AL01 - Anatomy of the anterior chest wall & breast
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| Jugular notch | Notch located on the superior surface of the manubrium; easy to palpate
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| Manubrium | "handle"; located above sternum body
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| Sternal angle | between manubrium and body; important landmark, easy to palpate
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| Angle of Louis | sternal angle
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| 2nd rib attachment site | sternal angle/angle of Louis
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| Is the sternum flat? | No. The body of the sternum is in a different plane than the maubrium
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| Xiphoid process | Most inferior part of the sternum
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| When does the xiphoid process ossify? | Ages 20-40
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| Sternum contains the articulating surface for | Ribs 1-7 and the clavicle
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| Costal margin | Upside down V from ribs 7-10
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| Ribs attach to the sternum via | cartilage at the costochondral joint
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| How many ribs | 12
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| Intercostal space | space between ribs
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| Rib 12 intercostal space | doesn't exist; called the subcostal space
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| Mid-sternal line | line that goes from the jugular notch down the sternum (black)
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| Mid-clavicular lines | lines that go from middle of clavicle down through nipple
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| Subcostal line | runs along border of costal margin
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| Anterior axillary line | line down from lateral border of pectoralis major
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| Mid-axillary line | line down from apex of axilla (most commonly referenced)
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| Posterior axillary line | line down from scapula or latissmus dorsi muscle
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| Vertebra - how many? | 7 Cervical, 12 Thoracic, 5 lumbar, 5 sacral, and 4 coccyx: 33 total
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| Vertebral body | Large round anterior-most portion
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| Pedicle | between transverse process and vertebral body
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| Lamina | flat areas the form the posterior wall of the vertebral foramen
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| Transverse process | projections on either side of vertebra where the lamina and pedicle meet, between the superior and inferior articular processes
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| Spinous process | spiny process that sticks out posteriorly at the junction of the lamina (easy to palpate)
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| Vertebral foramen | space formed by lamina and pedicle, the spinal cord runs through
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| Articulating process | two each (superior and inferior), where laminae and pedicles meet
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| Articulating facet | area where rib attaches
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| Intervertebral notch | above and below pedicles (in articulated vertebrae, notches form foramen that the spinal nerves pass through)
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| Intervertebral disc | between adjacent vertebrae in the spine, a cartilaginous joint that allows movement and holds the vertebrae together
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| True ribs | 1-7; attach via costal cartilage directly to the sternum
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| False ribs | 8-10; attach to the costal cartilage of rib 7
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| Floating ribs | 11-12, do not attach anteriorly
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| Posteriorly a rib is attached a few intercostal spaces _____ the anterior attachment | above
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| Anteriorly a rib is attached a few intercostal spaces _____ the posterior attachment | below
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| Head | attaches to vertebra: wide section containing 2 articulating facets
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| Neck | thinner area between head and tubercle
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| Tubercle | bump that includes an articulating facet which connects with transverse process of vertebra
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| Angle | where rib bends anteriorly and inferiorly (curves down about 2 intercostal spaces from back to front)
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| Costal groove | depression on bottom inside of rib where intercostal neurovascular bundle is located
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| Coastal demifacets | Superior and inferior notches on the lateral posterior surface of the vertebral body where the head of the rib articulates
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| Describe attachment of typical ribs to vertebrae | Rib 5 articulates to T5 on T5's superior demifacet and T4's inferior demifacet. The tubercle articulates with the transverse process of T5
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| Langer lines | the natural orientation of collagen fibers in the dermis and epidermis
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| Clinical application of Langer Lines | surgeons may choose to cut parallel to Langer lines for better healing and less scarring
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| Lateral cutaneous nerves | lateral branches of intercostal nerves which travel to skin surface and help to form dermatomes
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| Pectoralis major attaches to | clavicle, sternum, ribs and humerus
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| Cephalic vein located between what two muscles? | deltoid and pectoralis major
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| clavipectoral/deltopectoral groove/triangle | bordered by i. pectoralis major ii. deltoid and iii. Clavicle
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| deltopectoral groove contains | cephalic vein
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| Pectoralis major innervation | lateral pectoral nerve and medial pectoral nerve
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| Describe lateral pectoral nerve innervation of pectoralis major | lateral pectoral nerve pierces clavipectoral fascia and innervates upper part of muscle
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| Describe medial pectoral nerve innervation of pectoralis major | goes through pectoralis minor before innervating pectoralis major
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| Clavipectoral fascia position | deep to pectoralis major
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| Describe lateral pectoral nerve course and neurovascular bundle | pierces the clavipectoral fascia and runs below the clavicle and above the pectoralis minor with the thoracoacromial artery and thoracoacromial vein
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| The thoracoacromial artery branches off | axillary artery
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| thoracoacromial vein drains into | axillary vein
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| Pectoralis minor position | imbedded in clavipectoral fascia
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| Pectoralis minor attaches at | coracoid process and to the upper ribs (2-5)
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| Pectoralis minor action | Raises the ribs (secondary respiratory) and droops the shoulder
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| Pectoralis minor innervation | medial pectoral nerve – pierces pectoralis minor to innervate lower part of pectoralis major as well
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| Breast located in what fascia? | Superficial fascia
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| Axillary tail | breast extension into the axilla (armpit)
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| Male nipple location | 4th intercostal space
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| Female nipple location | varies; lower than male nipples
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| Areola | circular pigmented area around nipple
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| Nipple | elevated area in middle of areola that contains 15
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| Areolar glands | small bumps around the nipple in the areola that keep the nipple supple and moist
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| Mammallary crease | area where the breast attaches to the anterior chest wall (around the 6th rib), does not move with aging even if the breasts themselves become more pendulous
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| Glands of Montgomery | Areolar glands
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| Retromamallary space | space between the deep fascia of the pectoralis major and the breast upon which the breast is relatively mobile
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| Suspensory ligaments | holds breast in contour and attaches to the dermis of the skin and breast tissue but doesn’t attach to the deep fascia
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| Ligaments of Cooper | Suspensory ligaments
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| Internal anatomy of breast | 15-20 secretory units arranged radially with lactiferous sinuses toward the nipple
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| Milk line | Mammals can develop breast tissue on a line from the chest to the groin (e.g. cats and cows)
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| Polymastia | extra breasts – commonly alng axilla
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| Polythelia | extra nipples (most common)
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| Gynecomastia | male breasts (feminization)
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| Blood supply to the breast | Lateral thoracic artery - left lateral side of breast; internal thoracic (mammary) artery - medial side of breast
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| Lateral thoracic artery | comes off axillary artery laterally and supplies lateral side of breast
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| Axillary artery | subclavian artery after it runs past the first rib
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| Internal thoracic (or mammary) artery | comes off subclavian artery medially and supplies medial side of breast (located inside chest plate)
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| Best exam: Lump | tumor (or abscess or cyst)
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| Best exam: Dimpling | invasion of suspensory ligaments (or injury)
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| Best exam: Inverted (retracted) nipple | inversion of lactiferous ducts (occurs naturally in 10% of women)
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| Best exam: Peu d’orange (rough, hard, yellow skin resembling an orange peel) | blockage of subcutaneous lymphatics; sweat glands become more prominent
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| Best exam: Warmth | vascular signs (secondary to tumor recruiting blood vessels)
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| Best exam: Less mobile | invasion of underlying deep fascia of pectoral muscles
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| Breast Lymphatics (2 major drainages) | Axillary lymph drainage (more important), Parasternal lymph drainage
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| Which breast lymph drainage is more important? Why? | Axillary lymph drainage because breast cancer has a tendency to metastasize here
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| Parasternal lymph drainage runs | with the internal thoracic artery and vein
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| Where do the breast lymphatic drainages drain? | into the clavicular nodes
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| Where do the clavicular lymphatic nodes drain? | into the large veins of the neck
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| Pectoralis minor location | deep to pectoralis major and clavipectoral fascia
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| Pectoralis major origin | Sternal 1/2 of clavicle, sternum to 7th rib, aponeurosis of external oblique muscle
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| Pectoralis major insertion | Crest of greater tubercle of humerus: Lateral lip of bicipital grove.
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| Pectoralis major action | Clavicular (upper) fibers = flexion of humerus; Sternocostal (middle and lower) fibers = extension of humerus returning from flexion; Adduction, medial rotation
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| Pectoralis minor origin | Ribs 3-5
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| Pectoralis minor insertion | Coracoid process of scapula
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| Pectoralis minor action | Tilts scapula forward, depresses and abducts scapula, Pulls shoulder forward when rhomboids are weak
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| Innermost intercostal muscles give rise to | transversus thoracis muscles
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| transversus thoracis muscles function | hold down the internal thoracic artery
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| Nerves that supply the intercostal muscles run between | innermost intercostals and the internal intercostals
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