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Anatomy

Upper Limb

Question 99 of 239

A 23 year old gymnast presents to the ED following a fall in training. She is complaining of pain over the left pectoralis muscle. During examination you note her shoulder movements are abnormally weak. The pectoralis major muscle acts to produce which of the following movements:

Answer:

Acting together, the two heads of the pectoralis major flex, adduct and medially rotate the arm at the glenohumeral joint.

Pectoralis Major Muscle

Anatomy / Upper Limb / Pectoral Region

Last Updated: 8th April 2019

The pectoralis major is the largest and most superficial muscle of the anterior wall. Its inferior margin underlies the anterior axillary fold, which marks the anteroinferior border of the axilla.

Table: Function and Innervation of the Pectoralis Major Muscle

Muscle Pectoralis Major
Origin Clavicular head: Medial half of clavicle

Sternocostal head: Medial part of anterior thoracic wall (anterior surface of sternum, first seven costal cartilages, sternal end of sixth rib, aponeurosis of external oblique)
Insertion Lateral lip of intertubercular sulcus of humerus
Function Flexion, adduction and medial rotation of arm at glenohumeral joint
Innervation Medial and lateral pectoral nerves

Origin

The muscle has two heads:

  • the clavicular head originates from the anterior surface of the medial half of the clavicle
  • the sternocostal head originates from the medial part of the anterior thoracic wall (the anterior surface of the sternum, the first seven costal cartilages, the sternal end of sixth rib and the aponeurosis of the external oblique)

Insertion

The muscle inserts into the lateral lip of the intertubercular sulcus of the humerus.

Function

Acting together, the two heads of the pectoralis major flex, adduct and medially rotate the arm at the glenohumeral joint.

Innervation

The pectoralis major is innervated by the medial and lateral pectoral nerves which originate from the brachial plexus in the axilla.

Fig 1.1 Pectoralis Major Muscle Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Pectoralis Major Muscle. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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