Clavipectoral Fascia

Location and Attachments

The clavipectoral fascia lies deep in the infraclavicular region and is a continuation of the pectoral fascia (fascia pectoralis).

• Superiorly — attaches to the clavicle (clavicula) and the coracoid process of the scapula.
• Medially — originates near the origin of the pectoralis minor muscle.
• Inferiorly and laterally — fuses with the deep layer of the fascia of the pectoralis major muscle (fascia m. pectoralis major) at its lateral border.

Formed and Covered Structures

The clavipectoral fascia contributes to the formation of topographical spaces of the anterior chest wall and axillary region:

• Muscular sheaths — forms fascial sheaths for the pectoralis minor (m. pectoralis minor) and subclavius (m. subclavius) muscles.
• Subpectoral space (spatium subpectorale) — the fascia forms the posterior wall of this fascial cleft. The anterior wall is formed by the deep layer of the pectoralis major fascia.
• Anterior wall of the axilla — together with the pectoralis major and minor muscles, the fascia helps form and reinforce the anterior wall of the axillary fossa.
• Suspensory ligament of the axilla (lig. suspensorium axillae, Gerdy's ligament) — is a derivative of the clavipectoral fascia. It attaches to the deep surface of the axillary fascia along the lower border of the pectoralis major muscle, pulling the axillary fascia upward to maintain the concavity of the armpit.

Structures Piercing the Clavipectoral Fascia

The clavipectoral fascia spans between the clavicle and the apex of the axilla, allowing several key structures to pass through it:

• Branches of the thoracoacromial artery (a. thoracoacromialis) — the deltoid, pectoral, and acromial branches pierce the fascia to supply the corresponding muscles.
• Cephalic vein (v. cephalica) — passes through the fascia from the deltopectoral groove (sulcus deltoideopectoralis) into the axilla to drain into the axillary vein (v. axillaris).

Topography of the Infraclavicular Region

In the topography of the infraclavicular region, the clavipectoral fascia is intimately related to the subpectoral space, pectoral fascia, axillary fascia, endothoracic fascia, and axillary fat.

Relative to the subpectoral space:

1. The pectoralis major muscle (m. pectoralis major) lies superficial to the subpectoral space.
2. The subpectoral space (spatium subpectorale) lies deep to the pectoralis major muscle and contains loose connective tissue.
3. The clavipectoral fascia (fascia clavipectoralis) lies even deeper, forming the floor of the subpectoral space.
4. The clavipectoral fascia encloses the pectoralis minor muscle (m. pectoralis minor).

Deep structures of the infraclavicular region include the axillary vessels (a. et v. axillares) and the parietal pleura (pleura parietalis).

Clinical Significance

Suppurative infections can spread from the infraclavicular region into the axilla:

• Through fascial gaps or defects in the posterior wall of the subpectoral space (the clavipectoral fascia).
• Along the pathway of the branches of the thoracoacromial artery that pierce the clavipectoral fascia.