The Kidney (KI)
Narda G. Robinson in Interactive Medical Acupuncture Anatomy, 2016
Clinical Relevance: The pectoral nerves exhibit wide variability in their course, origin communications with other nerves, and presence or absence of sensory fibers.4 They are susceptible to injury from direct trauma, compression from hypertrophied musculature, and iatrogenic injury during mastectomy and breast augmentation. Chronic pain affects up to half of patients undergoing augmentation mammoplasty. The pain centers on the breasts or refers to other regions, including the sternum, infraclavicular tissue, lateral chest wall to the axilla, or interscapular territory on the back.5 Sternal pain likely results from traction on the lateral pectoral nerve during surgery, given that the nerve supplies both the clavicular and sternal portions of the pectoralis major muscle. Before pursuing invasive methods to treat neuralgia affecting the intercostal or pectoral nerves, acupuncture, manual therapy, and laser therapy (for nonmalignant conditions) should be considered. Caution is warranted, however, with needling near breast implants.
Complications of upper extremity bypass grafting for occlusive and aneurysmal disease
Sachinder Singh Hans, Mark F. Conrad in Vascular and Endovascular Complications, 2021
The axillary artery can be exposed for bypass from the infraclavicular or delta-pectoral approaches. For the infraclavicular approach, the patient is positioned with the arm extended, and a shoulder roll is placed to help with exposure. The incision is made a finger breadth (1–2 cm) below the middle third of clavicle, and the pectoral fascia is divided. The pectoralis major muscle fibers are separated in the direction of the incision. This exposes the clavipectoral fascia, which is divided to reveal the axillary neurovascular bundle. The pectoralis minor is retracted laterally to improve exposure. The vascular structures encountered will be the axillary vein first as it is anterior to the artery, which is posterior and superior to the vein. Overlying vein branches are ligated and the vein is retracted inferiorly to expose the artery. The brachial plexus usually lies deep to the axillary artery and should be identified to avoid an inadvertent clamp injury. At this juncture, the artery can be dissected free. The lateral pectoral nerve can cross the axillary artery and should be identified to avoid injury.
Pectoral Region and Breast
Gene L. Colborn, David B. Lause in Musculoskeletal Anatomy, 2009
The medial pectoral nerve is so named because it arises from the medial cord of the brachial plexus, to be described later. The lateral pectoral nerve arises from the lateral cord of the brachial plexus. Because of a communication between the lateral and medial pectoral nerves after arising from the plexus, each nerve probably contributes to the innervation of both the pectoralis major and minor. Damage to the lateral pectoral nerve may selectively paralyze the clavicular part of the pectoralis major.
Application of CUBE-STIR MRI and high-frequency ultrasound in contralateral cervical 7 nerve transfer surgery
Published in British Journal of Neurosurgery, 2023
Ai-Ping Yu, Su Jiang, Hua-Li Zhao, Zong-Hui Liang, Yan-Qun Qiu, Yun-Dong Shen, Guo-Bao Wang, Chunmin Liang, Wen-Dong Xu
On high-frequency ultrasound it was unfeasible to image the whole C7 nerve because its anterior and posterior divisions join into cords behind the clavicle (Figure 3A). However, ultrasonography could show supraclavicular brachial plexus and identify small branches from the region between the C7 intervertebral foramen and the clavicle and could image their course. For example, we found a small branch form the middle trunk which was about 3 cm from intervertebral foramen when the ultrasound was used to scan cross sections of C7 nerve (Figure 3B). In fact, a small branch was found during the surgery, which was exactly derived from the middle trunk about 3 cm distant from the intervertebral foramen (Figure 3C, D). Then, intra-operative EMG was performed to confirm the branch as the lateral pectoral nerve (LPN) derived from the middle trunk to innervate pectoralis major. Commonly, pectoralis major branches are derived from anterior divisions of upper and middle trunk, which makes it feasible to detect anatomic variation of the branches of supraclavicular C7 nerve through ultrasound.
Everything pectoralis major: from repair to transfer
Published in The Physician and Sportsmedicine, 2020
Kamali Thompson, Young Kwon, Evan Flatow, Laith Jazrawi, Eric Strauss, Michael Alaia
The pectoralis major is a triangular muscle that lies anterior to the subscapularis and coracobrachialis and inferior to the deltoid [30]. It contains two heads: the superior clavicular head and the inferior sternocostal head. The clavicular head originates at the anterior border of the medial half of the clavicle, from which the fibers run laterally in a downward direction. It is innervated by the lateral pectoral nerve (C5-C7), which exits the lateral cord of the brachial plexus medial to the pectoralis minor, travels with the pectoral branch of thoracoacromial artery, and enters the pectoralis major at a mean of 12.5 cm medial to the humeral insertion (95% confidence interval 10–14.9 cm) [4,30,31]. The primary role of the clavicular head is forward flexion, adduction, and internal rotation of the humerus. The clavicular head is also partially responsible for abduction once the arm is abducted to 90° and adduction with the arm below 90°.
Role of Intraoperative Nerve Monitoring in Postoperative Muscle and Nerve Function of Patients Undergoing Modified Radical Mastectomy
Published in Journal of Investigative Surgery, 2021
Serhat Tokgöz, Ebru Karaca Umay, Kerim Bora Yilmaz, Muzaffer Akkoca, Melih Akinci, Cem Azili, Mehmet Saydam, Yasin Ucar, Şener Balas
Radical mastectomy, which was long performed in breast cancer surgery, was replaced by modified radical mastectomy (MRM) in the 1970s. Breast-conserving surgery and oncoplastic surgical treatment protocols adopted in recent years have gained importance in the treatment of breast cancer [1, 2]. Despite these improvements in breast cancer treatment, MRM remains an important surgical treatment protocol [3]. The most common early complications of MRM are seroma formation, surgical site infection, flap necrosis, hematoma, and other major complications that are more important and permanent including nerve injuries, shoulder and arm impairments, and lymphedema [4, 5]. Problems related to nerve injury in patients undergoing axillary dissection are common in clinical practice. Radiotherapy may also cause nerve and muscle injuries. During MRM, there is a risk of injury to four nerves with motor functions: lateral pectoral nerve (LPN), medial pectoral nerve (MPN), thoracic longus nerve (TLN), and thoracodorsal nerve (TDN). The incidence of nerve injury related to breast cancer surgery is often unrecognized and underdiagnosed if specific physical examination and tests are not employed. No study to date has shown the incidence of injury of the MPN, LPN, and TDN nerves in breast cancer surgery in the literature; however, the incidence of TLN injury is reportedly 0.6–74.7% [6].
Related Knowledge Centers
- Axillary Artery
- Brachial Plexus
- Breast Augmentation
- Clavipectoral Fascia
- Lateral Cord
- Medial Pectoral Nerve
- Motor Neuron
- Nociception
- Proprioception
- Pectoralis Major