Download Region 11: Pectoral Region Cutaneous Vessels -

Region 11: Pectoral Region
Cutaneous Vessels
--Cephalic vein
*From: lateral dorsal venous network up lateral border of wrist and
anterolateral surface of forearm and arm, enters deltopectoral triangle and
joins into terminal part of axillary vein
Cutaneous Peripheral Nerves
--Supraclavicular nerves (C3, C4)
*Supplies: skin over clavicle and superolateral aspect of pectoralis major
--Anterior Perforating branches
*From: intercostal nerves
*Supplies: anterior skin of thorax
--Lateral Perforating branches
*From: intercostal nerves
*Supplies: lateral skin of thorax
Deep Fascia
--Pectoral Fascia
*Surrounds: pectoralis major
*Continuous with: fascia of anterior abdominal wall and at lateral border of
pectoralis major becomes axillary fascia
--Clavipectoral Fascia (deep to pectoral fascia and pec. major)
*Surrounds: subclavius and pectoralis minor
*Continuous with axillary fascia
*Costocoracoid Membrane: attaches pectoralis minor and subclavius
--Costocoracoid Ligament: slightly thickening of deep fascia just below
the subclavius muscle
*Suspensory ligament of axilla: inferior to pec. minor, supports axillary
fascia and pulls it and skin inferior to upward to form axillary fossa
Deltopectoral Triangle
--Boundaries: clavicular head of pectoralis major (inferior), deltoid (lateral), clavicle
(medial)
--Contents: cephalic vein, deltoid branch of thoracoacromial trunk
Movement of Rib Cage During Inspiration
--Bucket Handle: middle parts of lower ribs romve laterally to elevate
--Water Pump: manubrium shifts anterior, increasing A-P diameter
Breast
--Superficial fascia/subcutaneous fat: defines contour and volume
--Areolar/nipple: T4 dermatome
--Retromammary space: between breast and deep pectoral fascia
--Suspensory/Cooper’s Ligaments: connect mammary gland to dermis of overlying skin
and supports the mammary gland lobules
*Lobules: 15-20, each drained by a lactiferous duct with a dilated portion
(lactiferous sinus) deep to the areolar
--Arterial Supply
*Medial mammary aa. from interal thoracic/intercostal aa.
*Lateral mammary from lateral thoracic a.
--Nerve Supply
*4th through 6th intercostal nerve (VPR T4-T6)
Muscles of the Superficial Fascia of the Pectoral Region: platysma
Platysma
O Inferior border of mandible, skin, and subcutaneous tissues of lower face
I Fascia covering superior parts of pectoralis major and deltoid muscles
Inn. Cervical branch of facial nerve (CN VII)
Draws corners of mouth inferiorly and widens it as in expressions of sadness and
Act.
fright; draws skin superiorly when teeth are clenched
BS Facial artery
Anterior Axioappendicular (Pectoral) Muscles: pectoralis major, pectoralis mino,
subclavius, serratus anterior
Pectoralis Major
Clavicular head: anterior surface of medial half of clavicle
O Sternocostal head: anterior surface of sternum, superior six costal cartilages,
aponeurosis of external oblique muscle
I Lateral lip of intertubercular groove of humberus
Lateral and medial pectoral nerves; clavicular head (C5, C6), sternocostal head
Inn.
(C7, C8, T1)
ADDucts, and medial rotates humerus; draws scapula anteriorly and
Act. inferiorly Acting Alone: clavicular head flexes humerus and sternocostal head
extends it from the flexed position
Pectoral branches of thoracoacromial trunk, perforating branches of anterior
BS
intercostal arteries
Pectoralis Minor
3rd-5th ribs near their costal cartilages
Medial border and superior surface of coracoid process of scapula
Medial pectoral nerve (C8, T1) (pierces through it to go to major)
Stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall
Pectoral branches of thoracoacromial trunk, perforating branches of anterior
BS
intercostal arteries
Not Brachial plexus and axillar vessels pass POSTERIOR
O
I
Inn.
Act.
Subclavius
Junction of 1st rib and its costal cartilage
Inferior surface of middle third of clavicle
n. to subclavius
Anchors and dpresses clavicle
BS Clavicular branches of thoracoacromial trunk
O
I
Inn.
Act.
Serratus Anterior (Boxer’s Muscle)
External surfaces of lateral parts of 1st-8th ribs (interdigitation with external
oblique muscle)
I Anterior surface of medial border of scapula
Inn. Long thoracic nerve (C5, C6, C7)
Act. Protracts scapula and holds it against thoracic wall; rotates scapula
BS Lateral thoracic artery
O
Nerve Supplies of Region 11
--Lateral Pectoral n.
*From: side branch of lateral cord (C5, C6, C7)
--Medial Pectoral n.
*From: side branch of medial cord (C8, T1)
--N. to subclavius
*From: superior trunk (C5, C6)
--Long thoracic n.
*From: posterior aspect of anterior rami of C5, C6, C7
--Intercostal nn.
*From: VPR of T1-T11
--Subcostal n.
*From: VPR of T12
--CN VII: cervical branch of facial nerve
Blood Supplies of Region 11
--Facial artery
*From: external carotid artery
--Perforating anterior intercostal aa.
*From: internal thoracic arteries (intercostal spaces 1-6) and
musculophrenic arteries (intercostal spaces 7-9)
(Internal thoracic from 1st part of subclavian)
--Pectoral branches of thoracoacromial trunk
*From: Thoracoacromial trunk
(From 2nd part of axillary artery//first branch)
--Clavicular branches of thoracoacromial trunk
*From: Thoracoacromial trunk
(From: 2nd part of axillary artery//first branch)
--Lateral thoracic artery
*From: 2nd part of axillary atery//second branch
Region 12: Posterior Triangle of the Neck/Lateral Cervical Region
Cutaneous Vessels
--External Jugular Vein
*Begins: near angle of mandible (inf. to ear) by union of retromandibular
vein with posterior auricular vein
*Ends: subclavian vein
Cutaneous Peripheral Nerves (from cervical plexus)
--Lesser Occipital Nerve
*From: spinal nerves C2 and C3 via cervical plexus
*To: comes out behind SCM, runs post. border to behind ear
--Great Auricular Nerve
*From: spinal nerves C2 and C3 via cervical plexus
*To: skin over angle of mandible and inferior lob of ear, parotid sheath
(crosses over SCM en route to ear lobe)
--Transverse Cervical Nerve
*From: C2 and C3
*To: skin covering anterior cervical region/anterior triangle
--Supraclavicular Nerves (Medial, intermediate, lateral)
*From: C3, C4
*Supplies: skin over clavicle and superolateral aspect of pectoralis major
Deep fascia
--Investing layer of deep cervical fascia
*deep to skin around entire neck
*Surrounds trapezius, and sternocleidomastoid,
Posterior Triangle
--Boundaries: SCM (anterior), Trapezius (posterior), Clavicle (inferior)
--Subdivisions: Occipital triangle (SCM, trapezius, inferior belly of omohyoid)
Omoclavicular/Subclavian triangle (SCM, clavical, inf. belly of
omohyoid)
--Roof: skin, subcutaneous fascia, investing layer of deep cervical fascia
--Floor: prevertebral fascia overlying splenius capitis, levator scapulae, middle scalene,
posterior scalene, sometimes anterior scalene
--Contents:
*Occipital Triangle: external jugular vein, posterior branches of cervical
plexus of nerves; spinal accessory nerve, trunks of brachial plexus,
transverse cervical artery, cervical lymph nodes
*Omoclavicular Triangle: subclavian artery (third part), subclavian vein,
suprascapular artery, supraclavicular lymph nodes
--Communicates with axilla via cervicoaxillary canal
Muscles of the Superficial Fascia of the pectoral region: platysma
Platysma
O Inferior border of mandible, skin, and subcutaneous tissues of lower face
I Fascia covering superior parts of pectoralis major and deltoid muscles
Inn. Cervical branch of facial nerve (CN VII)
Draws corners of mouth inferiorly and widens it as in expressions of sadness and
Act.
fright; draws skin superiorly when teeth are clenched
BS Facial artery
Not In investing layer of cervical fascia
Muscle that divides the neck into anterior and posterior triangles:
Sternocleidomastoid
Sternocleidomastoid
Lateral surface of mastoid process of temporal bone and lateral half of superior
nuchal line
Sternal head: anterior surface of manubrium of sternum
I
Clavicular head: superior surface of medial third of clavicle
Inn. Spinal accessory nerve (CN XI; motor), C2, C3 nerves (proprioception and pain)
O
Unilateral: tilts head to same side and rotates it so face is turned superiorly toward
opposite side
Bilateral: Extends neck at atlanto-occipital joints C1/C2
Flexes the cervical vertebrae
Act.
Protrusion of the head
Fixed cervical vertebrae: elevate manubrium and medial end of clavicles, assisting
pump-handle action of deep respiration
BS Occipital artery
Muscles of floor of posterior triangle: splenius capitis, levator scapulae, posterior
scalene, middle scalene, anterior scalene (sometimes)
Anterior Scalene
O Anterior tubercles of transverse processes of C3-C6 vertebrae
st
I 1 rib
Inn. Cervical spinal nerves C4-C6
Act. Flexes head
BS Ascending cervical branch of inferior thyroid artery
Suprascapular and transverse cervical aa. pass ANTERIOR
Not Subclavian a. and brachial plexus passes between anterior and middle scalene
Subclavian v. passes ANTERIOR to anterior scalene
Middle Scalene
O
I
Inn.
Act.
BS
Not
Posterior tubercles of transverse processes of C2-C7 vertebrae
Superior surface of first rib; posterior groove for subclavian artery
Anterior rami of cervical spinal nerves
Flexes neck laterally; elevates 1st rib during forced inspiration
Ascending cervical branch of inferior thyroid artery
Dorsal scapular n. and long thoracic n. passes through the muscle
Posterior Scalene
O
I
Inn.
Act.
BS
Posterior tubercles of Transverses processes of C4-C6 vertebrae
External order of 2nd rib
Anterior rami of cervical spinal nerves C7 and C8
Flexes neck laterally; elevates 2nd rib during forced inspiration
Ascending cervical branch of inferior thyroid artery
Blood Supply of Region 12
--Facial artery
*From: external carotid artery
--Occipital Artery
*From: external carotid artery
--Ascending cervical branch of inferior thyroid artery
*From: thyrocervical trunk (from subclavian artery)
--Subclavian Artery: Parts named based on relationship to anterior scalene
*1st part: medial to scalene
*2nd part: posterior to scalene
*3rd part: lateral to scalene
*Becomes axillary artery at lateral border/inferior border of first rib