Upper Limb. Clavipectoral Fascia
Prepladdder anatomy upper limb video 9 clavipectoral fascia
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00:00clavipectoral fascia as the name is suggesting it is a fascia between the
00:09clavicle bone and one pectoral muscle pectoral minor muscle fascia is
00:14basically sheet of collagen fibers and in this case it is starting from the
00:19clavicle bone running inferiorly towards the pectoralis minor muscle has the name
00:25clavipectoral fascia it will be splitting and enclosing the pectoral
00:29minor muscle and then even continues inferiorly towards the floor of the
00:34axilla we'll be talking about that in a diagram where we also have to describe
00:39some of the structures which will be piercing the clavipectoral fascia so for
00:44example there is a vein which is running at the roof of the anatomy because the
00:48box the cephalic vein and it keeps running laterally on the forearm and the
00:53arm region subsequently it has to drain into the axillary vein in the axilla but
01:00to reach here it has to puncture clavipectoral fascia and drains into the
01:04axillary vein in the axilla we have axillary artery also giving a branch
01:09thoracoacromial artery which will be then puncturing the clavipectoral fascia
01:14and supplying the thorax region a nerve also is piercing the clavipectoral fascia
01:20lateral pectoral nerve coming from the lateral caudal brachial plexus in the
01:25axilla this lateral pectoral nerve has to supply a large muscle here pectoral
01:30major muscle so let us look at some of the diagrams and then draw one schematic
01:35diagram ourselves as well as we look from the front view this is the location
01:40of clavipectoral fascia as we can make out this is the right-sided clavicle and
01:46running from there a fascia is moving towards the pectoral minor muscle hence
01:52the name clavipectoral fascia we can demonstrate a magnified view of the
01:57clavicle in this diagram you see this is the right-sided clavicle bone and then
02:02we can look at the pectoral minor muscle as well which is taking its origin from
02:08the rib number three four and five having three digitations as the origin
02:14this muscle is moving towards the scapula bone so where does it insert on
02:19the scapula bone as we follow the fibers it is understood that it will be
02:24reaching the superior surface of the coracoid process of the scapula that is
02:29the insertion now once we have seen the attachment of the muscle this is the
02:33fascia which we are talking about between the clavicle bone and the
02:37pectoral minor muscle the clavipectoral fascia here we can see some of the
02:42structures piercing through the clavipectoral fascia which we have to
02:46discuss but along with that we should mention this fascia as it begins from
02:51the clavicle region it will be splitting and enclosing one muscle which lies
02:56inferior to the clavicle bone and hence called as the subclavius muscle so after
03:01splitting and enclosing the subclavius muscle the two lamina they fuse and once
03:06again split and enclose the next muscle which is pectoral minor muscle once they
03:11have traversed through the pectoral minor muscle the two lamina of the
03:16fascia again fuse and continue downwards towards the floor of the axilla and
03:21there it is merging with the axillary fascia this part of the fascia which
03:27lies between the pectoralis minor muscle and the floor of the axilla is called as
03:32the suspensory ligament of axilla this ligament is important because it will
03:38keep pulling on the floor of the axilla upwards and securing the contents of the
03:44axilla like brachial plexus, axillary artery and veins because if this upward
03:49pull is not there and the structures are just loose that will increase chances of
03:54injury to the content of axilla so they must be secured and that is where the
03:59suspensory ligament is helping to pull the floor of the axilla upwards
04:04securing the neurovascular structures here in the axilla comes as a question
04:08about the suspensory ligament of axilla will be drawing one schematic diagram
04:13for that as well now at the moment we wanted to discuss what are the
04:17structures piercing the clavipectoral fascia and one of that we have discussed
04:22was the cephalic vein you see the cephalic vein runs on the roof of an
04:27anatomical sub box laterally on the forearm on the arm and then it has to
04:32puncture clavipectoral fascia to enter a vein in the axilla the axillary vein
04:37and that is where we are now zooming up on the right-sided clavipectoral fascia
04:42in this particular diagram and as we do that this is the cephalic vein shown here
04:48entering into the axillary vein after piercing clavipectoral fascia you can
04:53also show the axillary vein running in the axilla here so this is the axillary
04:58vein running in the axilla receiving the cephalic vein and along with this
05:02axillary vein in the axilla we have the axillary artery as well axillary artery
05:07was giving a branch thoracoacromial artery which is seen here piercing the
05:13clavipectoral fascia along with cephalic vein and then there is one nerve as well
05:19as evident here called as the lateral pectoral nerve and this lateral pectoral
05:25nerve is supposed to be a branch from the lateral caudo-brachial plexus lying
05:31in the axilla sending the lateral pectoral nerve to supply the pectoralis
05:36major muscle remember pectoralis major muscle is a large muscle having two
05:41nerves supplying it lateral pectoral nerve and medial pectoral nerve,
05:46then what about the pectoralis minor muscle which nerve is supplying
05:50pectoralis minor it is supplied by medial pectoral nerve so medial pectoral
05:54nerve will supply two muscles pectoral major as well as pectoralis minor but
05:59this lateral pectoral nerve which was piercing clavipectoral fascia is not
06:03supplying pectoralis minor it will be supplying only pectoralis major muscle
06:08along with this neurovascular bundle there are some axillary lymphatics also
06:13piercing the clavipectoral fascia. Now we need a schematic diagram to revise the
06:18details. Now we are going to take one parasagittal section so as to discuss
06:24the details of clavipectoral fascia. See if you are passing through the midline
06:28of the body anterior to posterior it is mid-sagittal section as evident here but
06:34if we are taking a section anteroposterior in a lateral plane then
06:39how does it appear? For that let me mention that this sagittal section was
06:44not taken in the median plane anteroposteriorly but at a slightly
06:50lateral plane where you have these structures piercing the clavipectoral
06:54fascia so it is not mid-sagittal it is parasagittal section in
06:59anteroposterior direction. Now as it is understood which is the first muscle we
07:04are going to see focusing upon the right side the pectoral major muscle which you
07:09can show here in this parasagittal section anterior to posterior the most
07:14anterior muscle in the thorax region is pectoral major covered by pectoral fascia
07:20and which muscle will be deeper to that it will be the pectoral minor so
07:24undercover of pectoral major we have pectoral minor this is the same diagram
07:29which we are showing here now in a magnified view so as we understand the
07:34bone which we were focusing upon was the clavicle bone as evident here and below
07:40the clavicle we were having a muscle subclavius muscle and what happens is
07:46the clavipectoral fascia begins from its attachment to the clavicle to split
07:51and enclose the subclavius muscle and then the two lamina will fuse with each
07:55other but again to split and enclose the next muscle under cover of pectoral major
08:00the pectoralis minor muscle and after splitting and enclosing the pectoral
08:05minor will continue down towards the floor of the axilla so as to fuse with
08:11the axillary fascia we also need to draw this diagram ourselves where we
08:17will not only be talking about pectoral minor but the pectoralis major as well
08:21and the two fascia one covering anteriorly the pectoral fascia and the
08:26one which is deeper clavipectoral fascia and in our diagram we also have to show
08:31the various structures which will be piercing the clavipectoral fascia so let
08:36us first begin with the clavicle bone in a parasagittal section as you showed
08:41here under the clavicle bone we have got a muscle named accordingly the
08:46subclavius muscle and then we also have to mention continuation of the deep
08:51cervical fascia from the neck region it attaches to the clavicle bone so here is
08:57the investing layer of the deep cervical fascia coming from neck region attaching
09:03to the clavicle bone and it will continue over large muscle which
09:07attaches to clavicle anterior surface the pectoral major muscle now once we
09:13have drawn the pectoral major let us show the fascia covering it which is now
09:18called as the pectoral fascia and it will reach the floor of the axilla to
09:23become continuous with the axillary fascia now once we have shown it we can
09:28talk about the clavipectoral fascia as well which will begin from the clavicle
09:32bone split to enclose the subclavius muscle then the two lamina will be
09:37fusing but once again splitting and enclosing another muscle pectoralis minor
09:42muscle and after enclosing that muscle the two lamina they fuse together
09:48continue downward and fuse with the axillary fascia at the floor of the
09:53axilla and it is this portion of the fascia which is called as the
09:57suspensory ligament of the axilla which will keep pulling at the floor of the
10:02axilla so as to secure the content of the axilla the neurovascular bundle
10:06present in the axilla so this is the suspensory ligament of axilla and then
10:12what are the structures which were piercing the clavipectoral fascia as we
10:17remember there is a vein which will enter the cephalic vein into this larger
10:22vein called as the axillary vein after piercing the clavipectoral fascia so
10:27this is a cephalic vein entering the axillary vein along with the axillary
10:30vein in the axilla we have got axillary artery giving a branch thoracoacromial
10:36artery so let us show that here the axillary artery giving a branch
10:41thoracoacromial branch can be mentioned here there was one nerve also which was
10:47piercing the clavipectoral fascia coming from the lateral cord of brachial
10:52plexus so let us show it here the lateral cord of brachial plexus giving
10:57us the lateral pectoral nerve and even this lateral pectoral nerve is piercing
11:02the clavipectoral fascia and then obviously it is going to supply the
11:07pectoral major muscle as we have mentioned lateral pectoral nerve do not
11:12supply the pectoral minor muscle so this was the lateral cord of brachial plexus
11:17all of these are content of the axilla there will be some axillary lymphatics
11:21also which will be piercing the clavipectoral fascia that you need to
11:25remember