Henry Gray (18251861). Anatomy of the Human Body. 1918.
cartilages of all the true ribs, with the exception, frequently, of the first or seventh, or both, and from the aponeurosis of the Obliquus externus abdominis. From this extensive origin the fibers converge toward their insertion; those arising from the clavicle pass obliquely downward and lateralward, and are usually separated from the rest by a slight interval; those from the lower part of the sternum, and the cartilages of the lower true ribs, run upward and lateralward; while the middle fibers pass horizontally. They all end in a flat tendon, about 5 cm. broad, which is inserted into the crest of the greater tubercle of the humerus. This tendon consists of two laminæ, placed one in front of the other, and usually blended together below. The anterior lamina, the thicker, receives the clavicular and the uppermost sternal fibers; they are inserted in the same order as that in which they arise: that is to say, the most lateral of the clavicular fibers are inserted at the upper part of the anterior lamina; the uppermost sternal fibers pass down to the lower part of the lamina which extends as low as the tendon of the Deltoideus and joins with it. The posterior lamina of the tendon receives the attachment of the greater part of the sternal portion and the deep fibers, i. e., those from the costal cartilages. These deep fibers, and particularly those from the lower costal cartilages, ascend the higher, turning backward successively behind the superficial and upper ones, so that the tendon appears to be twisted. The posterior lamina reaches higher on the humerus than the anterior one, and from it an expansion is given off which covers the intertubercular groove and blends with the capsule of the shoulder-joint. From the deepest fibers of this lamina at its insertion an expansion is given off which lines the intertubercular groove, while from the lower border of the tendon a third expansion passes downward to the fascia of the arm.
Variations.The more frequent variations are greater or less extent of attachment to the ribs and sternum, varying size of the abdominal part or its absence, greater or less extent of separation of sternocostal and clavicular parts, fusion of clavicular part with deltoid, decussation in front of the sternum. Deficiency or absence of the sternocostal part is not uncommon. Absence of the clavicular part is less frequent. Rarely the whole muscle is wanting.
Costocoracoideus is a muscular band occasionally found arising from the ribs or aponeurosis of the External oblique between the Pectoralis major and Latissimus dorsi and inserted into the coracoid process.
Chondro-epitrochlearis is a muscular slip occasionally found arising from the costal cartilages or from the aponeurosis of the External oblique below the Pectoralis major or from the Pectoralis major itself. The insertion is variable on the inner side of the arm to fascia, intermuscular septum or internal condyle.
Sternalis, in front of the sternal end of the Pectoralis major parallel to the margin of the sternum. It is supplied by the anterior thoracic nerves and is probably a misplaced part of the pectoralis.
Coracoclavicular Fascia (fascia coracoclavicularis; costocoracoid membrane; clavipectoral fascia).The coracoclavicular fascia is a strong fascia situated under cover of the clavicular portion of the Pectoralis major. It occupies the interval between the Pectoralis minor and Subclavius, and protects the axillary vessels and nerves. Traced upward, it splits to enclose the Subclavius, and its two layers are attached to the clavicle, one in front of and the other behind the muscle; the latter layer fuses with the deep cervical fascia and with the sheath of the axillary vessels. Medially, it blends with the fascia covering the first two intercostal spaces, and is attached also to the first rib medial to the origin of the Subclavius. Laterally, it is very thick and dense, and is attached to the coracoid process. The portion extending from the first rib to the coracoid process is often whiter and denser than the rest, and is sometimes called the costocoracoid ligament. Below this it is thin, and at the upper border of the Pectoralis minor it splits into two layers to invest the muscle; from the lower border of the Pectoralis minor it is continued downward to join the axillary fascia, and lateralward to join the fascia over the short head of the Biceps brachii. The coracoclavicular fascia is pierced by the cephalic vein, thoracoacromial artery and vein, and external anterior thoracic nerve.