The document discusses the anatomy of the pectoral region and breast. It identifies structures like the clavicle, sternum, ribs, and scapula as bony landmarks. It also describes muscles like the pectoralis major and minor. The breast tissue develops from the mammary line and the breast has a base that extends from the 2nd to 6th rib.
The document discusses the anatomy of the pectoral region and breast. It identifies structures like the clavicle, sternum, ribs, and scapula as bony landmarks. It also describes muscles like the pectoralis major and minor. The breast tissue develops from the mammary line and the breast has a base that extends from the 2nd to 6th rib.
The document discusses the anatomy of the pectoral region and breast. It identifies structures like the clavicle, sternum, ribs, and scapula as bony landmarks. It also describes muscles like the pectoralis major and minor. The breast tissue develops from the mammary line and the breast has a base that extends from the 2nd to 6th rib.
The document discusses the anatomy of the pectoral region and breast. It identifies structures like the clavicle, sternum, ribs, and scapula as bony landmarks. It also describes muscles like the pectoralis major and minor. The breast tissue develops from the mammary line and the breast has a base that extends from the 2nd to 6th rib.
04/10/2024 DR.J.AHENKORAH NEW TERMS: "Fascia" is the Latin word for a "band or bandage” It is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding some structures together, while permitting others to slide smoothly over each other.
Superficial fascia –just under the skin and in the pectoral region characterised by fat deposition and supraclavicular nerves near the clavicle. It has blood vessels, lymph vessels and sweat glands. DEEP FASCIA- a layer of dense connective tissue which can surround individual muscles
04/10/2024 DR.J.AHENKORAH THE PECTORAL (L. pectus, chest) REGION
The Pectoralis major muscle
defines the region and it covers the anterior and part of lateral thoracic wall.
04/10/2024 DR.J.AHENKORAH CLAVICLE/ COLLAR BONE • It is a solid bone that lies horizontally across the root of the neck. A bony landmark between the thorax and the neck. • It appears by the 5th and 6th weeks of intra-uterine life • The first bone to begin to ossify in the body • It is subcutaneous throughout its length. CLAVICLE • Shape : f-Shaped • Its medial 2/3rd is convex forward. • The lateral 1/3rd is convex backwards/ concave forwards and flattened. The inferior aspect is grooved • The junction between the medial 2/3rd and lateral 1/3rd is the weakest part of the bone. It usually has no medullary cavity
Female clavicle is relatively shorter, thinner, less curved and
smoother.
NOTE: By looking at the curvatures and the surfaces, it is possible
to determine the (laterality) ie. which side of the body it belongs to (ie.left or right).
NOTE: The clavicle demarcates zones of lymphatic drainage ie
-above the clavicle, lymph drains into the inferior jugular nodes -Below the clavicle, lymph drains into the axillary nodes
04/10/2024 DR.J.AHENKORAH CLAVICLE • Functions : • 1.Holds the arm away from the trunk. • 2. Transmits forces from the upper limb to the axial skeleton. • 3. Gives attachment to muscles. Functions of the clavicle: It attaches the upper limb to the axial skeleton at the Sternoclavicular joint This joint forms the sole articulation of the upper limb to the trunk. (This joint suspends the upper extremity so the humerus can experience extensive mobility)
It is commonly fractured during a fall on the
outstretched hand or by a violent impact to the hand or shoulder Fracture of the clavicle shown in the plain X-RAY Sternum It is subcutaneous and can be palpated throughout its length PARTS: • Jugular(suprasternal)notch-inf. border of T2 vertebra • Manubrium (L. Handle)-T3 &T4 vertebral bodies Left and right side of the manubrium are landmarks? Ant. To which structures? Sternal angle (of Louis)-T4/T5 IV DISC, LEVEL OF 2ND PAIR OF COSTAL CARTILAGES, COUNT RIBS starts FROM HERE
• Body-T5-T9 vertebrae Xiphoid (Gr. Xiphos) process-lie in the epigastric fossa (ossifies fully by 40yrs +) 04/10/2024 DR.J.AHENKORAH MUSCLES OF THE PECTORAL REGION
• Pectoralis major muscle
• Pectoralis minor muscle • Subclavius muscle • Serratus anterior muscle etc.
Upper fibres of the Rectus abdominis muscle
External oblique muscle
NOTE: Some muscles act on the upper limb
(thoracoappendicular muscles eg. Latissimus dorsi- superficial back muscles).
04/10/2024 DR.J.AHENKORAH P. Major Origin: Clavicular head, Sternal head & Upper 6-7 costal cartilages, apponeurosis of the external oblique. Insertion: Lateral lip of intertubercular (bicipital) groove of humerus. Actions: Powerful Adductor and a medial rotator of the arm mainly. Its clavicular head assists in flexion at the shoulder joint. When the humerus is fixed , it helps pull the trunk over the arms eg. Climbing a rope or acts as an accessory muscle of respiration
It’s removal during a radical mastectomy causes negative side
effects i.e: weakness in combing hair, bringing a fork to the mouth
Hypertrophy in swimmers or weight lifters
NERVE SUPPLY: Medial and Lateral Pectoral nerves
04/10/2024 DR.J.AHENKORAH Hyperplasia ? Hypertrophy? Muscle atrophy ? PECTORALIS MAJOR MUSCLE P. minor ORIGIN: 3RD to 5TH RIBS (frequently 2nd to 4th) INSERTION: Medial border and superior surface of coracoid process of scapula Actions: Stabilizes the scapula bone together with serratus anterior muscle by pulling it inferiorly and anteriorly towards the thoracic wall as in touching an object that is just out of reach. Respiration-assist
NERVE SUPPLY ???:
04/10/2024 DR.J.AHENKORAH SUBCLAVIUS A small triangular muscle that lies between the clavicle and the 1st rib. It arises from the 1st rib, close to the costochondral junction. It ascends laterally to be inserted into the middle 3rd of the inferior surface of the clavicle at the area known as the subclavian groove.
NERVE SUPPLY Nerve to subclavius
ACTION The subclavius muscle stabilizes the clavicle at the stenoclavicular joint. NOTE: In fracture of the clavicle it serves as a cushion to prevent the jagged edge from lacerating the vessels (subclavian vessels) that pass below it.
04/10/2024 DR.J.AHENKORAH SERRATUS ANTERIOR one of the most powerful muscles of the pectoral girdle that clothes the side wall of the thorax. Strong protractor of scapula –Abduction used when punching or reaching anteriorly (boxer's muscle).
Origin : series of digitations from the upper 8 ribs
Insertion: costal/inner surface of scapula Nerve supply? CLAVIPECTORAL FASCIA
A deep fascia attached to the clavicle, splits to
surround the subclavius m., thickened below as costocavicular ligament, extends inferiorly to pectoralis minor as costocoracoid membrane (pierced by Cephalic v., lateral pectoral n., thoracoacromial a.), Lymphatics. It encloses P. minor, extends inferiolaterally to attach to axillary fascia as suspensory ligament of axilla. THE PECTORAL REGION PECTORAL MUSCLES & CLAVIPECTORAL FASCIA
Costoclavicular ligament
Costocoracoid membrane
Suspensory ligament of axilla
Pectoral fascia is a deep fascia
04/10/2024 DR.J.AHENKORAH WHAT ARE THE REGIONAL CUTANEOUS NERVE SUPPLY OF THE PECTORAL REGION?
WHICH SPINAL NERVES SUPPLY THESE AREAS?
MAMMARY GLAND/BREAST The breast tissue develops from the embryonic mammary or milk line which runs through to the groin/Inguinal area. It is only those on the thorax that develops, the rest regress. It is a specialized gland of the skin that secretes milk.
It is a secondary sexual feature of
females It is used primarily for feeding babies.?? The glands of the breast are within the superficial fascia of the thoracic 04/10/2024 wall. DR.J.AHENKORAH BREAST 1 Anatomically, the breast has a base that extends to part of the thoracic cage from the 2nd to the 6th rib in the mid-clavicular line.
It may be hemispherical, conical, variable pendulous,
big, small, sagging, asymmetrical , thin and flattened etc
The size varies with pregnancy, breastfeeding, and
during the menstrual cycle (under the influence of various hormones).
Pre-puberty, puberty, post-menopause
04/10/2024 DR.J.AHENKORAH 04/10/2024 DR.J.AHENKORAH The nipple is located in the 4th intercostal space, lateral to the mid-clavicular line in men & nulliparous women –not fixed
The nipple can be flat, round,
or cylindrical. Deep to the nipple & areola are smooth muscle cells-contract when cold or tactile stimulation cause erection of nipple
Inverted nipple?
04/10/2024 DR.J.AHENKORAH Hypoplastic or underdeveloped The areola can be a very narrow ring, or may cover half of a small breast.
Montgomery ‘s Tubercles/glands are little “bumps” on the
areola containing numerous sweat and sebaceous glands. They produce oil that lubricates the nipple/areola complex.
04/10/2024 DR.J.AHENKORAH SUSPENSORY LIGAMENT (OF ASTLEY COOPER) are fibrous tissues that attach the upper parts of the breast to the skin. They make the breast protrude.
04/10/2024 DR.J.AHENKORAH The breast can be divided into quadrants, for description of tumors & cysts --Upper (superior) lateral, lower (inferior) lateral, upper medial and lower medial. Related to the clock The upper lateral quadrant may extend into the axilla called THE AXILLARY TAIL (OF SPENCE).
04/10/2024 DR.J.AHENKORAH THE RETROMAMMARY/SUBMAMMARY SPACE This space enables the breast to be moved freely over the deep muscles. If the breast can not be moved it shows a possible case of advanced malignancy. NOTE THE FOLLOWING ABOUT THE BREAST Important internal gross features are glandular, namely secretory glands, lactiferous ducts, and lactiferous sinuses.
Each of the approximately 15-20 lactiferous sinuses
have an individual opening on the nipple.
It is the glandular nature of the breast that makes it a
common site for the development of cancer.
04/10/2024 DR.J.AHENKORAH HOW IS THE BREAST
EXAMINED CLINICALLY? 04/10/2024 DR.J.AHENKORAH BLOOD SUPPLY OF THE BREAST
• Arterial supply • Venous drainage • Innervation
04/10/2024 DR.J.AHENKORAH Medial mammary branches of the perforating branches of the internal thoracic artery Lateral mammary branches of the Lateral thoracic artery Lateral mammary branches of the anterior Intercostal arteries Branches from thoracoacromial trunk [PACD]
Venous drainage is mainly into the axillary vein and
into the internal thoracic vein
04/10/2024 DR.J.AHENKORAH 04/10/2024 DR.J.AHENKORAH Blood Supply of the Breast
Syllabus p. 31 INNERVATION OF THE BREAST Nerves:The skin of the breast is innervated by anterior and lateral cutaneous branches of the 4TH through the 6th intercostal nerves.
Eg., the area around the nipple and areola is
innervated via the anterior branch of the lateral cutaneous branch of T4 spinal nerve. It conveys sensory information from and sympathetic fibers to blood vessels in that area. 04/10/2024 DR.J.AHENKORAH Lymphatic drainage: Lymph passes from the nipple, areola, and lobules to the subareolar lymphatic plexus. From there: MOST (75%) of the lymph especially from the lateral quadrants drains to the axillary lymph nodes, via the pectoral (Anterior) lymph nodes.
Most of the remaining, drains to the parasternal lymph nodes.
A small amount of lymph goes to the opposite breast. Some amount of lymph goes to the abdominal wall and downward.
Remember that the lymph vessels do not have valves!!!!
(It is therefore important to consider the axillary nodes when performing
a breast exam on a patient).
04/10/2024 DR.J.AHENKORAH The lymphatic flow of the breast is of great clinical significance because metastatic dissemination occurs principally by the lymphatic routes.
04/10/2024 DR.J.AHENKORAH LYMPH DRAINAGE OF THE BREAST
04/10/2024 DR.J.AHENKORAH Skin dimpling of the breast - due to retraction or tension on the suspensory ligaments as a tumor begins to grow and occupy more and more space. CLINICAL CORRELATIONS
Polymastia (supernumerary breasts) and polythelia
(supernumerary nipples) may develop in males and females anywhere along the length of the mammary ridges .
In Polythelia, usually no underlying glandular tissue
develops.
Breast tissue may not develop at all (amastia)
Nipple development without breast tissue (AMAZIA)
04/10/2024 DR.J.AHENKORAH Intra-areola polythelia BREAST CANCER-INVERTED NIPPLE, DIMPLING
Peau d’orange sign, nipple retraction and deviation, abnormal
contours etc. A breast abscess is a localized pocket of infection containing pus in the breast tissue. When bacteria invade through an irritated or cracked (fissured) nipple in a woman who recently gave birth, the resulting infection that spreads through the tissues (cellulitis) is called postpartum mastitis. A breast enlargement, breast augmentation, boob job – augmentation mammaplasty
04/10/2024 DR.J.AHENKORAH The male breast is rudimentary throughout life and so it is in females prior to puberty. A post pubertal male with large breast has a condition known as GYN (A)ECOMASTIA which is due to hormonal imbalance (see Klinefelter syndrome “XXY” trisomy)
04/10/2024 DR.J.AHENKORAH Supernumerary nipple or breast tissue/ pseudomamma
Pseudomamma on the plantar region of the left foot in a 22 year-old woman.
Close-up of supernumerary nipple surrounded by an obvious areola on the plantar region of the left foot (pseudomamma). Hair is observed on the surface.
Délio Marques Conde et al., 2006. see Dermatology Online Journal: 12 (4): 7
04/10/2024 DR.J.AHENKORAH Cancer develops in the right breast of a 25 year old woman. The woman experiences a loss of sensation in her left nipple. Which of the following is most likely to be affected by the tumor?
A. Right T4 vertebra B. Left T4 vertebra C. Right T3 Spinal nerve D. Left T4 Spinal nerve E. T4 SEE YOU IN THE “DR”
What Process Is Best Seen Using A Perpendicular CR With The Elbow in Acute Flexion and With The Posterior Aspect of The Humerus Adjacent To The Image Receptor
What Process Is Best Seen Using A Perpendicular CR With The Elbow in Acute Flexion and With The Posterior Aspect of The Humerus Adjacent To The Image Receptor
