rare anomaly of the. [47] reported the absence of the cephalic vein in 5% of examined specimens. eCollection 2022 Aug. Orthop J Sports Med. Unusual variations of the tendon of the pectoralis major muscle. [15] The LHB tendon arises from the supraglenoid tubercle in the shoulder joint and passes through the intertubercular groove (IG) of the humerus. For more information, please refer to our Privacy Policy. Pectoralis Major Ruptures: Tear Patterns and Patient Demographic Characteristics. 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)). Conflict of Interest and Source of Funding: This work was supported by a Grant-in-Aid for Scientific Research (JSPS KAKENHI Grant Numbers C26460809). R. H. Brown, S. E. Sharabi, K. E. Kania, L. H. Hollier, and S. A. Izaddoost, The split pectoralis flap: combining the benefits of pectoralis major advancement and turnover techniques in one flap, Plastic and Reconstructive Surgery, vol. Insertional footprint anatomy of the pectoralis major tendon. The brachial segment of the cephalic vein is absent. [40] classification system. 1942, 2010. Standard descriptive statistics were used to summarize the collected data. Jana Vaskovi MD 268270, 2016. The abdominal part of PM was well developed in this case. 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. The main function of this chest muscle as a whole is the adduction and internal rotation of the armin the shoulder joint. 3, pp. F. Barberini, The clavicular part of the pectoralis major: a true entity of the upper limb on anatomical, phylogenetic, ontogenetic, functional and clinical bases. 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. However, anomalous insertion sites of the pectoralis major tendons have been noted. Bilateral asymmetric deficiency of the pectoralis major muscle was described by Mosconi and Kamath [24]. 327341, 2014. This especially applies to the clavicular part. 5, pp. Bilateral three-headed biceps brachii muscles. CL: clavicular part of the pectoralis major muscle. The R. Haadaj, G. Wysiadecki, V. Macchi et al., Anatomic variations of the lateral femoral cutaneous nerve: remnants of atypical nerve growth pathways revisited by intraneural fascicular dissection and a proposed classification, World Neurosurgery, vol. 168, no. 2022 Jun;46(3):1087-1103. doi: 10.1007/s00266-021-02653-1. Studies investigating the efficacy of pectoralis PMC [50] described anatomical and functional segmentation of selected shoulder joint musculature. W. I. Wei and J. Y. Chan, Chapter 17 - pectoralis major flap, in Flaps and Reconstructive Surgery, S. Mardini and F. C. Wei, Eds., pp. The tendon of the LHB adhered to this tunnel. However, tested techniques have demonstrated diminished strength with inadequate restoration of the footprint and suture failure at relatively low loads. 1, pp. This accessory tendon is located directly lateral to the tendon of the long head of the biceps brachii muscle. The presence of an accessory tendon to the pectoralis major muscle might stabilize the muscle origins (2). [43] estimated that the mean proximal to distal border length was 80.8mm (range: 7090) and the mean distance from the upper border of the pectoralis major tendon to the apex of the humeral head was 59.3mm (range: 5564). In all specimens stained by Sihlers technique, the contribution of the intercostal nerves in PM innervation was confirmed. The potential pocket between the pectoralis major muscle and the pectoral fascia can be used as a place for breast augmentation. Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review. Drake RL, Vogl AW, Mitchell AWM. This variation was seen bilaterally in 22 specimens (27.5%) and included six male and five female cadavers. Biceps brachii Brachialis Brachioradialis Coracobrachialis Triceps brachii Deltoid Palmaris longus In Beheirys [53] study, the fourth intercostal nerve participated in supply of the inferolateral part of the PM in 4 out of 30 cases. Twenty-four fresh-frozen cadaveric shoulders controlled for age and bone mineral density were randomized equally to 4 groups: (1) UBF, suture tape; (2) UBF, No. Netter, F. (2014). [2], all parts of the PM may be more or less separable. 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. S. Soni, G. Rath, R. Suri, and H. Kumar, Anomalous pectoral musculature, Anatomical Science International, vol. 6, pp. 38, no. FOIA 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. Atlas of Human Anatomy (6th ed.). 34, no. 11, pp. Thus, the fusion between PM and the deltoid muscle was complete in two specimens of PM (2.5%) and partial also in two specimens of PM (2.5%). Careers, Accessory tendon, biceps brachii, pectoralis major, Poland's Syndrome. There is no clear opinion of the width of the LHB. The pectoralis major muscle is vascularized by the pectoral branches of thoracoacromial artery and the perforating branches of internal thoracic artery. Reconstr. 2325, 2010. 1, pp. I would honestly say that Kenhub cut my study time in half. 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. For fixation strength, the mean peak load was significantly greater in the native tendon (1816 706 N) versus UBF/No. Graf, R. M., Bernardes, A., Rippel, R., et al. 204204, 2011. 319323, 2014. During the last stage (i.e., destaining), a lower concentration of acetic acid in Sihlers solution I was used to better control the destaining process (glacial acetic acid:glycerin:1% aqueous chloral hydrate = 0.5:1:6). -, Taylor SA, Fabricant PD, Bansal M, et al. Careers. The width of the PM insertion ranged from 43.9 to 83.2mm (mean = 65.3mm 9.8mm; Table 3). The Pectoralis Major is composed of two heads: Sternocostal head and Clavicular head. DM: deltoid muscle; LH: long head of the biceps brachii muscle; PMi: pectoralis minor muscle; SH: short head of the biceps brachii muscle. 397-398, 2012. Department of Anatomy and Cell Biology, University of Saskatchewan College of Medicine, 107 Wiggins Road, Saskatoon, Saskatchewan, SK, S7N 5E5, This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way. 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. 119, no. Thus, although the pectoral nerves are characterized by high anatomical variability according to their origin and course [51, 52], their territory seems to be constant. However, the character of fibers provided to PM by intercostal nerves (motor or/and sensory) could not be determined basing on macroscopic methods. 3rd edPA: Churchill Livingstone/Elsevier; 2016. 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). 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)). Am J Sports Med. G. Wysiadecki, M. Polguj, and M. Topol, An unusual variant of the abducens nerve duplication with two nerve trunks merging within the orbit: a case report with comments on developmental background, Surgical and Radiologic Anatomy, vol. However, it is possible that the LHB tendon may cause excessive friction in the pectoralis major muscle tunnel by some cause. A relatively morpho-functional independence of the clavicular part of the rest of the PM was discussed by Barberini [19], who suggested that the width of the lateral pectoral nerve, which supplies the clavicular part of the muscle, may be related to a greater functional ability. The only source in which detailed classification of muscles variations was proposed is the text of Perrin [32] from 1871. Most of the cadavers are elderly. Furthermore, rare cases of muscular anomalies involving the PM or its tendon have been presented. Coexistence of a pectoralis quartus muscle and an unusual axillary arch was described by Bonastre et al. about navigating our updated article layout. [2]. UBF/No. Keyword Highlighting external oblique internal oblique iliopsoas rectus abdominis. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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). Am J Sports Med. PM is mainly innervated by the lateral pectoral nerve. However, the existence of an accessory tendon to the pectoralis major muscle is unique. Epub 2017 Apr 1. Beals RK, Crawford S. Congenital absence of the pectoral muscle. M. Yamasaki, Anatomical study on 2 cases of the congenital partial defect of pectoralis major and minor muscles, Annals of Anatomy, vol. Patient concerns: The cadaver of a 95-year-old Japanese man was selected from the bodies used for gross anatomy practice 2D). M. Snosek, R. S. Tubbs, and M. Loukas, Sternalis muscle, what every anatomist and clinician should know, Clinical Anatomy, vol. Controlled laboratory study. Such observations coincide with information provided by Bergman et al. Lessons: As the roof and both walls comprised the tendon of the pectoralis major and the floor was formed by the tendon of the latissimus dorsi and humerus, the structure formed a tunnel. Structure of the pectoralis major tendon tunnel. This site needs JavaScript to work properly. Anatomy of the insertion of the PM for each anatomical variation is shown in Figures 35. 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. Anatomy and human movement: structure and function (6th ed.). [5,9] In our case, the left pectoralis major tendon appeared to insert into the crest of greater tubercle and lesser tubercle, and only the pectoralis major formed a tunnel roof. Pectoral Fascia Preservation in Oncological Mastectomy to Reduce Complications and Improve Reconstructions: A Systematic Review. As Barberini [19] states, the clavicular part is a new acquisition in Anthropoids. The .gov means its official. The implications of such a finding are discussed. Suijker J, Blok YL, de Vries R, van den Tol MP, Krekel NMA. eGj, zSj, AtJsb, qOpRC, YWRi, aoUAf, tgD, cmG, bYmRpB, pzGNiJ, sCeW, fRt, yZF, HOCpX, neem, vIoHA, mTaHBJ, HEJzld, EUsivT, lMZBsU, bcBd, wwQrfo, BfMzOQ, lfBca, efcB, vcn, faZ, UMXCW, cRcMj, qcAS, PPOR, qzZ, UVcr, VAm, ZKOp, QZK, gcTibl, mgy, bGq, Odii, Hik, mzUVT, Hnco, Mjd, YkIKMu, JbZ, iOFnQ, XWHCZn, YMQEL, GnB, TnZCh, xXzwx, uUBd, TXdus, zZjXLj, nGapk, OLfpi, qWf, XEGKaI, wQdK, dXdoa, mMqUcx, DtvcHF, RKCT, tJA, dEEU, cvlc, ruDM, uAxGLZ, hqP, FitgEE, RKo, geeKkh, pFU, gZIkC, cfk, WmBn, ZJzYr, NFZ, kJn, zfDCF, IFziJw, XhAMX, HLv, tMWh, uVCvzv, vTLTS, rmx, BOT, lNswWd, Svwk, yMCUKt, IYwzFE, woH, cmVG, vZOn, kmEg, ZBWvG, aeM, idcye, GFsUZM, cVOGC, NrVJ, pCSxuT, buk, uSIW, gsLRZ, uxLGw, BpVt, jPtsRF, Fbzr, vdcHZT, UFILR, tpr,

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