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Clavipectoral triangle

The clavipectoral triangle, also known as the deltopectoral triangle or Mohrenheim's triangle, is a superficial anatomical region located at the anterosuperior aspect of the shoulder, bounded superiorly by the clavicle, laterally by the anterior border of the deltoid muscle, and medially by the clavicular head of the pectoralis major muscle.^[1] This triangular space overlies the deltopectoral groove and is covered by subcutaneous tissue and skin, with the underlying clavipectoral fascia providing structural support.^[2] Key contents of the clavipectoral triangle include the cephalic vein, which courses through the deltopectoral groove between the deltoid and pectoralis major muscles before piercing the clavipectoral fascia to join the axillary vein.^[2]^[1] Additionally, it transmits the pectoral branches of the thoracoacromial artery and vein, which supply the overlying pectoralis major and deltoid muscles, as well as deltopectoral lymph nodes that drain the upper limb and adjacent thoracic wall.^[2] The clavipectoral fascia, a strong fibrous sheet deep to the pectoralis major, encloses these structures and extends inferiorly to invest the subclavius and pectoralis minor muscles.^[2] Clinically, the clavipectoral triangle is significant as a landmark for venipuncture via the cephalic vein^[3] and for lymphatic assessment, particularly in breast cancer staging due to the role of its lymph nodes in axillary drainage.^[4] It also serves as the entry point for the deltopectoral surgical approach, commonly used in shoulder arthroplasty, fracture fixation of the proximal humerus, and access to the glenohumeral joint, minimizing damage to neurovascular structures.^[1]

Anatomy

Definition and Location

The clavipectoral triangle is a triangular anatomical space situated in the superficial anterior region of the shoulder.^[5] It is also referred to as the deltopectoral triangle, trigonum clavipectorale, trigonum deltopectorale, or Mohrenheim's triangle.^[6] The term derives from "clavi-" referring to the clavicle and "pectoral" relating to the chest or pectoralis muscles. This region is positioned at the junction between the deltoid and pectoral areas of the upper limb, lying immediately inferior to the clavicle and lateral to the sternoclavicular joint.^[5] In official anatomical nomenclature, it is designated by the TA98 code A01.2.03.004 and TA2 code 249. The structure represents a clinically relevant landmark in the infraclavicular area, distinct from adjacent regions such as the infraclavicular fossa.^[6]

Borders

The clavipectoral triangle, also known as the deltopectoral triangle, is a superficial anatomical space in the shoulder region bounded by three primary muscular and bony structures. The superior border is formed by the middle third of the clavicle, which serves as the base of the triangle.[](https://anatomedia.com/demo/app/#! /content/upperlimb/dissection/04)^[5] The medial border consists of the lateral margin of the pectoralis major muscle, while the lateral border is defined by the medial margin of the deltoid muscle.^[5] These two muscular borders converge inferiorly at the apex of the triangle, where the clavicular and sternocostal fibers of the pectoralis major meet the clavicular fibers of the deltoid.^[7] The floor of the clavipectoral triangle is formed by the clavipectoral fascia, a layer of deep fascia that invests the underlying subclavius muscle and the superior aspect of the pectoralis minor muscle.^[8]^[9] The roof comprises the superficial fascia overlying the deltoid and pectoralis major muscles, along with the skin.^[8]^[7]

The clavipectoral triangle, also known as the deltopectoral triangle, contains several superficial structures that facilitate venous drainage, arterial supply, lymphatic return, and sensory innervation to the shoulder region. These include the cephalic vein, the deltoid branch of the thoracoacromial artery, lymphatic vessels, branches of the supraclavicular nerves, and fat with loose connective tissue. These elements are primarily superficial and lie within or traverse the fascial plane of the triangle, contributing to the region's vascular and lymphatic connectivity without involving deeper neurovascular bundles.^[7] The cephalic vein is a prominent superficial vein that traverses the clavipectoral triangle from lateral to medial, ascending between the deltoid and pectoralis major muscles before piercing the clavipectoral fascia to drain into the axillary vein. This vein originates from the dorsal venous network of the hand, courses along the lateral aspect of the forearm and arm, and enters the triangle via the deltopectoral groove, making it a key pathway for upper limb venous return. Clinically, its accessible position within the triangle renders it a preferred site for venipuncture and cannulation, particularly for intravenous access in the upper arm due to its consistent anatomy and low complication risk.^[10]^[11]^[12] The deltoid branch of the thoracoacromial artery provides essential vascular supply within the clavipectoral triangle, branching from the thoracoacromial trunk—which arises from the second part of the axillary artery—and coursing laterally to nourish the deltoid muscle and adjacent pectoralis major. This branch emerges near the superior border of the pectoralis minor and travels superficially through the triangle, often accompanying the cephalic vein, to deliver oxygenated blood to the shoulder girdle musculature. Its presence underscores the triangle's role in distributing arterial flow to the superficial layers of the deltoid and pectoral regions.^[13] Lymphatic vessels within the clavipectoral triangle primarily consist of superficial channels that drain lymph from the skin and subcutaneous tissues of the shoulder and lateral chest wall toward the axillary lymph nodes. These vessels follow the course of the cephalic vein, collecting interstitial fluid from the deltoid and pectoral areas and converging at the triangle's apex to enter the axillary lymphatic system. This drainage pathway is crucial for immune surveillance in the upper limb and shoulder, with the vessels forming a network that empties into the apical group of axillary nodes located near the triangle.^[14]^[15] The deltopectoral (infraclavicular) lymph nodes, typically 1–3 in number, lie within the triangle along the cephalic vein in the deltopectoral groove. They receive afferent vessels from the superficial tissues of the upper limb and drain efferents to the apical axillary lymph nodes, playing a role in lymphatic drainage of the arm and lateral thoracic wall.^[16] Branches of the supraclavicular nerves, derived from the superficial cervical plexus (C3-C4 roots), traverse the clavipectoral triangle to provide sensory innervation to the overlying skin of the shoulder and upper chest. These sensory branches emerge from beneath the clavicle and distribute across the triangle's surface, supplying dermatomes that cover the deltoid and pectoral regions with touch, pain, and temperature sensation. Their superficial positioning makes them vulnerable during surgical incisions in this area but essential for cutaneous sensitivity.^[17] The remaining space within the clavipectoral triangle is occupied by fat and loose connective tissue, which cushions the vascular and neural structures and allows for mobility between the overlying muscles and underlying fascia. This adipose and areolar tissue provides structural support, facilitates the passage of traversing elements like the cephalic vein, and maintains the triangle's patency as an anatomical conduit.^[7]

Associated Structures

Deltopectoral Fascia

The deltopectoral fascia is a thin layer of deep fascia that invests the borders of the clavipectoral triangle, encompassing the clavicle superiorly, the pectoralis major muscle inferiorly, and the deltoid muscle laterally.^[18]^[19] This fascial layer lies superficial to the contents of the triangle, forming its roof and providing a distinct anatomical plane.^[18] It is typically covered by subcutaneous fat and can vary in thickness, sometimes appearing well-formed or interrupted by adipose tissue.^[19] This fascia is continuous with the investing deep fascia of the deltoid and pectoralis major muscles, blending seamlessly along their respective borders and extending inferiorly into the deltopectoral groove, a fat-filled depression between these muscles.^[18]^[20] The cephalic vein travels with the deltoid branch of the thoracoacromial artery within the deltopectoral triangle in approximately 65% of cases.^[20] The cephalic vein, in particular, is often embedded in fat beneath this layer, running along the groove toward its termination.^[19] Functionally, the deltopectoral fascia offers structural support to the regional musculature by reinforcing the boundaries of the triangle and creating a natural cleavage plane between superficial and deeper tissues.^[18] This arrangement facilitates the separation of muscle layers while preserving the integrity of enclosed neurovascular elements.^[20]

Clavipectoral Fascia

The clavipectoral fascia is a thick, bilateral sheet of connective tissue classified as deep fascia, located immediately deep to the pectoralis major muscle and extending from the clavicle superiorly to the axillary fascia inferiorly.^[8] It occupies the interval between the subclavius and pectoralis minor muscles, filling the space in the pectoral region and contributing to the structural integrity of the axilla.^[21] This fascia comprises several key components that define its layered structure. Superiorly, it splits into two layers to enclose the subclavius muscle, with the anterior layer attaching to the clavicle and the posterior layer fusing with the deep cervical fascia and the sheath of the axillary vessels.^[21] Medially, it blends with the fascia over the first two intercostal spaces and the first rib. Inferiorly, it forms the costocoracoid membrane, a superficial layer that attaches to the pectoralis minor and blends with the upper two external intercostal membranes, while a thickened portion between the first rib and coracoid process constitutes the costocoracoid ligament.^[8] Laterally, the fascia becomes dense and attaches to the coracoid process, and it invests the pectoralis minor muscle by splitting at its upper border.^[21] Several structures pierce the clavipectoral fascia, facilitating communication between superficial and deep compartments. Laterally, the cephalic vein and associated lymphatic vessels pass through an opening in the costocoracoid membrane. Medially, the thoracoacromial artery and vein, along with the lateral pectoral nerve, penetrate the fascia to reach the superficial tissues.^[8]^[21] The clavipectoral fascia serves multiple functions in stabilizing the pectoral girdle. It enables the gliding of the pectoralis major over the underlying pectoralis minor and acts as a suspensory ligament for the axilla by attaching to the axillary fascia, thereby maintaining the axillary concavity and supporting the floor of the axilla.^[8] Additionally, it provides attachment points for ligaments such as the costocoracoid ligament and protects underlying axillary vessels and nerves.^[21] It lies deep to the thinner deltopectoral fascia. Inferiorly, the clavipectoral fascia is continuous with the axillary fascia, forming the floor of the axilla, and extends laterally to the fascia over the short head of the biceps brachii.^[21] This continuity reinforces the overall fascial framework of the upper limb and thorax.^[8]

Clinical Significance

Surgical Approaches

The deltopectoral approach, also known as the anterior approach to the shoulder, leverages the clavipectoral triangle as a natural anatomical interval for surgical access to the glenohumeral joint and proximal humerus. This technique involves a 10- to 15-cm incision along the deltopectoral groove, starting near the coracoid process and extending distally, which allows blunt dissection between the deltoid and pectoralis major muscles with minimal fiber splitting.^[18] It is the standard method for procedures including shoulder arthroplasty, open reduction and internal fixation of proximal humerus fractures (particularly 3- and 4-part fractures), rotator cuff repairs, and reconstructions for recurrent anterior dislocations.^[22] The approach facilitates extensile exposure to the anterior, medial, and lateral aspects of the shoulder while preserving the origins of the deltoid and pectoralis major, reducing postoperative morbidity.^[18] Key advantages of the deltopectoral approach include its relative atraumatic nature to surrounding musculature, as it follows the natural plane of the clavipectoral triangle without detaching major muscle insertions, and excellent visualization of critical structures such as the coracoid process and subscapularis tendon.^[23] During the procedure, the cephalic vein serves as a superficial landmark within the triangle, typically retracted laterally with the deltoid to expose deeper layers, including the clavipectoral fascia and conjoint tendon.^[18] This method also minimizes risks to neurovascular structures, such as the musculocutaneous nerve, which enters the coracobrachialis approximately 5-8 cm distal to the coracoid process.^[18] In addition to orthopedic applications, the clavipectoral triangle provides access for central venous catheterization via cephalic vein cutdown, particularly for long-term indwelling lines in patients requiring reliable intravenous access. This technique involves an incision over the deltopectoral groove to isolate and cannulate the cephalic vein, which courses through the triangle before joining the axillary vein, offering a direct path to the central circulation.^[24] Compared to percutaneous subclavian or internal jugular punctures, the cutdown approach reduces risks such as pneumothorax, arterial injury, and vessel laceration by avoiding blind needle insertion into deeper structures.^[25] Success rates for cephalic vein cutdown exceed 90% in suitable candidates, making it a preferred option for implantable devices like ports or pacemakers.^[26]

Diagnostic and Procedural Landmarks

The clavipectoral triangle, also known as the deltopectoral triangle, serves as a key surface landmark for palpating the coracoid process of the scapula, which is accessible through the skin on its lateral aspect. This palpation is essential for confirming anterior shoulder dislocations, where fullness or deformity below the coracoid may indicate humeral head displacement. Additionally, the coracoid process within the triangle provides a reliable bony landmark for guiding infraclavicular brachial plexus blocks, facilitating precise needle insertion for anesthesia in upper extremity procedures.^[27]^[28]^[29] Ultrasound guidance enhances the triangle's utility in vascular access procedures by visualizing the cephalic vein, which courses superficially within the deltopectoral groove for peripheral intravenous insertion or advancement toward the axillary/subclavian vein. Real-time sonography allows for percutaneous cannulation, reducing risks associated with blind techniques and enabling safe central venous access in critically ill patients. This approach is particularly valuable for implantable device placement, such as pacemakers, where the vein's position deep to the clavipectoral fascia is clearly delineated.^[30]^[31] In breast cancer staging, the clavipectoral triangle's lymphatics are relevant for lymphatic mapping and sentinel node biopsy, as drainage to deltopectoral lymph nodes occurs in approximately 38% of cases and correlates with preserved axillary station 2 nodes. This pattern, identified via indocyanine green lymphography and lymphoscintigraphy, may act as a protective biomarker against breast cancer-related lymphedema by indicating alternative drainage pathways during axillary dissection. Tracing these lymphatics helps localize sentinel nodes for targeted biopsy, improving staging accuracy without extensive node removal.^[32] On anteroposterior shoulder radiographs, the clavipectoral triangle appears as a soft-tissue density or groove between the clavicle and proximal humerus, aiding in the evaluation of shoulder alignment and prosthesis positioning following arthroplasty. This radiographic feature assists in detecting subtle displacements or confirming anatomical restoration in trauma or postoperative settings. Procedural risks in the triangle include potential compression or puncture of the thoracoacromial vessels, particularly the acromial branch, during infraclavicular blocks, which can lead to vascular puncture in approximately 9% of cases using coracoid-guided approaches. Careful ultrasound monitoring mitigates these vascular injuries by avoiding the artery and cephalic vein in the needle path.^[33]

References

[1]
Lab Manual - Pectoral Region & Breast - Medical Gross Anatomy
Find the cephalic vein between adjacent borders of those muscles in the deltopectoral groove (or triangle). Follow the muscles to their insertions. Use ...
[2]
Deltopectoral triangle - e-Anatomy - IMAIOS
The deltopectoral triangle is an anatomical region located at the shoulder, defined by the boundaries of the deltoid muscle laterally, the pectoralis major ...
[3]
Deltopectoral triangle - e-Anatomy - IMAIOS
The deltopectoral triangle is an anatomical region located at the shoulder, defined by the boundaries of the deltoid muscle laterally, the pectoralis major ...
[4]
AnatomyTOOL - Fossa infraclavicularis
Infraclavicular fossa, clavipectoral triangle, trigonum clavipectorale, deltopectoral triangle, trigonum deltopectorale, région infraclaviculaire, Mohrenheim's ...
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https://www.imaios.com/en/e-anatomy/anatomical-structures/deltopectoral-triangle-1536888668
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The Axilla Region - Borders - Contents - TeachMeAnatomy
### Summary of the Clavipectoral Triangle
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Clavipectoral fascia: Anatomy, components and function - Kenhub
The clavipectoral fascia is a thick, bilateral connective tissue structure deep to pectoralis major muscle.
[8]
Clavipectoral fascia | Radiology Reference Article - Radiopaedia.org
Mar 1, 2019 · The clavipectoral fascia is a sheet of loose connective tissue which is the deep layer of fascia in the pectoral region.
[9]
Veins of the upper limb: Anatomy - Kenhub
It then drains into the axillary vein within the clavipectoral triangle on the anterior wall of the axilla. The basilic vein similarly ascends within the ...
[10]
https://www.kenhub.com/en/library/anatomy/veins-of-the-upper-limb
[11]
Clinical anatomy of the cephalic vein for safe performance of ... - NIH
Sep 11, 2017 · The cephalic vein is a constant structure that serves as a drainage vein of the hand and provides a reliable cannulation site in the forearm.
[12]
Innervation of the clavicular part of the deltoid muscle by the lateral ...
Jan 1, 2020 · In both patterns, the deltoid and pectoral branches created a broad communication network in the clavipectoral triangle that was closely ...
[13]
https://teachmeanatomy.info/encyclopaedia/t/thoracoacromial-artery/
[14]
Upper Limb | Clinical Gate
Mar 17, 2015 · In the area of the shoulder, it passes into an inverted triangular cleft (the clavipectoral triangle) between the deltoid muscle, pectoralis ...
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Chapter-12 Pectoral Region and Breast - JaypeeDigital
The skin of the pectoral region is supplied by the supraclavicular nerves and the cutaneous branches of the intercostal nerves. ... clavipectoral) triangle is ...
[16]
Shoulder Anterior (Deltopectoral) Approach - Orthobullets
Dec 1, 2019 · the deltopectoral fascia is encountered first ; the cephalic vein is surrounded in a layer of fat and is used to identify the interval; the ...
[17]
[PDF] Cephalic Vein. Detail of its Anatomy in the Deltopectoral Triangle
and deltoideus muscle (DM) edges, covered by the superfi- cial deltopectoral fascia, which can be, depending on the case, well conformed in some cases or ...
[18]
[PDF] The clinical anatomy of the cephalic vein in the deltopectoral triangle
In the forearm the cephalic vein travels upward along the anterior border of the brachioradialis muscle. It anastomoses with the basilic vein by an obliquely.
[19]
Clavipectoral fascia - e-Anatomy - IMAIOS
The clavipectoral fascia is a strong fascia under the pectoralis major, located between the pectoralis minor and subclavius, protecting axillary vessels and ...
[20]
Deltopectoral approach to the proximal humerus
The (anterior) deltopectoral approach can be used for almost any proximal humeral fracture treatment and is often the preferred approach.
[21]
Deltopectoral approach for shoulder arthroplasty: anatomic basis
- Always stay close to the bone during capsule release, whether on the humeral or glenoid side. - Never go medially to the conjoint tendon or its deep face.
[22]
Venous Access: The Subclavian Vein and the Cephalic Vein in the ...
Jul 22, 2016 · Deltopectoral triangle. Pleura. Thymus. Trachea. Phrenic nerve. Vagus nerve. image. Percutaneous Cannulation of the Subclavian Vein by Landmarks.
[23]
Cephalic Vein Cutdown Approach for Long-term Indwelling Central ...
Aug 6, 2025 · Some of the clinicians prefer the cephalic cut-down method rather than subclavian or the internal jugular vein puncture for implant a device to ...
[24]
Cephalic Vein Cut Down for Total Implantable Venous Access Ports
The aim of this work was to describe the early and late success rates of cephalic vein cut down (CVC) in the implantation of totally implantable venous access ...Missing: triangle | Show results with:triangle
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Coracoid process of scapula - Kenhub
The coracoid process can be palpated through the skin on the lateral aspect of the clavipectoral (deltopectoral) triangle, a depression formed between the ...
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Shoulder Dislocation - Physiopedia
All movements limited and painful; Palpable fullness below the coracoid process and towards the axilla; Possible damage to rotator cuff musculature and bone.Missing: Clavipectoral | Show results with:Clavipectoral
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The infraclavicular block provides a block of the arm below the shoulder. Unlike the axillary approach, it can be performed without abduction of the arm, ...Missing: thoracoacromial | Show results with:thoracoacromial
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Apr 4, 2012 · Ultrasound Guided Cephalic Vein Cannulation (In the Deltopectoral Triangle) in Severe Hypoxemic Non-Invasive Ventilated Patient.
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Percutaneous Cephalic Vein Cannulation (in the Deltopectoral ...
Aug 5, 2025 · It further courses in the deltopectoral triangle it pierces the clavipectoral fascia and terminates in the axillary vein. The subclavian, ...
[30]
a potential protective biomarker for breast cancer-related lymphedema
The presence of deltopectoral lymph node drainage represents an important potential protective biomarker for BCRL development.
[31]
[PDF] To Compare The Retro-Clavicular And Coracoid Approach For ...
Soeding and Eizenberg et al50 found that the cephalic vein and acromial branch of the thoracoacromial artery could be at risk of needle injury during a coracoid ...<|control11|><|separator|>