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Distal insertion of the clavicular portion of pectoralis major muscle: anatomical study

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Abstract

Purpose

Several descriptions of the anatomy of the pectoralis major (PM) have been published. However, the precise description of its distal humeral insertion, which is involved in traumatic tears, remains controversial. The distal tendon is classically described as being made of two layers, one anterior (ALPM) and one posterior (PLPM), which regroup at their distal edge. The clavicular head (CH) participates in the ALPM according to most authors. However, others describe a more superficial termination in a close relationship with the deltoid humeral insertion. The objective of this anatomical work is to precisely describe the anatomy of the CH and its relationship with the rest of the distal PM tendon and the distal deltoid tendon.

Materials

Twenty-three fresh cadaveric specimens were dissected (41 shoulders). The entire PM as well as the deltoid were exposed. Several measurements were collected to establish the relationships between the distal tendon of the CH and the PM, the deltoid and the bony landmarks.

Results

In all cases, the CH muscular portion sits on the ALPM but does not participate in the connective structure of the PM distal tendon. The inferolateral part of its distal end gives a thin tendinous portion that inserts lower on the humerus in conjunction with the distal tendon of the deltoid. In 24.4%, this tendon was more difficult to isolate but was always observed.

Conclusions

The distal tendon of the PM only comes from the muscle fibres of its sternal head. The CH fibres do not contribute to this tendon but appear to terminate in a separate tendon fusing with the humeral insertion of the deltoid: the deltopectoral tendon. This could explain the different patterns of tears observed in clinical practice.

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Acknowledgements

We thank the Surgery School of Paris (Fer à Moulin) for allowing us to conduct this study.

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Authors and Affiliations

  1. Medical Clinic Ambroise Paré, 92200, Neuilly sur seine, France

    Héléna Guerra Bresson, Renaud Guiu, Laurent Bourcheix, Téodor Grand, Marc Juvenspan & Charles Schlur

  2. Ambroise Paré Hospital, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France

    Jean-David Werthel

  3. Polyclinic of the Ormeau, ELSAN, 65000, Tarbes, France

    Vincent Martinel

  4. Surgery School, 17 rue du Fer à Moulin, 75005, Paris, France

    Laurent Bourcheix

Authors
  1. Héléna Guerra Bresson
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  2. Renaud Guiu
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  3. Jean-David Werthel
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  4. Vincent Martinel
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  5. Laurent Bourcheix
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  6. Téodor Grand
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  7. Marc Juvenspan
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  8. Charles Schlur
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Contributions

All authors contributed to the study’s conception and design. Dissection and data collection were performed by Guerra Bresson Héléna, Schlur Charles, Guiu Renaud, Juvenspan Marc and Bourcheix Laurent. Analysis was performed by Grand Téodor. Schemes were drawn by Martinel Vincent. The first draft of the manuscript was written by Guerra Bresson Héléna and adjusted by Werthel Jean-David. All authors commented on previous versions of the manuscript, read and approved the final manuscript

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Correspondence to Héléna Guerra Bresson.

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Guerra Bresson, H., Guiu, R., Werthel, JD. et al. Distal insertion of the clavicular portion of pectoralis major muscle: anatomical study. International Orthopaedics (SICOT) 48, 1071–1077 (2024). https://doi.org/10.1007/s00264-023-06083-3

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  • DOI: https://doi.org/10.1007/s00264-023-06083-3

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