1

A patient suffers a puncture wound in the back just lateral to the 2nd

thoracic vertebra. The puncture wound courses until it hits the

erector spinae muscle group. From superficial to deep, identify the

correct order of muscles hit by the protruding object.

Tra

peziu

s, la

tissi

mus.

..

Tra

peziu

s, rhom

boids.

..

Tra

peziu

s, rhom

boid..

Tra

peziu

s, rhom

boids.

..

Tra

peziu

s, rhom

boids.

..

20% 20% 20%20%20%

A. Trapezius, latissimus dorsi, rhomboids, erectorspinae m.

B. Trapezius, rhomboids, serratus posteriorsuperior, splenius ., errector spinae m.

C. Trapezius, rhomboids, splenius m, erectorspinae m.

D. Trapezius, rhomboids, serratus posteriorsuperior, erector spinae m.

E. Trapezius, rhomboids, splenius m., serratusposterior superior, erector spinae m.

Anterior Chest Wall

• Anterior Chest Wall

-Osteology (dry lab)

-Gray’s pp. 118-126

-Gray’s Dissector pp. 49-54

-Anterior Chest Wall

-Gray’s pp. 115-135; 333-336

-Gray’s Dissector pp. 55-72

2

Skin of the Anterior Chest Wall

Syllabus p. 30

Lines of the Thoracic Wall

Syllabus p. 30

3

Breasts

Female Male

Syllabus p. 31

Anatomy of the Female Breast

Syllabus p. 31

4

Innervation of the Breast

Blood Supply of the Breast

Syllabus p. 31

5

Lymphatics of the Breast

Syllabus p. 31

The Lymphatic System

-Capillaries-Vessels-Nodes-Lymphocytes

The Lymphatic System

-Capillaries-Vessels-Nodes-Lymphocytes

6

Lymphatic Ducts

-Thoracic Duct-Right Lymphatic Duct

Lymphatics of the Right Breast

7

Lymphatics of the Left Breast

Cancer develops in the right breast of a 34 year old woman. The woman

experiences a loss of sensation in her nipple. Which nerve is likely affected

by the tumor?

T1

T2

T3

T4

T5

20% 20% 20%20%20%

A. T1

B. T2

C. T3

D. T4

E. T5

8

Lymphatic drainage to the right upper quadrant of the breast is also

compromised. Which of the following lymph nodes are more greatly

affected?

Max

illar

y ly

mph n

odes..

Par

aste

rnal

lym

ph n...

Inte

rcost

al ly

mph n

od..

Axi

llary

lym

ph nodes

..

Inte

rcost

al ly

mph n

od..

20% 20% 20%20%20%

A. Axillary lymph nodes - Right lymphaticduct

B. Parasternal lymph nodes - Rightlymphatic duct

C. Intercostal lymph nodes – Rightlymphatic duct

D. Axillary lymph nodes – Thoracic duct

E. Intercostal lymph nodes – Thoracic duct

Muscles of the Thoracic Wall

-Pectoralis Muscles*-Serratus Anterior Muscles*-Subclavius*-Intercostals*-Transversus Thoracis-Subcostalis-Diaphragm

Syllabus pp. 32

9

Pectoralis Major and Minor

Innervation of the Pectoralis Major and Minor

10

Innervation of the Pectoralis Major

Serratus Anterior

11

The Lateral Thoracic Artery (Serratus Anterior)

Subclavius

12

Innervation of the Subclavius

A mastectomy is used to remove a cancerous tumor from a 46 year old

woman. The procedure involves excision of the breast tissue to the

pectoralis major muscle, associated fascia, and into the medial axillary wall.

After the procedure the woman has a noticeable winged scapula. The

following nerve is most likely damaged:

Spin

al a

cces

sory

n.

Lat

eral

pec

tora

l n.

Long th

oraci

c n.

Dors

al s

capula

r n.

Med

ial p

ecto

ral n

.

20% 20% 20%20%20%

A. Spinal accessory n.

B. Lateral pectoral n.

C. Long thoracic n.

D. Dorsal scapular n.

E. Nerve to the subclavius.

13

Intercostal Muscles

Intercostal Nerves and Vessels

14

Clinical Correlates

FYI: Diaphragm will be discussed

in the next lecture

15

Arteries of the Thorax

Syllabus p. 33

Veins of the Thorax

Syllabus p. 34

16

SCREEN 2

Trapezius

17

Trapezius, Rhomboid m., Serratus Posterior Superior, Splenius m.

Trapezius, Rhomboid m., Serratus Posterior Superior, Splenius m.,

Deep Muscles of Back

18

Segmental Innervation of the

Anterior Skin

19

The Female Breast

20

Innervation of the Breast

Blood Supply of the Breast

21

Lymphatics of the Right Breast

22

Lymphatics of the Left Breast

23

Innervation of the Pectoralis Major and Minor

24

Serratus Anterior

Subclavius

25

Intercostal Muscles

26

Intercostal Nerves and Vessels