Chapter 6

Pectoral Region
Textbook of
Human Anatomy
Volume 1: Upper Limb
Author: Dr Yogesh Sontakke, JIPMER, Pondicherry

©CBS Publishers & Distributors Pvt Ltd, New Delhi

As per:
1
Competency based Undergraduate curriculum
AN9.1: Describe attachment, nerve supply, and action of
pectoralis major and pectoralis minor.
AN10.11: Describe and demonstrate attachment of serratus
anterior with its action
AN13.7: ………, Testing of muscles: ………., pectoralis major,
serratus anterior, ……..
This chapter includes pectoralis major and minor, and serratus
anterior muscles and their clinical testing.

Medical Council of India, Competency based Undergraduate curriculum for the Indian Medical Graduate,
2018. Vol. 1; pg 1-80.
2
Human Anatomy/Yogesh Sontakke
 INTRODUCTION
• Pectoral region lies in front of trunk anterior to the thoracic
cage (pector = breast or pectus = chest in Latin).

• It connects the upper limb and anterolateral part of thoracic

wall.

• Major structure of pectoral region:

– Mammary gland (breast) – for details, refer Chapter 7.

– Muscles
Pectoralis major
Subclavius
Pectoralis minor
Serratus anterior

– Pectoral and clavipectoral fascia

Human Anatomy/Yogesh Sontakke 3

 INTRODUCTION
• Gross anatomy of the pectoral region
should be studied in the following
sequence:
Surface landmarks →
Superficial fascia →
Deep fascia →
Muscles (origin, insertion, nerve supply,
action, clinical testing)

Human Anatomy/Yogesh Sontakke 4

SURFACE LANDMARKS
• Surfacelandmarks are useful for clinical integration of
the gross anatomy.
• Only few of the structures present deep to the skin can
be palpated (felt) or seen as surface projection. With the
help of these structures, all other structures can be
approximately located and examined.
• These surface landmarks also help for surgeries.

Human Anatomy/Yogesh Sontakke 5

 SURFACE LANDMARKS
Bony landmarks

• Clavicle: Lies horizontally at the root of the neck. As it is

subcutaneous, it can be felt (palpated) throughout its
length.

• Sternum: Lies subcutaneously in the midline. It has three

parts: manubrium, body, and xiphoid process.

• Suprasternal notch (jugular or interclavicular notch): It lies

between the clavicles just above the superior border of
manubrium sterni.Viva

Human Anatomy/Yogesh Sontakke 6

 SURFACE LANDMARKS
Bony landmarks

• Sternal angle (angle of Louis) – Transverse ridge, about 5

cm below the suprasternal notch.Viva

Importance of sternal angle:

– Rib identification: Second costal cartilage articulates on

either side, opposite the sternal angle. It helps in counting
ribs.Viva, Clinical fact

– Vertebral level: Sternal angle lies at the level of lower

border of the fourth thoracic vertebra

Human Anatomy/Yogesh Sontakke 7

 SURFACE LANDMARKS
Bony landmarks

• Acromion process of scapula is palpable at the summit of

the shoulder (akros = highest and omos = shoulder, in
Greek).

• Tip of coracoid process: Can be palpated 2–3 cm below

the clavicle in the infraclavicular fossa (can be felt only on
deep palpation).Clinical fact

• Costal margin (costal arch or arcus costalis): Lower edge

of thoracic cage formed by 7th to 10th costal cartilages and
free ends of 11th and 12th ribs.

Human Anatomy/Yogesh Sontakke 8

 SURFACE LANDMARKS
Soft tissue landmarks
• Nipple and areola:
Nipples are located in the 4th intercostal space
about 10 cm from midsagittal plane.
Nipple is surrounded by a pigmented circular
area called areola.
Position of nipple is variable even in males;
hence it is not useful to correlate with other
structures or rib counting.

Human Anatomy/Yogesh Sontakke 9

 SURFACE LANDMARKS
Anatomical lines
– Anterior axillary line – lies along the
anterior axillary fold
– Posterior axillary line – lies along the
posterior axillary fold
– Midaxillary line – lies midway
between anterior and posterior axillary
folds

Human Anatomy/Yogesh Sontakke 10

 SURFACE LANDMARKS
Soft tissue landmarks
Infraclavicular fossa or deltopectoral triangle
Triangular depression
Boundaries
– Medial: Pectoralis major muscle
– Lateral: Deltoid muscle
– Base (superior): Clavicle

Human Anatomy/Yogesh Sontakke 11

 SURFACE LANDMARKS
Anatomical lines
– Midsternal line – middle line of sternum and it
passes through the midsagittal plane.
– Parasternal line – lies along the lateral edge
of sternum.
– Midclavicular line – an imaginary line passing
through the middle of clavicle, tip of 9th costal
cartilage, and midinguinal point

Human Anatomy/Yogesh Sontakke 12

SUPERFICIAL FASCIA
• Lies just beneath the skin.
Contents of Superficial Fascia
1. Fat
2. Loose connective tissue
3. Cutaneous nerves
4. Cutaneous blood vessels
5. Platysma
6. Breast (mammary gland)

Human Anatomy/Yogesh Sontakke 13

SUPERFICIAL FASCIA
Cutaneous Nerves of Pectoral
Region
1. Supraclavicular nerves:
Medial, intermediate, and lateral
supraclavicular nerves (arising from C3 and
C4 spinal nerves)

2. Intercostal nerves:
Anterior and lateral cutaneous branches of
2nd to 6th intercostal nerves.

Human Anatomy/Yogesh Sontakke 14

 Area of supply
• Supraclavicular nerves
– skin above the horizontal line
passing through the sternal angle (root
value C3, C4)

• Intercostal nerves
– skin below this horizontal
line (root value T2–T6).

Human Anatomy/Yogesh Sontakke 15

 Cutaneous Blood Vessels of Pectoral Region
• Branches of internal thoracic
artery
• Lateral cutaneous branches of
posterior intercostal arteries
• Supraclavicular artery (branch of
transverse cervical artery)

Human Anatomy/Yogesh Sontakke 16

 DEEP FASCIA
• Called pectoral fascia
• Extension:
– Superiorly: Attaches to the clavicle
– Medially: Attaches to the sternum
– Superolaterally: Continues as deep
fascia over deltoid muscle
– Inferolaterally: Turns to continue as
axillary fascia (axilla = armpit).
– Inferiorly: Continue as fascia covering
the lower part of thoracic cage.

Human Anatomy/Yogesh Sontakke 17

Some Interesting Facts
• How to study the muscle?Study guide
Each muscle should be studied under the following heads:
1. Location (regions)
2. Attachments (origin and insertion)
3. Innervation (nerve supply)
4. Actions
5. Clinical testing
6. Clinical integration (applied aspects)

Human Anatomy/Yogesh Sontakke 18

Some Interesting Facts
• Each muscle crosses at least one joint and produces action at that joint
only (subcutaneous muscle does not cross the joints).Study guide
• Recent conceptStudy guide
Origin and insertion of the muscle are relative terminologies. Origin is the
attachment of the muscle that does not move during its contraction and insertion is
the attachment that moves.
But if the insertion is fixed by external force, then origin moves.
However, many authors consider proximal attachment
and distal attachment instead of origin and insertion.Practical guide

Human Anatomy/Yogesh Sontakke 19

MUSCLES OF PECTORAL REGION

1. Pectoralis major
2. Pectoralis minor
3. Subclavius

Human Anatomy/Yogesh Sontakke 20

Pectoralis Major
Q. Write a short note on pectoralis major.
• Largest muscle of the pectoral region Spotters
• Thick, bulky, fan-shaped muscle
Origin (proximal attachment)Neet
• Two heads of origin:
Clavicular head
• Smaller head
• Arises from anterior surface of medial half of
clavicle

Human Anatomy/Yogesh Sontakke 21

Pectoralis Major
Origin (proximal attachment)Neet
Sternocostal head
• Has manubrial, sternal, and aponeurotic fibers
• Manubrial fibers – from lateral half of anterior surface
of manubrium
• Sternal fibers –from lateral half of anterior surface of
sternum up to 6th costal cartilage
• Costal fibers – from 2nd to 6th costal cartilages.
• Aponeurotic fibers – from aponeurosis of external
oblique muscle of abdomen

Human Anatomy/Yogesh Sontakke 22

Pectoralis Major
Insertion (distal attachment)
• Form U-shaped bilaminar tendon that inserts on the
lateral lip of bicipital groove Viva, Neet
• Bilaminar tendon has two laminae as follows:
– Anterior lamina – shorter than posterior lamina,
formed by clavicular fibers of the muscle
– Posterior lamina –formed by sternocostal fibers

Human Anatomy/Yogesh Sontakke 23

Pectoralis Major
Direction of fibers
• Clavicular fibers –downward, and laterally.
• Sternocostal fibers – upward, and laterally.
Twisted around lower border of the muscle in such a way that
lowest fibers insert at higher level

• Anterior axillary fold – fold of skin formed by lateral

edge of pectoralis major muscle, specifically by twisted
fibers

Human Anatomy/Yogesh Sontakke 24

Pectoralis Major
Innervation (nerve supply)
• Supplied by medial and lateral pectoral nerves
Neet

Human Anatomy/Yogesh Sontakke 25

Pectoralis Major
Actions
1. As a whole muscle: Adduction and medial
rotation of armNeet
Draws the scapula forward along with serratus
anterior
2. Clavicular head: Flexion of arm.
3. Sternocostal head: Extension of flexed arm
against resistance.

Human Anatomy/Yogesh Sontakke 26

Pectoralis Major
Clinical testing
• Clavicular head: Ask to lift the heavy rod – makes clavicular head
prominent.
• Sternocostal head: Ask to depress the fixed rod – makes sternocostal
head prominent.

Human Anatomy/Yogesh Sontakke 27

Human Anatomy/Yogesh Sontakke 28
Human Anatomy/Yogesh Sontakke
29
Clinical Integration

• Pectoralis major – the most common muscle to be

congenitally absent Neet
• There may be a congenital complete or partial absence
of clavicular or sternocostal heads
• Separate cleft between clavicular and sternocostal heads
of pectoralis major may be present

Human Anatomy/Yogesh Sontakke 30

Human Anatomy/Yogesh Sontakke 31
Pectoralis Minor
Q. Write a short note on pectoralis minor.
• Thin, flat, triangular muscle
• Lies beneath the pectoralis major
• Lies within the clavipectoral fascia
Origin
• 3rd, 4th, and 5th ribs near their costal
cartilages, and from the fascia covering the
external intercostal muscles Neet

Human Anatomy/Yogesh Sontakke 32

Pectoralis Minor
• Run upward and laterally and
converge to form or short flat tendon.
Insertion
• On the medial border and superior
surface of coracoid process of
scapula Neet

Human Anatomy/Yogesh Sontakke 33

Pectoralis Minor
• Innervations (nerve supply)
• Medial and lateral pectoral nerves.

Human Anatomy/Yogesh Sontakke 34

Pectoralis Minor
Actions
• Draws the scapula forward along with the
serratus anterior muscle and helps in
punching action Neet
• Depresses the shoulderNeet
• In forced inspiration, it acts as accessory
muscle of respiration.Neet

Human Anatomy/Yogesh Sontakke 35

Human Anatomy/Yogesh Sontakke 36
 Subclavius
• Small triangular muscle that lies horizontally
inferior to the clavicle
• Lies within the clavipectoral fascia
. To visualize subclavius muscle, remove the
clavicular head of pectoralis major muscle
from the clavicle. Then dissect out
clavipectoral fascia just beneath the
clavicle.Practical guide

Human Anatomy/Yogesh Sontakke 37

 Subclavius
Origin
• First rib at the costochondral junction.
Direction
• Run horizontally toward the under surface of
clavicle (superolaterally)

Human Anatomy/Yogesh Sontakke 38

 Subclavius
Insertion
• On subclavian groove
Innervations (nerve supply)
• Nerve to subclavius (branch of upper
trunk of brachial plexus, root value: C5,
6)

Human Anatomy/Yogesh Sontakke 39

 Subclavius
Actions
• Protects the brachial plexus and
subclavian vessels by forming
cushion.
• Stabilizes the clavicle during the
movements of shoulder.

Human Anatomy/Yogesh Sontakke 40

Human Anatomy/Yogesh Sontakke 41
 Clavipectoral fascia
Q. List the structures piercing clavipectoral
fascia.
Q. Write a short note on clavipectoral fascia.
• Part of deep fascia that is situated deep to
pectoralis major

Human Anatomy/Yogesh Sontakke 42

 Clavipectoral fascia
Extent
• Medially – blends with fascia covering
the first two intercostal spaces.
• Laterally: It is attached to coracoids
process.

Human Anatomy/Yogesh Sontakke 43

 Clavipectoral fascia
Extent
• Superiorly: Splits to enclose
subclavius muscle
• Inferiorly: encloses pectoralis minor
muscle. Below this muscle, the fascia
extends downward up to the axillary
fascia as suspensory ligament of
axilla.

Human Anatomy/Yogesh Sontakke 44

 Clavipectoral fascia
Content

•Two muscles: Subclavius and

pectoralis minor Viva, NEXT

Human Anatomy/Yogesh Sontakke 45

 Clavipectoral fascia
Structures piercing High yielding facts, NEXT
1. Lateral pectoral nerve
2. Cephalic vein
3. Thoracoacromial trunk
4. Lymphatic vessels from breast to
apical axillary group of lymph nodes

Human Anatomy/Yogesh Sontakke 46

 Fig. 6.10: Structures piercing clavipectoral fascia

Human Anatomy/Yogesh Sontakke 47

Human Anatomy/Yogesh Sontakke 48
 SERRATUS ANTERIOR
MUSCLE
Q. Write a short note on serratus anterior
muscle.
Serrate = to saw, in Latin
• Other names: Boxer’s muscle,
swimmer’s muscle.

Human Anatomy/Yogesh Sontakke 49

 SERRATUS ANTERIOR
MUSCLE
Origin
• 8 digitations (slips) from upper eight ribs and
fascia intervening intercostal muscles in the
midaxillary plane
Direction
• Curve around thoracic wall to reach the medial
border of scapula

Human Anatomy/Yogesh Sontakke 50

 SERRATUS ANTERIOR
MUSCLE
Insertions
• On costal surface of medial border of scapula as
follows:
– 1st digitation at the superior angle
– 2nd and 3rd digitations along the entire medial
border
– Remaining digitations on the triangular area at
the costal surface of inferior angle of scapula

Human Anatomy/Yogesh Sontakke 51

 SERRATUS ANTERIOR
MUSCLE
Innervation (nerve supply)
• Long thoracic nerve (nerve to serratus
anterior)Viva, Spotters
• Arises from C5, C6, C7 roots of brachial
plexus

Human Anatomy/Yogesh Sontakke 52

 SERRATUS ANTERIOR
MUSCLE
Actions
• Pushing and punching action (Boxer’s
muscle)
• Serratus anterior and pectoralis minor
together pulls the scapula forward around
the chest wall for pushing and punching
action.

Human Anatomy/Yogesh Sontakke 53

 SERRATUS ANTERIOR
MUSCLE
Actions
• Overhead abduction of arm Serratus
anterior (lower 4–5 digitations) and
trapezius (lower part) rotate the scapula
and thus help in overhead abduction of
arm Neet
• Keeps the scapula in position

Human Anatomy/Yogesh Sontakke 54

Human Anatomy/Yogesh Sontakke 55
Thank you………….

56