Author: Outlander Anatomist

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Fun Fact: Manubriosternal Junction

Anatomy def: Manubriosternal junction is a prominent joint between manubrium and body of the sternum (breastbone). 

Outlander def: Wee Mary MacNab’s chest mound, sweetly straining toward the Dunbonnet. Surrender, Jamie! She kens they both need “this.” 😉

Learn about the manubriosternal junction in Anatomy Lesson #15, Crouching Grants –  Hidden Dagger. 

An adult sternum has three parts:

  • manubrium (top)
  • body (middle; a.k.a. gladiolus)
  • xyphoid process (tip)

These parts are typically fused into a single, elongated bony structure in adults.  Notably, the juncture between manubrium and body forms an elevated bump, the manubriosternal junction.

As this word is a real mouthful, many anatomists and clinicians use the term sternal angle, angle of Louis, or sternal angle of Louis, to supplant manubriosternal junction. (Why use one name when three will do?) <G> And, some anatomists push the envelop further, preferring the term, sternomanubrial joint. So many terms, so little time. Gah!

Taking an easier route, the sternal angle of Louis is a splendid topographical feature because it is easily palpated!  It is the site where costal cartilages of the second ribs attach to the sternum. The T4 – T5 intervertebral disc also lies at this level. And, that is not all. This angle is used to locate or define some 15 (!!!) clinically significant structures and/or compartments of the chest. A useful example: starting at the second ribs, a practitioner can count intercostal (between ribs) spaces to locate organs and evaluate normal anatomy. Lots of splendid stuff going on here!

Try this: Place your fingers at the top of your chest in the small bony divot (suprasternal notch); this marks the top of the manubrium. Run fingers downward about 2” or 5 cm and feel the raised knob of bone? This is your sternal angle of Louis. Run fingers to each side – these are your second ribs and their costal cartilages. Feel them? Yay!  

Here’s a useful hint: If you avoid heavy necklaces because they give you neck pain, choose one that sits above the sternal angle. This way, manubrium and clavicles help support the weight of the piece, easing pull on the neck.

Read about the sternum in Voyager book. Herself conjured this scene between Dr. Claire Randall and a dying Scottish patient (not filmed in S3): 

“I have been thinking,” Graham announced. The sound of his voice echoed tinnily through the earpieces of my stethoscope. “Have you?” I said. “Well, don’t do it out loud ’til I’ve finished here, that’s a good lad.” 

He gave a brief snort of laughter, but lay quietly as I auscultated his chest, moving the disc of the stethoscope swiftly from ribs to sternum. “All right,” I said at last, slipping the tubes out of my ears and letting them fall over my shoulders. “What have you been thinking about?” 

“Killing myself.”

Whoa! Best read the book to find out what happens to Graham (and Claire)!

See Mary’s sternal angle (red arrow) in Starz episode 302, Surrender.  Sweet, sweet Mary is so very slender, her sternal angle of Louis with its curved 2nd ribs and costal cartilages are plain as cave light. Way to rock it, Mary! Ye are a bonny lass!

The deeply grateful,

Outlander Anatomist

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Photo credit: Starz episode 302, Surrender

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Fun Fact: Deltopectoral Triangle

Anatomy Def:  The deltopectoral triangle is a groove between deltoid and pectoralis major muscles (above figure – blue arrow). 

Outlander def: That groovy depression between chest and shoulder masses. A fav spot for a Claire bliss-kiss! (check it out on yourself or a pal!)

Learn about the deltopectoral triangle and deltoid and pectoralis major muscles in Anatomy Lesson #19, To Arms, Too Arms, Two Arms!  

The deltopectoral triangle (again, blue arrow above) is important because it:

  • Contains the cephalic vein, pectoral nerves and pectoral artery (a branch of thoracoacromial trunk). All are important structures!
  • Provides surgical access to the genohumeral (shoulder) joint, sparing adjacent muscles.
  • Serves as a landmark for percutaneous infra-clavicular cannulation of the subclavian vein. Whew! No worries, it means placing a tube through the skin below the clavicle into the subclavian vein.  

BTW, the cephalic vein is that yummy vessel at the tip of the red arrow. In most folks, this vein ascends through the arm, entering the deltopectoral triangle before diving deeply to end in the subclavian vein – warning – a few folks don’t have one!

Read about Claire’s cephalic vein passing up her arm, through the triangle and heading for the subclavian vein in Outlander book. Yay, once again, Diana has provided!

“Your skin is so fine I can see the blood moving beneath it,” Jamie said, tracing the path of a sunbeam across my bare stomach. “I could follow the veins from your hand to your heart.” He drew his finger gently up my wrist to the bend of the elbow, up the inner side of my upper arm, and across the slope below my collarbone. “That’s the subclavian vein,” I remarked, looking down my nose at the path of his tracking finger. “Is it? Oh, aye, because it’s below your clavicle.

See Jamie’s deltopectoral triangle in Starz ep 313, Eye of the Storm. Claire has her eye on that triangle and the splendid vein leading to it- creates a storm for Claire, too! <G>

The deeply grateful,

Outlander Anatomist

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Photo creds: Starz ep 313, Eye of the Storm

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Fun Fact: Breast

Common Use Def: The breast is one of two soft, protruding organs on the upper front of a woman’s torso that secrete milk after birth.

Anatomy Def:  But, the scientific definition rightly includes male and female breasts as both are derived from the same embryonic tissue and diseases occur in the breasts of both sexes.

Outlander Def: Taming-of-the-sea organs? Or, so goes the argument posited by Captain Raines of the Artemis!

Learn about the breast in Anatomy Lesson #51 The Breast – Male and Female.

Anatomy Lesson #51 was not written to be titillating (hah).

Seriously, it was written as a public service. The incidence of breast disease is so high, it behoves one to understand breast structure and function so as to better understand prognosis, disease progression and treatment options should the need arise.

Breast anatomy also helps us understand the diseases plaguing the breast: cancer, cysts, fibrocystic changes, mastitis, gynecomastia, to name a few.

The worst: Though breast cancer in males is relatively rare, only 1 per 1000 adult males, the incidence of invasive breast cancer in US women is 1 in 8!!!

Read about the breast in Outlander books; there’s a mess of quotes to choose from! <G> This one is particularly special…  From Voyager, the reunion between Claire and A. Malcolm:

A little reluctantly, I took his hand, and stepped out of the inadequate shelter of the remains of my dress. He drew me gently in, to stand between his knees as he sat on the bed. Then he kissed me softly, once on each breast, and laid his head between them, his breath coming warm on my bare skin. “Your breast is like ivory,” he said softly, the word almost “breest” in the Highland Scots that always grew broad when he was truly moved. His hand rose to cup one breast, his fingers tanned into darkness against my own pale glow. 

See Captain Raines inform Claire that if a woman bears her breasts before a tempest, the seas will be calmed in. Huh??? Industriously chewing (tough mutton?), the Captain waxes poetic about the sailing superstition:

“After all, on this ship, your very presence is ill luck… By rights, you and Mistress MacKimmie should this moment be bare breasted! … A woman’s bare breasts calm an angry sea… The figure head at the bow, she bears her breasts for you, and prevents us being subject to any curses.”

Claire is not amused. Not on Jamie’s watch!!! 

The deeply grateful,

Outlander Anatomist

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Photo Credit: Outlander ep 307, The doldrums