Pectoralis major muscle

Fig. 4.20 A Incision carried down to the surface of the pectoralis major muscle and its orientation with respect to the deltopectoral groove noted. B Insert demonstrating the deltopectoral groove and orientation of the lateral border of the clavicular head of the pectoralis major. (From Belott PH. Blind axiUar venous access. Pacing Clin Electrophysiol 1999 22(7) 1085-1089, with permission.)...

Blind puncture through pectoralis major muscle using deep landmarks... 

Edge sternal head of pectoralis major muscle... 

Fig. 4.51 Deltopectoral groove subpectoral approach. The lateral border of the pectora-Us major clavicular head is gently retracted and a plane of dissection established medially behind the pectoralis major muscle. (From Belott PH, Reynolds DW. Permanent pacemaker and cardioverter defibrillation implantation. In Ellenbogen KA, Kay N, WUkoff BL, eds. Clinical cardiac pacing and defibrillation, 2nd ed. Philadelphia WB Saunders, 2(XX), with permission.)...

Reflecting the lateral clavicular head of the pectoralis major muscle creates the lateral submuscular approach. In this case, an initial vertical incision is made along the deltopectoral groove. The dissection is carried down to the snrface of the pectoralis fascia. The lateral border of the pectoralis major clavicnlar head is retracted medially and a subpectoralis major muscle plane of dissection established. 

The lateral anterior axillary submuscular pectoral approach calls for creation of a dissection plane in the anterior axillary fold (104). A dissection plane is easily established as the pectoralis major is separated at the planes created between the pectoralis major and minor muscles. A skin incision is created inferiorly along the anterolateral axillary fold. It is carried down to the surface of the pectoralis major muscle. Both the pectoralis major and minor muscles are identified and separated and a plane of dissection is created between them. This approach usually requires a separate incision for venous access and tunneling to the axillary fold ineision. The inferolateral margin of the pectoralis major muscle is easily separated from the adjacent subcutaneous tissue for establishing a large plane of dissection. The ICD should be placed as medial as possible with the leads lateral to avoid the risk of CAN abrasion. With the ICD or pacemaker in the pocket, a careful multilayered closure is used. 

It is typical to find somatic dysfunction in the upper thoracic region, both of the vertebrae and their ribs. Upper cervical somatic dysfunction is often present. A fairly common finding is that of a trigger point in the left pectoralis major muscle. 

Fig. 6.61a,b.Normal brachial plexus infraclavicular region. Oblique transverse 12-5 MHz US images obtained under the clavicle a over the major axis of the axillary artery (AA) and b immediately behind it. The cords of the brachial plexus (open and white arrowheads) are visualized as elongated fascicular structures coursing around the axillary artery and deep to the pectoralis minor muscle (Pm). PMj, pectoralis major muscle. The insert at the upper left side of the figure indicates transducer positioning... 

Aarimaa V, Rantanen J, Heikkila J et al (2004) Rupture of the pectoralis major muscle. Am J Sports Med 32 1256-1262... 

Connell DA, Potter HG, Sherman ME et al (1999) Injuries of the pectoralis major muscle evaluation with MR imaging. Radiology 210 785-791... 

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