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Pectoral region.ppt
- 1. Introduction of upper limb & Pectoral region
- 3. Introduction to upper limb • Limbs are outgrowth of anterior part of body wall • Rotation occurs at 7th week
- 4. Introduction to upper limb • Divided into – Shoulder • Pectoral • Scapular • Axilla – Arm – Forearm – Hand
- 5. Arrangement of muscles • Arranged in 2 groups – Anterior compartment – Posterior compartment • A few muscles of posterior compartment occupy anterolateral side in forearm • No muscles in posterior compartment Hand
- 7. Pectoral region • Surface landmarks – Clavicle – Jugular notch – Sternal angle – Epigastric fossa – Midclavicular line – Infraclavicular fossa – Coracoid process – Acromion process – Nipple – Midaxillary line
- 8. Skin • Dermatome – Area of skin supplied by • An individual spinal nerve – In trunk dermatome arranged • Successive Horizontal strip – Unusual in pectoral region • In upper part of chest – Upto sternal angle • C3 & C4 – But below sternal angle • T2 • Why this overlap – Upper ;imb is developed from C5-T1
- 9. Superficial fascia • Subcutaneous • Contains – Fat – Mammary gland – Cutaneous nerves • Supraclavicular nerves (C3,4) • Anterior and lateral cutaneous branches of intercostal nerve T2 – T6 – Cutaneous vessels – Platysma
- 10. Skeletal frame work • Sternum • Clavicle • Ribs • Humerus • Scapula
- 11. Dermatome
- 12. Deep fascia • Pectoral • Clavipectoral
- 13. Pectoral fascia • Deep fascia of pectoral region • Covers pectoralis major • Attachment – Medially • Sternum – Superorlaterally • Deltoid fascia – Inferiorly • Merges with rectus sheath – Laterally • Axillary fascia
- 14. Muscles • Pectoralis major • Pectoralis minor • Subclavius • Serratus anterior
- 15. Pectoralis major • Largest muscle of pectoral region • Forms anterior axillary fold • Climbers muscle
- 16. Pectoralis major • Origin – 2 heads • Clavicular head – From medial ½ of the front of the clavicle. • Sternocostal head – Sternum – Upper 6 costal cartilages. • Aponeurosis of external oblique muscle • Insertion – Lateral lip of bicipital groove • Upper fibres in lower part • Lower fibres in upper part
- 17. Pectoralis major • Deltopectoral groove – Intermuscular groove – Upper part of Pectoralis major is near to Deltoid – A gap between • Deltoid & pectoralis major • Structures traversing – Cephalic vein – Deltoid branch of • Thoracoacromial artery – Deltopectoral lymph node • Drain lymph from – Superficial tissue of upper limb along cephalic vein (including thumb)
- 18. Pectoralis major • Nerve supply – Lateral pectoral • Pierces clavipectoral fascia – Medial pectoral nerve • Pierces pectoralis major muscle • Action – Medial rotation & adduction of arm
- 20. Pectoralis minor • Origin – 3rd, 4th & 5th ribs • Close to their costal cartilages • Insertion – Coracoid process • Nerve supply – Medial pectoral nerve • Action – Depression of shoulder • Draw the ribs upward and outwards during deep inspiration
- 21. Relations • Anteriorly – Pectoralis major – Interpectoral nodes • Posteriorly – Axillary artery (2nd part) – Axillary vein – Cords of brachial plexus • Lower border – Lateral thoracic vessels – Anterior group of axillary lymph nodes • Tail of breast
- 22. Subclavius • Origin – 1st rib • At its junction with 1st costal cartilage • Insertion – Subclavian groove • At middle 3rd of inferior surface of clavicle • Nerve supply – Nerve to subclavius • From upper trunk of brachial plexus • Action – Fixes the clavicle during movement of shoulder joint
- 23. Clavipectoral fascia • Deep fascia between the subclavius and pectoralis minor
- 24. Clavipectoral fascia • Location – In anterior wall of axilla • Deep to pectoralis major (clavicular part) • Vertical extent – Above • Clavicle – Below • Axillary fascia • Suspensory ligament of axilla – Clavipectoral fascia • Below pectoralis minor • Maintains concavity of axilla • Encloses – 2 muscles • Subclavius • Pectoralis minor
- 26. Horizontal extent • Medial – Costoclavicular ligament – First 2 external intercostal membrane • Lateral – Coracoid process – Coracoclavicular ligament • Costocoracoid ligament – Upper thickened part – Extend • First costochondral junction • Coracoid process
- 27. Structures piercing • Lateral pectoral nerve – From lateral cord • Thoraco- acromial artery – Branch from 2nd part of axillary • Cephalic vein – Into axillary vein • Few lymph vessels – From • Breast to apical group of axillary lymph node
- 29. Serratus anterior • Origin – Upper eight ribs • Insertion – Medial border and inferior angle of scapula • Anterior aspect • Nerve supply – Long thoracic nerve • Action – Draws the scapula forward (protrusion, in boxing) 8 6 4 2
- 30. Long thoracic nerve • Otherwise – Nerve of Bell • Arises from – Roots of brachial plexus • Root value – C5, C6 & C7 • Protected by – Deep fascia – Not injured during surgery at axilla
- 31. Winging of scapula • Paralysis of serratus anterior • Medial margin of scapula becomes prominent • Why – Protraction of scapula is by serratus anterior • In the absence of action of serratus • Rhomboideus retract • So medial margin prominent
- 32. Mammary gland • Parts • Architecture • Relations • Blood supply • Lymphatic drainage
- 33. Mammary gland - Extent • Vertical • 2nd to 6th rib in midclavicular plane • Horizontal • Lateral border of sternum to mid axillary plane - 4th rib • Axillary tail of Spence • Projection from upper outer quadrant
- 34. Mammary gland - Parts • Nipple -Erectile projection -15 – 20 Lactiferous ducts open - 4th intercostal space • Areola - pigmented circular area -Contains modified sebaceous glands
- 35. Mammary gland - Architecture • Glandular -Modified sweat gland -15 – 20 pyramidal lobes - lactiferous ducts • Fibrofatty tissue -Fibrous tissue forms septa – ligament of Cooper * Fatty tissue gives shape
- 36. Mammary gland - Relations • Mammary bed • Medial 2/3rd – pectoralis major • Lateral 1/3rd – serratus anterior • Inferomedial - external oblique • Retro mammary spaceRetromammary Space
- 37. Mammary gland – Blood supply • Arteries • Perforating branches – internal thoracic • Lateral thoracic – axillary • Intercostal arteries • Veins • Corresponding to arteries
- 38. Mammary gland – Lymphatic drainage • Parenchyma (including nipple & areola) • Skin
- 40. Nerve supply • 4th, 5th and 6th intercostal nerves
- 41. • Peau d’ orange – obsruction in superficial lymphatics leads to appearance of orange peel
- 42. Supernumerary breast - polythelia
- 43. Age changes • Appearance of milk ridge – 7th week of IUL • Nipple appears just before birth • Lactiferous ducts without alveoli –till puberty • Deposition of fibrofatty tissue – puberty • Proliferation of parenchyma –pregnancy • Alveoli shrink – after lactation • Atrophy of skin & fibrous tissue – old age