Anterior Pectoral Girdle

Muscle
Pectoralis
Major

Origin
Medial part of
clavicle
Sternum
On abdominal
aponeurosis that
covers the
medial part of 6th
(& 7th) ribs

Insertion
Antero-laterally on
the humerus, on the
outer lip of the
intertubercular
groove

Innervation
Lateral pectoral
nerve (C5-C7)
Medial pectoral
nerve (C8-T1)
(Arising from the
lateral/medial cords
of the brachial
plexus)

Blood Supply
Branches of the
thoracoacromial
truck (a branch of
the axillary artery)

Function
Flexion of humerus
Extension of humerus
Adductor of humerus
Medial rotator of
humerus
Helps to downwardly
rotate (moving glenoid
fossa downward),

Pectoralis
Minor

Ribs 3-5

Coracoid process of
scapula

Medial pectoral nerve

Serratus
Anterior

Ribs 1-8

Along entire length

of medial border of
scapula

Long thoracic nerve (C5C7 roots of brachial

plexus)

Subclavius

Junction of 1st rib and

its costal cartilage

Inferior surface of
middle third of
clavicle

Nerve to subclavius (C5C6)

Branches of the
thoracoacromial
truck
Branches of the
lateral thoracic
artery
(both branches
of the axillary
artery)
Lateral thoracic
artery (branch of
axillary artery)

Clavicular branch of
the thoraocacromial
artery

protract and depress

scapula
Helps to downwardly
rotate scapula (rotation
of glenoid cavity
downward)
Helps to protract and
retract scapula

Protracts scapula
Depresses scapula
Rotates scapula upward
(glenoid cavity rotates
upward)
Upward rotation must
occur before flexion and
abduction can be
performed to full extent
Anchors clavicle
Depresses clavicle

Surface Anatomy
Nipple
Areola
Suprasternal Notch
Sternal Angle

Xiphoid process of the sternum

Location
Lies at level of 4th intercostal space
Ring of pigmented skin around nipple
Superior margin of the manubrium of the sternum
Junction between manubrium and the body of the sternum
Located at level where:
2nd ribs articulate with the sternum
Aortic arch begins and ends

Trachea bifurcates into right and left bronchi at the carina

Inferior border of the superior mediastinum is demarcated
Transverse plane can pass through intervertebral disc between
T4 and T5

Flat cartilaginous process at birth

Ossifies slowly from central core and unites with body of
sternum after middle age
Lies at level of T10 vertebra, and xiphesternal joint lies at level
of T9 vertebral body, which marks the lower limit of the
thoracic cavity in front, the upper surface of the liver,
diaphragm and lower border of the heart
Can be palpated in the epigastrium and is attached via its
pointed caudal end to the linea alba

Xiphisternal Joint

At the level of T9

Clavicle/Collar Bone

Acromioclavicular joint

Forms the pectoral girdle with the scapula, which connects the
upper limb to the axial skeleton (sternum)
Medial 2/3 tilted convex forward and lateral 1/3 flattened with
a marked concavity
First bone to begin ossification during fetal development, but
last to complete ossification (~21years)
Only long bone to be ossified intramembranously
Joint between acromion and clavical
Synovial plane joint that allows gliding movement when the
scapula rotates
Reinforced by the coracoaclavicular ligament, which consists of
concoid and trapezoid ligaments

Scapula/ shoulder blade

Coracoid processes
Provides origin of the coracobrachialis and biceps brachii
Provides insertion of pectoralis minor
Provides attachment site for the coracoclavicular,
coracohumeral and coracoarcomial ligaments and the
costocoracoid membrane
Acromion
Lateral edge of scapula spine
Articulates with clavicle
Provides an origin for the deltoid
Provides insertion for the trapezius

Infraclavicular fossa/deltopectoral triangle

Ribs
Intercostals spaces

Groove that separates the lateral border of the pectoralis

major from the deltoid
Contains the cephalic vein

12 pairs of bones that form the main part of the thoracic cage,
extending from the vertebrae to or toward the sternum
Between ribs

Nerves

Lateral cutaneous branches of

intercostal nerves

Location

Arises from the axillary

nerve and innervates the
lateral side of the arm

Picture

Long thoracic nerve

Descends behind the

brachial plexus and runs
on the external surface of
the serratus anterior
muscle, which it supplies.

Intercostobrachial nerve

Is the lateral cutaneous

branch of the second
intercostal nerve
emerging from the
second intercostal space
and may communicate
with the medial brachial
cutaneous nerve.

Medial pectoral nerve

Passes forward between

the axillary artery and
vein and forms a loop in
front of the axillary artery
with the lateral pectoral
nerve
Enters and supplies the
pectoralis minor muscle
and reaches the overlying
pectoralis major muscle.

(Pec Major is reflected)

Lateral pectoral nerve

Innervates the pectoralis

major muscle primarily
and also supplies the
pectoralis minor muscle
by way of a nerve loop
Sends a branch over the
first part of the axillary
artery to the medial
pectoral nerve and forms
a nerve loop through
which the lateral pectoral
nerve conveys motor
fibers to the pectoralis
minor muscle.
Pierces the costocoracoid

Lateral cord of Brachial Plexus

membrane of the
clavipectoral fascia.
Is accompanied by the
pectoral branch of the
thoracoacromial artery.
Branches to form lateral
pectoral nerve which
innervates the pectoralis
major muscle primarily as
well as minor
Also branches to form the
Musculocutaneous nerve
that pierces the
coracobrachialis muscle,
descends between the
biceps brachii and brachialis
muscles and innervated
these three muscles

Medial cord of Brachial Plexus

Branches to form medial

pectoral nerve which enters
and supplies the pectoralis
minor muscle and reaches
the overlying pectoralis
major
Also branches to from the:
- Medial cutaneous nerve
- Medial antebrachial
nerve
- Ulnar nerve

*Lateral and anterior cutaneous nerves and arteries

Lateral cutaneous nerves- arises from the axillary nerve and innervates the lateral side of the arm

Vessels
Cephalic Vein

Thoracoacromial trunk/Artery

Location
In the superficial fascia of
the arm
On lateral side of bisceps
brachii
Ascends into shoulder
between pectoralis major
and the deltoid muscles

Is a short trunk from the

first or second part of the
axillary artery and has
pectoral, clavicular,
acromial, and deltoid
branches.
Pierces the costocoracoid
membrane (or
clavipectoral fascia).

Picture

Axillary Artery

Is considered to be the
central structure of the
axilla.
Extends from the outer
border of the first rib to
the inferior border of the
teres major muscle, where
it becomes the brachial
artery.
The axillary artery is
bordered on its medial side
by the axillary vein.
is divided into three parts
by the pectoralis minor
muscle
Axillary artery gives off the
superior thoracic,
thoracoacromial (which
has pectoral, clavicular,
deltoid, and acromial
branches), lateral thoracic,
subscapular (which has
circumflex scapular and
thoracodorsal branches),
and anterior and posterior
humeral circumflex
arteries

Lateral thoracic Artery

Runs along the lateral

border of the pectoralis
minor muscle.
Supplies the pectoralis
major, pectoralis minor,
and serratus anterior
muscles and the
axillary lymph nodes and gives rise
to lateral mammary branches.