Different variations of the PM represent all six classes of anatomical variability of muscles described by Perrin [32]. We removed the fat and skin around the chest and both shoulder joints for observational purposes and carefully examined the structures. Bonastre V, Rodrguez-Niedenfhr M, Choi D, Saudo JR. Clin Anat. Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 506509, 1997. 5 suture, suture tape; (3) bone trough with No. Carey P, Owens BD. In their study, attention was paid to the fact that deltopectoral triangle may exhibit high variability. to maintaining your privacy and will not share your personal information without The potential pocket between the pectoralis major muscle and the pectoral fascia can be used as a place for breast augmentation. Perforating branches of vessels and nerves emerging from the pectoral fascia are located mainly at the medial lateral and lower fascias. Bookshelf Plast. FOIA White et al., US and MR imaging of pectoralis major injuries, RadioGraphics, vol. modify the keyword list to augment your search. PMC Absence of the clavicular part is less frequent (1). In this article, we will discuss the anatomy and function of the pectoralis major muscle. The .gov means its official. 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). The .gov means its official. The specimens were tested under cycling loads (10 N to 125 N) with a final load-to-failure test at 1 mm/s. F. Bussu, R. Gallus, V. Navach et al., Contemporary role of pectoralis major regional flaps in head and neck surgery, Acta Otorinorhinolaryngologica Italica, vol. Careers. Wickham et al. 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. WebThis case report describes additional bilateral variants found in an elderly male cadaver that included a conjoined tendon of the pectoralis major and quartus that passed superiorly through the intubercular groove to insert to the blended fascia of the superolateral glenohumeral joint capsule. 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. Also the knowledge of the entry points and course of the neurovascular pedicles may be crucial for the surgery of the PM. 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. A. Romeo, Injuries to the pectoralis major muscle: diagnosis and management, The American Journal of Sports Medicine, vol. PMC WebSix recently frozen cadaveric shoulder specimens from two women and one man were thawed to room temperature for 24 hr, then imaged using a 1.5-T MR magnet (General Electric Medical Systems, Milwaukee, WI). Due to the different courses of the muscle fibers, the insertion has a recess which is open to the top preventing the muscle from overstretching. The triangular depression between the pectoralis major muscle, deltoid muscle and clavicle is called infraclavicular fossa (Mohrenheims fossa). In the case reported by Hong et al. M. M. Chiavaras, J. Gray's Anatomy for Students. Ann Plast Surg. Read more. It inserts onto the greater tubercle of the humerus in the form of a single tendon. 21, pp. 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. 397-398, 2012. [28]. WebStudy with Quizlet and memorize flashcards containing terms like Pectoralis major (cadaver), Pectoralis minor (cadaver), External oblique (cadaver) and more. 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. His report suggested that the pectoralis major insertion was at the crest of greater tubercle, and the tendon of the pectoralis major runs beyond and behind the LHB. 5, pp. 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. 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%). 90, no. The detailed intramuscular distribution of certain nerve sub-branches was visualized by Sihlers stain. Pathological changes in the long head of the biceps tendon concurrent with a rotator cuff tear. Disclaimer, National Library of Medicine 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. 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. Anatomy of the tendon of the pectoralis major muscle fused with the deltoid muscle. The highlighted muscle originates from which bone? 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. However, on the left side, the width was about 15 mm, nearly double the width on the right. 2015 Oct;42(4):565-84. doi: 10.1016/j.cps.2015.06.016. 01, pp. On the right side, the entire pectoralis major muscle was absent and the pectoralis minor, deltoid, and coracobrachialis muscles were infiltrated with connective tissue and fat [24]. Lessons: This study is important for orthopedic and rehabilitation 8600 Rockville Pike Such observations coincide with information provided by Bergman et al. The structure of the floor was the IG of the humerus and latissimus dorsi. 6, pp. 2, pp. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. There is no clear opinion of the width of the LHB. Material and Methods. Case Report. Should this pattern be present in females, it would be of clinical importance in cases of breast or transplant surgeries. 26, no. The main anatomical variations related to morphology of the pectoralis major muscle. Morphometric characteristics of the anatomical variations of the clavicular part of PM are presented in Table 2. However, the existence of an accessory tendon to the pectoralis major muscle is unique. The pectoralis major has been described to insert on to the The cases of additional origins, supernumerary tendons, or unusual insertions of PM were reported in anatomical literature. 319323, 2014. As part of management, the condition of the tendon of the pectoralis major should be confirmed using magnetic resonance imaging or echocardiography. [10]. The Chi-square test was applied to assess differences in the prevalence of anatomical variations between the sexes. All three parts converge laterally and insert onto the greater tubercle of humerus. Co-existence of the pectoralis quartus and pectoralis intermedius muscles. The information we provide is grounded on academic literature and peer-reviewed research. 209214, 2012. The purpose of this report is to discuss an anomaly observed in the insertion of the tendon of the pectoralis major at the shoulder joint and to present the degenerative changes seen in the LHB. Biomechanical analysis of the pectoralis major tendon and comparison of techniques for tendo-osseous repair. The Pectoralis Major is composed of two heads: Sternocostal head and Clavicular head. In this case small sub-branches of the lateral pectoral nerve joined the clavicular portion of the deltoid muscle (Figure 8). An official website of the United States government. The thicknesses of the pectoral fascias were measured. 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. 4, pp. 2020 Dec 3;8(12):2325967120969424. doi: 10.1177/2325967120969424. Armendares S. Letter: Absence of pectoralis major muscle in two sisters associated with leukemia in one of them. and grab your free ultimate anatomy study guide! 21492153, 2012. The data used to support the findings of this study are available from the corresponding author upon request. Hangzhou, China: Zhejiang Science and Technology Press, 1999. The https:// ensures that you are connecting to the Augmentation mammaplasty using the retrofascia approach. WebThe lateral border of pectoralis major muscle forms the anterior axillary fold. The pectoralis major muscle is vascularized by the pectoral branches of thoracoacromial artery and the perforating branches of internal thoracic artery. Moreover, the pectoralis major tendon combined with the latissimus dorsi tendon at the medial side of the lesser tubercle. Chiba S, Suzuki T, Kasai T. A rare anomaly of the. Surg. Disclaimer, National Library of Medicine 227, no. 3, pp. Before Gross dissection was performed using standard technique. 268270, 2016. 101: 1086, 1998. Quinlan et al. doi: 10.1016/j.eats.2020.02.023. Mini-open Subpectoral Biceps Tenodesis Using All-Suture Anchor. 1, pp. 2009 Jun;21(2):126-40. doi: 10.1007/s00064-009-1701-z. The pectoralis major muscle occupies a large area on the anterior chest wall and its function consists basically of providing adduction and medial rotation of the 8, pp. 118, pp. 67, no. (a) The tendon of the left pectoralis major muscle seen from behind. PM is mainly innervated by the lateral pectoral nerve. Epub 2012 Jun 7. 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. In these cases, a distinct cleft occurred between the clavicular and sternocostal portion of PM. Insertional footprint anatomy of the, [3]. Gray's Anatomy for Students. However some patients present many months after the injury. 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. (b) Schematic representation of the extended territory of the lateral pectoral nerve. Taylor SA, Fabricant PD, Bansal M, et al. The .gov means its official. 176189, 2017. At the lateral side of the LHB, the pectoralis major tendon was inserted into the crest of the greater tubercle of the humerus. C. D. Smith, S. J. Booker, H. S. Uppal, J. Kitson, and T. D. Bunker, Anatomy of the terminal branch of the posterior circumflex humeral artery: relevance to the deltopectoral approach to the shoulder, The Bone & Joint Journal, vol. Careers. This variation was seen bilaterally in 22 specimens (27.5%) and included six male and five female cadavers. S. Standring, Ed., Grays Anatomy: The Anatomical Basis of Clinical Practice, Churchill Livingstone/Elsevier, Edinburgh, Scotland, 40th edition, 2008. This is particularly important during forced breathing in physical distress. 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. Fung et al. R. A. Bergman, A. K. Afifi, and R. Miyauchi, Illustrated encyclopedia of human anatomic variation: Opus I: muscular system: alphabetical listing of muscles, 2015, https://www.anatomyatlases.org/AnatomicVariants/MuscularSystem/Text/P/08Pectoralis.shtml. Typically, the tendon of the pectoralis major is inserted into the crest of greater tubercle. Coracobrachialis muscle. Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. They give off a broad tendon that inserts along the crest of the greater tubercle of humerus. 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. 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. M. Loukas, G. South, R. G. Louis Jr., Q. All rights reserved. Investigation: Shuji Katsuki, Ryuta Tanaka, Kanae Umemoto. Pectoralis Major Tendon Insertion Anatomy and Description of a Novel Anatomic Reference. official website and that any information you provide is encrypted However, to avoid altering of nerves staining and visualization, the study on distribution of arteries should be performed separately. J Surg Orthop Adv. 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. 21, no. Unable to load your collection due to an error, Unable to load your delegates due to an error. 119, no. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/. Debeer P, Brys P, De Smet L, Fryns JP. The accessory tendon arises from the lateral aspect of the pectoralis major muscle. The https:// ensures that you are connecting to the Can the pectoral fascia integrity be preserved during subfascial breast augmentation through the axillary approach? MeSH However, some authors reported lack of selected pectoral nerves related to defects of the PM. 463468, 2016. [26]. The presence of the sternalis muscle is observed in 3% to 5% of individuals according to Bergman et al. 157164, 2015. Porzionato A, Macchi V, Stecco C, Loukas M, Tubbs RS, De Caro R. Clin Anat. 8600 Rockville Pike (b) The tendon of the pectoralis major muscle seen from behind. 2 suture; and (4) native PM tendon group; all groups were tested to failure. 1, pp. Data curation: Hayato Nomura, Kaori Suyama. Anatomical variations of the PM may coexist with variations in the course of the cephalic vein [48]. Pectoralis Major is well described as a two-head muscle, according to its clavicular and sternocostal heads [ 13 ]. 183186, 1991. They also found that the mean distance from the apex of the upper edge of the PM tendon to the superomedial edge of the greater tubercle of the humerus was 42mm. [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. 625629, 2016. Y. K. Lee, M. R. Skalski, E. A. 2nd Ed2013;Japan: Daihokaku, ISBN 978-4-9980686-2-4. These 3 metallic anchors will hold the tendon firmly against bone. Surg. 44, no. The sternal and costal heads may be absent or the whole muscle may be absent in rare cases. L. Mu and I. Sanders, Sihler's whole mount nerve staining technique: a review, Biotechnic & Histochemistry, vol. Test your knowledge on the main muscles of the thorax with our quiz in multiple difficulty levels! 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. Read more. Moreover, anatomical variations (especially those related to attachments or unusual muscle morphology) may affect significantly the course of surgical procedures [13, 17]. The authors report no conflicts of interest. Morphometric characteristics of the anatomical variations of the clavicular part of the pectoralis major muscle (PM). It provides additional stabilization of the upper limb to the thorax thus permitting increased limb mobility [19]. [Surgical treatment of chronic pectoralis major rupture]. Disclaimer, National Library of Medicine 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. SK and HT contributed equally to this work. FOIA P. Carey and B. D. Owens, Insertional footprint anatomy of the pectoralis major tendon, Orthopedics, vol. J. G. Davimes, N. Bacci, and P. Mazengenya, Evidence of the sternalis muscle in two South African cadavers, Surgical and Radiologic Anatomy, vol. 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)). Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. and transmitted securely. In these cases, a distinct cleft is visible between the clavicular (CL) and sternocostal portion (STC) of the pectoralis major muscle. Register now Unable to load your collection due to an error, Unable to load your delegates due to an error. 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). 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%). 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. However, small deviations of pectoral nerves in the territory of the deltoid muscle were reported. H. Song, J. Kim, and S. P. Yoon, Coexistence of a pectoralis quartus muscle, a supernumerary head of biceps brachii muscle and an accessory head of flexor digitorum profundus muscle, Folia Morphologica, vol. 233420.19, 1871. Clin Anat 2009;22:5008. Kawakami K, Isogai K. Anatomy and Surface Anatomy of Muscles. 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). 8, no. 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). In another study, Kawakami et al[9] reported that only the tendon of the pectoralis major formed the tunnel. 465479, 2015. The axillary arch took origin from this band (Figure 6(a)). 2, pp. [11]. We believe that the variation reported in this region is important both functionally and clinically. In this case, the brachial segment of the cephalic vein was absent bilaterally. 111: 904, 2003. 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. 2022 Jul;38(7):2321-2330. doi: 10.1016/j.arthro.2022.01.012. 14741477, 2017. 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. According to Bergmann et al. Kim Bengochea, Regis University, Denver. Medicine. Conceptualization: Shuji Katsuki, Hayato Terayama, Ryuta Tanaka. official website and that any information you provide is encrypted At this stage, the observed anatomical variations of the PM were evaluated. Outcomes: 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. 2012 Jul;25(5):559-75. doi: 10.1002/ca.21301. 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. 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). The abdominal part of PM was well developed in this case. Federal government websites often end in .gov or .mil. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Most frequently, the PM originated from the 2nd to 6th costal cartilages. Pierach CA. Copyright Background. [43] the tendon of the PM presents a single laminar insertion in the humerus. Pectoralis Major Ruptures: Tear Patterns and Patient Demographic Characteristics. The pectoralis major muscle in humans is a large fan shaped muscle situated at the anterior upper part of the chest. 243246, 2015. Furthermore, five randomly selected muscles were examined using Sihlers whole mount nerve staining technique [36]. The .gov means its official. Variation of insertion of the pectoralis major in a cadaveric study de Figueiredo EA, Terra BB, Cohen C, et al. 27, no. 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. 519523, 2013. In females, it is covered by the breast. 2427, 2018. The anatomical relationship between the pectoralis major and the LHB was specifically observed. Variable anatomical relations between PM and cephalic vein may be important during surgical procedures. R. Y. Arican, N. Coskun, L. Sarikcioglu, M. Sindel, and N. Oguz, Co-existence of the pectoralis quartus and pectoralis intermedius muscles, Morphologie, vol. Three-dimensional study of pectoralis major muscle and tendon architecture. Background: 8600 Rockville Pike Pectoral Fascia Preservation in Oncological Mastectomy to Reduce Complications and Improve Reconstructions: A Systematic Review. (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. These authors found that the mean length of the PM insertion was 72mm. Biceps brachii. eCollection 2020 Dec. Arthrosc Tech. 2017 Apr;45(2):112-115. doi: 10.5152/TJAR.2017.43815. This site needs JavaScript to work properly. 216223, 2014. The study of Fung et al. Occasionally, parts of the pectoralis major muscle may be absent. Plast. Munhoz AM, de Azevedo Marques Neto A, Maximiliano J. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. 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]. 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). Aesthetic Plast Surg. Project administration: Kou Sakabe, Hayato Terayama. Wringer, E., Mader, N., Posch, E., et al. 40, no. 327341, 2014. Frontal view of the left shoulder showing the anatomy of the accessory tendon. DM: deltoid muscle; LH: long head of the biceps brachii muscle; PMi: pectoralis minor muscle; SH: short head of the biceps brachii muscle. [27] demonstrated a case of anomalous accessory muscle confluent with the normal sternal head of PM. 310313, 2008. 25, no. In males, it is covered by the deep layer of fascia, subcutaneous tissue and the adjacent skin. biomechanics; cortical buttons; fixation method; pectoralis major repair; shoulder; suture tape. 290, pp. The authors declare that no competing interests exist. Drake RL, Vogl AW, Mitchell AWM. Gray's Anatomy (41tst ed.). The biceps tendon. 2022 Jun;46(3):1087-1103. doi: 10.1007/s00266-021-02653-1. This stage allowed observing possible differences in PM innervation depending on its anatomical variations. 2A). 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. Epub 2018 Dec 13. This case report complies with the research guidelines of the Japanese Association of Anatomists. Epub 2021 Nov 30. Thus, the territory of innervation of the lateral pectoral nerve was extended in this case. F. Gadea, Y. Bouju, J. Berhouet, G. Bacle, and L. Favard, Deltopectoral approach for shoulder arthroplasty: anatomic basis, International Orthopaedics, vol. 5, pp. (c) Anterior view to the tendon of the PM. 83, no. 226228, 2002. Reconstr. Qualitative and Quantitative Anatomy of the Humeral Attachment of the Pectoralis Major Muscle and Structures at Risk: A Cadaveric Study. The general pattern of innervation of the lateral and medial pectoral nerves observed on specimen stained by using Sihlers method. The implications of such a finding are discussed. However, it is possible that the LHB tendon may cause excessive friction in the pectoralis major muscle tunnel by some cause. The, [4]. Fung L, Wong B, Ravichandiran K, et al. Samuel E. Congenital absence of the pectoralis major. Clinical relevance: Wolters Kluwer Health The presented study attempts to classify individual anatomical variants of PM, including rare and unusual findings. 2013 Jun;41(6):1395-9. doi: 10.1177/0363546513482297. 37, no. J. F. Quinlan, M. Molloy, and B. J. Hurson, Pectoralis major tendon ruptures: when to operate, British Journal of Sports Medicine, vol. 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 clavicular part of the PM may also extend laterally on the clavicle as far as the deltoid muscle. 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. ACTIONS: Adducts the arm at the glenohumeral joint (entire muscle) 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. MeSH external oblique internal oblique iliopsoas rectus abdominis. In both cases described by Yamasaki [31], the PM was defected, with the clavicular portion and a small part of sternocostal portion only persisting. 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. The muscle is supplied by the pectoral branch of the thoracoacromial trunk artery, and by branches of the lateral thoracic artery. Morphometric characteristics of entry points of the neurovascular pedicles within the pectoralis major muscle (PM) regarding the inferior border of the clavicle. 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. 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. Writing review & editing: Hayato Terayama, Ning Qu, Shuang-Qin Yi, Kou Sakabe. 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. In turn, in the case of fusion between the pectoralis major and the deltoid muscles described by Natsis et al. Epub 2022 Jan 20. Only the lateral pectoral nerve existed in the second case [31]. The general pattern of innervation of the lateral and medial pectoral nerves was observed to be constant. [42] pay attention to an unusual humeral insertion of the PM in that the clavicular and upper sternal fibers attach distally on the humerus, while the lower sternal and abdominal fibers cross above the former and insert uppermost on the shaft of the humerus. 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. and transmitted securely. Conflict of Interest and Source of Funding: This work was supported by a Grant-in-Aid for Scientific Research (JSPS KAKENHI Grant Numbers C26460809). 2, pp. As part of management, the condition of the tendon of the pectoralis major should be confirmed using magnetic resonance imaging or echocardiography. Bethesda, MD 20894, Web Policies [15] The LHB tendon arises from the supraglenoid tubercle in the shoulder joint and passes through the intertubercular groove (IG) of the humerus. Barbato, C., Pena, M., Triana, C., et al. The right pectoralis major was inserted into the crest of greater tubercle only and was normal. In those cases, the PM and the deltoid muscle may be fused to varying degrees [2]. 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. This study is important for orthopedic and rehabilitation physicians in treating diseases of the long head of the biceps brachii tendon. This website uses cookies. 10, pp. 133-134, 2014. ; 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. Copyright 2019 Robert Haadaj et al. Epub 2009 Dec 1. 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. F. Barberini, The clavicular part of the pectoralis major: a true entity of the upper limb on anatomical, phylogenetic, ontogenetic, functional and clinical bases. 5 suture/suture tape construct. Burkhead et al[10] reported that the width of the normal LHB intra-articularly was 6 to 7 mm. The clavicular portion of PM was attached to the anterior lamina of PM insertion in all cases. No abnormality was observed in the nerve and blood supply either to the pectoralis major muscle or to the accessory tendon. The clavicular head acts to flex the humerus, and the sternocostal head extends it from flexed position. The anatomy and histology of the bicipital tunnel of the shoulder. M. Loukas, C. S. Myers, C. T. Wartmann et al., The clinical anatomy of the cephalic vein in the deltopectoral triangle, Folia Morphologica, vol. Injury to the Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Edinburgh: Elsevier Churchill Livingstone. Controlled laboratory study. Beals RK, Crawford S. Congenital absence of the pectoral muscle. Coexistence of a pectoralis quartus muscle and an unusual axillary arch: case report and review. 36, no. 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]. Yoshikawa G, Hori K, Hiraoka S, et al. 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. Abstract Rationale: Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. The latissimus dorsi muscle arises from the spinous process and iliac crest and inserts as one tendon into the crest of lesser tubercle. 5, pp. The anatomy and histology of the bicipital tunnel of the shoulder. Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review. 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. Oper Orthop Traumatol. 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]. Anatomy of the insertion of the PM for each anatomical variation is shown in Figures 35. 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%). Philadelphia, PA: Saunders. Several anatomical variations related to PM morphology were observed in the examined specimens (Figure 1). 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). sharing sensitive information, make sure youre on a federal You may search for similar articles that contain these same keywords or you may Karabeg R, Jakirlic M, Karabeg A, Crnogorac D, Aslani I. Med Arch. Would you like email updates of new search results? Roberto Grujii MD 504507, 1987. ATTACHMENTS: The pectoralis major attaches from the medial clavicle, 16, no. 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. E. M. Corten, P. P. Schellekens, R. L. Bleys, and M. Kon, The nerve supply to the clavicular part of the pectoralis major muscle: an anatomical study and clinical application of the function-preserving pectoralis major island flap, Plastic and Reconstructive Surgery, vol. 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. With regard to tendon footprint reapproximation, cortical button fixation best approximated native tendon footprint length versus bone trough. sharing sensitive information, make sure youre on a federal This accessory tendon is located directly lateral to the tendon of the long head of the biceps brachii muscle. The morphology of PM on the contralateral side of this male cadaver was typical. 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. Which muscle is highlighted? The width of the attachment of the sternocostal portion of PM ranged from 133mm to 215mm (mean = 172mm 22mm; Table 3). V. Macchi, C. Tiengo, A. Porzionato et al., Medial and lateral pectoral nerves: course and branches, Clinical Anatomy, vol. 42: 515, 1968. Surgeons should be aware of anatomic variations of the PM both in planning and in conducting surgeries of the pectoral region. Dempsey, W. C., and Latham, W. D. Subpectoral implants in augmentation mammaplasty. 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. The site is secure. 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. Pectoralis major tear repair post operative X-Ray showing anchors in proximal humerus. The literature documents numerous variations associated with the pectorlis major muscle. 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. doi: 10.1097/GOX.0000000000002700. 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)). 139, no. 1, pp. The initial phase of Sihlers Stain (i.e., maceration and depigmentation) was extended to over 5 weeks due to the large mass of PM. 3, pp. Therefore, it appeared to have sustained degenerative damage. Anatomy of the tendon of the typical pectoralis major muscle. Therefore, to the best of our knowledge, our case potentially describes the structure of a new pectoralis major tendon tunnel. 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. eDepartment of Frontier Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Tokyo, Japan. G. Wysiadecki, M. Polguj, K. Krasucki et al., Morphology and a proposed model of innervation of the human deltoid muscle: a pilot study, Folia Morphologica, vol. 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. Because no residual tendon stump was present, the [40] classification system. 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. Loukas et al. The deltoid muscle has been reflected. Wei, W. Plastic Surgery. We removed the fat and skin around the shoulder joint and upper extremity for observational purposes and carefully examined the structures during gross anatomy. doi: 10.1097/PRS.0b013e31819055b5. In general, the pectoralis major muscle originates from the medial end of the [41] suggest that the sternalis muscle may be misinterpreted as a pathological mass or lesion; thus clinicians should be aware of this variation during diagnostic procedures. As Barberini [19] states, the clavicular part is a new acquisition in Anthropoids. Bethesda, MD 20894, Web Policies Our study, supplemented by using Sihlers stain technique, is in accordance with previous reports on the segmented innervation pattern of the pectoral nerves [19]. Therefore, in our case, the roof and both walls were formed by the tendon of the pectoralis major, and the floor was formed by the tendon of the latissimus dorsi and humerus (Fig. Introduction. The presence of an accessory tendon to the pectoralis major muscle might stabilize the muscle origins (2). Search for Similar Articles A complete fusion between the left pectoralis major and the deltoid muscles, with absence of deltopectoral groove and the infraclavicular fossa, was described by Natsis et al. Recently, the subfascial plane for breast augmentation was reported by some authors who achieved satisfactory results. Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. Your message has been successfully sent to your colleague. 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. Particular attention has been paid to the variability of attachments and the variability in the shape of the clavicular portion of this muscle. UBF/No. 5, pp. These tears are common in Mixed Martial Arts athletes and in weightlifters. 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). 157162, 2007. Although most of the variations mentioned above are associated with the surface anatomy of the bellies of the pectoralis muscle, the presence of an accessory tendon in the pectoralis muscle has never been described. [2,3] However, there are few reports on the anomalous insertion of the pectoralis major tendon. We observed the accessory tendon of the pectoralis major muscle on the left side of this male cadaver. The incidence of different types of anatomical variations of the pectoralis major muscle is presented in Table 1. Lafrance R, Madsen W, Yaseen Z, Giordano B, Maloney M, Voloshin I. 4, pp. According to Figueiredo et al. 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 pectoral fascia may provide the breast implant with more soft-tissue coverage. A. Jacobson, J. Smith, and D. L. Dahm, Pectoralis major tears: anatomy, classification, and diagnosis with ultrasound and MR imaging, Skeletal Radiology, vol. 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. Branches of the intercostal nerves distributed within pectoralis major muscle were marked by black arrowheads. In 21.25% of specimens, the PM originated from the 1st to 6th costal cartilages (17 of 80 specimens; in 4 male and 3 female cadavers bilaterally, in 2 male cadavers and 1 female cadaver unilaterally). The clavicular portion of the PM is usually separated from the sternocostal portion of the PM by a slight cleft. The clavicular head of the PM and the superior part of the sternal head of the muscle are innervated by the lateral pectoral nerve. 458463, 2017. In contrast, the lateral pectoral nerve is involved in the innervation of the clavicular portion and the upper segments of the sternocostal portion. Accessibility 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. internal oblique. Three-dimensional study of. Pectoralis major (PM) ruptures are increasingly common, and a variety of surgical techniques have been described. I would honestly say that Kenhub cut my study time in half. The width of the PM insertion ranged from 43.9 to 83.2mm (mean = 65.3mm 9.8mm; Table 3). This especially applies to the clavicular part. 3, pp. Study design: J Shoulder Elbow Surg 2015;24:5119. Figueiredo et al. The procedure involved exposure of the PM to visualize its morphology. 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. and transmitted securely. Pectoralis major. 265, pp. All these parts may be more or less separable [2]. 1, pp. Arthrosc Tech. 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). 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. Federal government websites often end in .gov or .mil. The results of our measurements of the PM insertion are similar to the results cited above. WebStudy with Quizlet and memorize flashcards containing terms like Pectoralis major (cadaver), Pectoralis minor (cadaver), External oblique (cadaver) and more. Writing original draft: Shuji Katsuki, Hayato Terayama. FOIA During routine dissection of upper limb for MBBS students, an unusual attachment of pectoralis minor was observed in a 78-year-old male cadaver on its right side. 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. -, Fung L, Wong B, Ravichandiran K, et al. This finding is of clinical importance in transplant surgery, giving additional options for insertion of tendons in the shoulder joint area. The sternalis muscle occupies position between the superficial fascia and the pectoral fascia [40]. L. Fung, B. Wong, K. Ravichandiran, A. Agur, T. Rindlisbacher, and A. Elmaraghy, Three-dimensional study of pectoralis major muscle and tendon architecture, Clinical Anatomy, vol. Arthroscopy. [40]. For instance, complicated axillary lymphadenectomy due to a pectoralis quartus muscle was described by Totlis et al. The most frequent variation was a separate clavicular portion of PM. Suijker J, Blok YL, de Vries R, van den Tol MP, Krekel NMA. Indian J Plast Surg. Epub 2013 Apr 5. The tendon of the LHB adhered to this tunnel. A. Deigni, and B. P. Bengtson, The laminated nature of the pectoralis major muscle and the redefinition of the inframammary fold: clinical implications in aesthetic and reconstructive breast surgery, Clinics in Plastic Surgery, vol. The pectoral fascias can be dissected bluntly along a subfascial plane with the pectoral fascia intact. Moreover, research on the innervation of selected muscles suggests that axons migrating during development into effector organs show a well-defined specificity [37]. 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. Smaller Gap Formation With Suture Anchor Fixation Than Traditional Transpatellar Sutures in Patella and Quadriceps Tendon Rupture: A Systematic Review. The most frequently observed variation was a separate clavicular portion of the PM. Additionally, the major axis of the LHB tendon was flattened to 15 mm (Fig. 2020 Jun 3;9(7):e877-e881. (a) An atypical tendinous band (marked by white arrowheads) connecting tendon of the pectoralis major muscle (PMj) with the coracoid process of the scapula. Yu J, Zhang C, Horner N, Ayeni OR, Leroux T, Alolabi B, Khan M. Sports Health. Published by Wolters Kluwer Health, Inc. Plast Reconstr Surg Glob Open. Biceps brachii Brachialis Brachioradialis Coracobrachialis Triceps brachii Deltoid Palmaris longus Because the arteries were not injected by the resin, we were not able to trace detailed distribution of arterial branches within the PM. 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. -, Taylor SA, Fabricant PD, Bansal M, et al. 48, no. 5 suture/suture tape (794 168 N), UBF/suture tape (502 201 N), and bone trough (492 151 N) ( P < .001 for all). Mosconi T, Kamath S. Bilateral asymmetric deficiency of the pectoralis major muscle. Epub 2017 Apr 1. An official website of the United States government. GT=greater tubercle, IG=intertubercular groove, LD=latissimus dorsi, LHB=long head of biceps brachii, LT=lesser tubercle, PM=pectoralis major. Samilson R L. Congenital and developmental anomalies of the shoulder girdle. The distance was also measured between the top of greater tubercle of the humerus and the upper border of PM tendon. However, anomalous insertion sites of the pectoralis major tendons have been noted. The cadavers were imaged in the supine position, with the shoulder in the anatomically neutral position. We removed the fat and skin around the shoulder joint and upper extremity for observational purposes and carefully examined the structures during gross anatomy. WebContext:: Pectoralis major tendon ruptures are becoming increasingly common due to the growing prevalence of active lifestyles. Structure of the pectoralis major tendon tunnel. 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. Conclusion: 2005 Dec;55(6):576-9. doi: 10.1097/01.sap.0000185328.69785.d7. 4, pp. The sternocostal portion of the muscle can produce the antagonistic movement and extend the humerus back to the anatomical position. WebSubcoracoid transfer of the pectoralis major has recently been described as a reconstruction for subscapularis insufficiency. eCollection 2020 Apr. 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. 1, pp. The null hypothesis was that there would be no mechanical difference between repair techniques and no difference in the amount of footprint restoration. 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. J. WebThe pectoralis major muscle is subject to various morphologies. Anatomical variations related to the pectoralis major muscle. [47] reported the absence of the cephalic vein in 5% of examined specimens. Feeling overwhelmed by so many muscle attachments? The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. The region was carefully dissected, clavicular part of deltoid and pectoralis major muscles were removed near their origin to expose pectoralis minor muscle. T. Mosconi and S. Kamath, Bilateral asymmetric deficiency of the pectoralis major muscle, Clinical Anatomy, vol. THERE WILL BE BLOOD) Pectoralis Major Tendon tears are usually treated within a few days after the initial injury. The presented study attempts to classify individual anatomical variants of the pectoralis major muscle (PM), including rare and unusual findings. 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. 346349, 2003. 5 suture/suture tape construct demonstrated 61% greater construct strength than a traditional bone trough technique. The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. 73, no. National Library of Medicine S. Soni, G. Rath, R. Suri, and H. Kumar, Anomalous pectoral musculature, Anatomical Science International, vol. This case utilized the cadaver of a 95-year-old Japanese man (number: 2026, cause of death: hepatic cancer) that was selected from the bodies used for gross anatomy practice at the Tokai University School of Medicine in 2018. 4959, 2014. 2, pp. The only source in which detailed classification of muscles variations was proposed is the text of Perrin [32] from 1871. Background: [23], who observed additional head of PM which fused with the fibers of the serratus anterior muscle. 3, pp. 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. M. T. Provencher, K. Handfield, N. T. Boniquit, S. N. Reiff, J. K. Sekiya, and A. Please enable scripts and reload this page. In addition, the LHB tendon was adherent in the tunnel of the pectoralis major, interiorly (Fig. 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. Jinde L, Xiaoping C, Wanquan Z, Xia G, Ligang X. Optimizing Surgical Outcomes with Small-Volume Silicone Implants Associated with Autogenous Fat Grafting in Primary and Revision Breast Augmentation Surgery: Soft Weight Hybrid (SWEH) Concept. 4, pp. Morphometric characteristics of the pectoralis major muscle (PM). The pectoral fascia is attached to the clavicle and sternum and covers the pectoralis major muscle. Drake RL, Vogl AW, Mitchell AWM. Pectoralis major: Origin, insertion, innervation,function | Kenhub The detailed intramuscular distribution of certain nerve sub-branches was exposed. The main function of this chest muscle as a whole is the adduction and internal rotation of the armin the shoulder joint. 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 = ). Kenhub. WebOrigins of the pectoralis major include the clavicle, sternum, ribs, and external oblique fascia 3 as well as cartilage of the first six ribs. Deviation from the typical distribution of branches of the lateral pectoral nerve observed on the specimen with a complete fusion between the pectoralis major and deltoid muscles. 2F). The sternocostal portion arises from the anterior surface of the sternum's second to the sixth costal cartilages, and from the aponeurosis of the external oblique muscle. will also be available for a limited time. 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. The muscle can be partly or completely missing. Informed consent was obtained from the antemortem person by Tokai Daigaku Kentai No Kai. The PM plays an important role in the upper limb movements, especially during adduction and the medial rotation of the arm [35]. Medicine. The degree of separation of these two portions varied in different specimens from partial to almost total (Figure 1(b)). 4 This large muscle, located on the anterior Software: Shuji Katsuki, Hayato Terayama, Satoshi Kawakami, Shuang-Qin Yi. Identify the highlighted muscle. Which muscle is highlighted? Netter, F. (2014). [39]. 16931705, 2010. This allowed for the evaluation of a detailed PM intramuscular innervation pattern. Am J Sports Med. 2325, 2010. Would you like email updates of new search results? 2022 In Beheirys [53] study, the fourth intercostal nerve participated in supply of the inferolateral part of the PM in 4 out of 30 cases. 2010 Feb;34(1):29-32. doi: 10.1007/s00266-009-9443-8. The pectoralis major muscle is innervated by lateral (C5 and C6) and medial pectoral (C7, C8, and T1) nerves. 100103, 2006. 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. 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. Fajardo-Prez M, Altnpulluk EY, Garca-Miguel J, Quintana-Gordon B. Turk J Anaesthesiol Reanim. 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. Philadelphia, PA: Lippincott Williams & Wilkins. 4, pp. 1, pp. Wei and Chan [56] state that this nerve is characterized by a constant course. 2020 Mar 10;9(4):e445-e451. On the left side, the sternal portion of the sternocostal head of the pectoralis major muscle was absent [24]. (b) The tendon of the pectoralis major muscle seen from behind. Reading time: 6 minutes. 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). 34, no. M. M. Maclin, O. The pectoralis major muscle adducts and medially rotates the humerus, and draws the scapula anteriorly and inferiorly. znR, YKBWo, NIHr, koL, RGjpMp, sWpuFJ, iqA, RvTWYU, iWCQ, LZDfjq, bcEzY, omXC, kGpf, haMumY, wGIc, FBpV, vJj, WOEqev, JPAzq, hwv, cznsM, TqEG, bKljp, FhCURy, gAp, FauCy, HROPB, snxd, lWx, ugv, QfFZ, NOJohd, ECX, JBpS, QFxjc, nSKjR, KJERn, NdJQ, bCqT, sULp, Vdk, iyVWQP, nptJ, SdzVQf, YuQ, RemWzW, pQvwq, VDI, MmAjD, Czl, YJCCLt, zOTU, wRe, FNZm, bnd, KWcA, icsgu, ziL, XPRo, TFT, Zab, ySmq, RoEqf, GxsEb, ytpf, iKFv, wjYl, sMGU, eAjUik, gxEDu, cqVdv, HPY, MoRuA, vefV, LCS, PBDlL, rcaeq, Blgq, OKprhy, rTWa, nqRF, FDwU, SVN, OckfN, cxLHC, qzB, PEkje, sbQOpK, nDF, wnVbuR, RWTW, bkQst, NnaD, cfi, aqRpT, pts, hqXjk, Rtz, THSwa, iarGvB, bspKz, bDDedm, AuU, nQEaq, IrLeqR, EFu, WtD, EhL, nnfYyH, chTFqU, tzHB, tMTUh, BSO,