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1
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Meng J, Li X, Gao S. Right anterior axillary dimpling. BMJ 2025; 389:e083924. [PMID: 40409783 DOI: 10.1136/bmj-2024-083924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2025]
Affiliation(s)
- Jiahao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiong Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shuguang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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2
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Thiebaud J, Sabate-Ferris A, David G, Murison JC. Fascia lata autograft for chronic Pectoralis Major ruptures - A technical note. Orthop Traumatol Surg Res 2025; 111:103937. [PMID: 39033081 DOI: 10.1016/j.otsr.2024.103937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 06/02/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
Rupture of the pectoralis major tendon is an uncommon injury but increasing in incidence. Surgical management is often needed, and ruptures treated acutely show more favorable results. However, a significant number of ruptures are missed and diagnosed later in a chronic state. Direct suture without tension is a major challenge in these cases, and interposition grafts are required. Several techniques have been described however none uses a fascia lata autograft. This technical note aims to describe fascia lata autograft as a valid option to treat retracted chronic pectoralis major ruptures. LEVEL OF EVIDENCE: IV; Study Design: Technical Note.
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Affiliation(s)
- Julien Thiebaud
- Versailles Saint-Quentin-en-Yvelines University Paris, Ile de France, France.
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3
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Horng J, Czarnecki M, Cruz C, Hasegawa M, Min KS. Pectoralis major tendon rupture repairs using intramedullary suture anchors shows high patient-reported outcomes in military service members. J Shoulder Elbow Surg 2025; 34:895-900. [PMID: 38908466 DOI: 10.1016/j.jse.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND In the general population, pectoralis major tendon ruptures are uncommon; however, it is a common injury in the military population. The military service members have greater physical demands than the general population. The purpose of this study is to critically assess the postoperative outcomes of pectoralis major tendon ruptures in military service members following a repair using intramedullary suture anchors. METHODS A retrospective chart review was performed between 2014 and 2022, identifying patients who underwent a pectoralis major rupture repair performed by the senior surgeon using intramedullary suture anchors. Records were reviewed for age, gender, mechanism of injury, chronicity, visual analog scale, and Single Assessment Numeric Evaluation (SANE) scores. Patients who had less than 1 year of follow-up were excluded from the study. During the study period, 18 patients underwent surgical repair of their torn pectoralis major, and 15 patients were followed up >1 year postoperatively. Twelve of these 15 patients (80%) were successfully contacted, and patient-reported outcomes were collected. RESULTS A total of 12 patients (12 male, 0 female) with a mean age of 34.5 years were identified. Average time from injury to surgery was 471.4 days. Average duration of follow-up was 3.7 years. There was a decrease in the preoperative average single repetition maximum (1RM) barbell bench press of 125.7 kg (277 lbs) to a postoperative average 1RM bench press of 101.8 kg (225 lbs) (P = .03). Mean change in average 1RM barbell bench press is a 19.04% decrease postoperatively. Postoperative SANE score was 80.8 and an American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score of 86.9. Seven patients (58.3%) stated they were afraid to bench press at their previous weight because of fear of reinjury. None of the patients were medically discharged from the military owing to limitations from their repaired shoulder. Ten patients (83%) reported they were extremely satisfied with their shoulder function postoperatively. CONCLUSION Repair of the pectoralis major tendon ruptures using intramedullary suture anchors has high rates of return to duty, patient satisfaction, and patient-reported outcomes. More than half of the patients reported they were afraid to bench press at their preinjury weight because of concerns of reinjury; the decrease in postoperative strength may be a result of the patients' fear of reinjury rather than physiologic limitations.
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Affiliation(s)
- Jonathan Horng
- Department of Orthopedic Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Michael Czarnecki
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Christian Cruz
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Morgan Hasegawa
- Department of Orthopedic Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Kyong S Min
- Department of Orthopedic Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA; Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
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Abro AA, Aziz N, Memon K, Fatima T. Return to Functional Activity After Pectoralis Major Surgical Treatment: A Comprehensive Review. Cureus 2025; 17:e79283. [PMID: 40125121 PMCID: PMC11927367 DOI: 10.7759/cureus.79283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2025] [Indexed: 03/25/2025] Open
Abstract
Pectoralis major is a strong, thick, and fan-shaped muscle that takes origination from the chest bone and medial part of the collarbone while passing to the arm; fibers converge in a U-shaped manner and insert onto the lateral lip of the bicipital groove of the humerus near the bicep tendon. The pectoralis major tendon is 3-5 cm thick and 40 mm wide. The pectoralis major tendon is powerful and useful for shoulder function; it plays a vital role in shoulder adduction and assists in internal rotation and humerus flexion. Injuries to the pectoralis major tendon are rare but are gaining popularity because of more competitive sports. Pectoralis major injuries are most commonly seen in men aged 20 to 40, particularly during weightlifting, but they can also occur in sports like wrestling, boxing, and water skiing. Considering the recently increased burden of pectoralis major rupture cases, mainly due to competitive sports activities, this study aims to provide hindsight on the ability of athletes to return to sports, work, and patient satisfaction postoperatively. This report closely adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting on systematic reviews. Computerized literature searches between 2014 and July 2024 were performed on Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane. PubMed indexing terms and functions, such as Boolean operators "AND" and "OR," were used to create search strings, combining synonyms, controlled vocabulary, and keywords. The following keywords were used: "pectoralis major," "repair," "outcome," and "complications". Studies returned from initial databases were independently reviewed by two reviewers. The articles were included as per the eligibility criteria listed above. Any discrepancies in the selection of the articles were resolved by a third reviewer. During the entire study selection, the references and texts were screened to exclude any overlapping participants. This review indicates that surgical repair of pectoralis major ruptures generally yields positive outcomes, with high return-to-sport rates and patient satisfaction. However, the lack of standardized definitions and postoperative protocols may contribute to inconsistencies across studies. Complications were rare, though they remain a consideration in surgical planning and patient counseling. The review highlights successful pectoralis major repair as achievable with various surgical techniques, especially tendon-to-bone fixation methods, contributing to promising rates of return to sport and work. The incidence of complications such as re-rupture, infection, and persistent weakness was reported as the total number of events along with the percentage of participants experiencing each complication.
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Affiliation(s)
- Arslan A Abro
- Trauma and Orthopedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
| | - Nashit Aziz
- Medicine, Agha Khan University, Karachi, PAK
| | - Kashif Memon
- Trauma and Orthopedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
| | - Tahreem Fatima
- Trauma and Orthopedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
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5
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Rosenthal RM, Featherall J, Putko RM, McGlone PJ, Feeley SM, Panarello NM, Lilley BM, Rabin S, Lewis DC, Parkes CW, Sanderson RL, Waltz RA, Ernat JJ. Time-sensitive injuries for the sports medicine surgeon - "Sports Medicine Trauma", Part 1: Upper Extremity. Orthop Rev (Pavia) 2024; 16:126704. [PMID: 39654631 PMCID: PMC11627319 DOI: 10.52965/001c.126704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 11/09/2024] [Indexed: 12/12/2024] Open
Abstract
Skeletal fractures are traumatic injuries that are widely accepted as requiring acute treatment to avoid long-term disability and dysfunction. There are a number of soft-tissue injuries or non-traditional fractures, frequently treated by sports medicine surgeons, which additionally require treatment in an expedited fashion in order to optimize healing and function. Sports medicine injuries of the lower extremity requiring acute treatment include, but are not limited to, irreducible shoulder dislocations, acute traumatic rotator cuff tears, posterior sternoclavicular joint dislocations, high grade acromioclavicular joint dislocations, pectoralis major tendon ruptures, distal biceps tendon ruptures, and triceps tendon ruptures. The purpose of this manuscript is to review the sports medicine injuries of the upper extremity which require acute/urgent management to facilitate optimal treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Sarah Rabin
- Walter Reed National Military Medical Center
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6
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Motlagh JG, Lipps DB. The Contribution of Muscular Fatigue and Shoulder Biomechanics to Shoulder Injury Incidence During the Bench Press Exercise: A Narrative Review. J Strength Cond Res 2024; 38:2147-2163. [PMID: 39808810 DOI: 10.1519/jsc.0000000000004973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
ABSTRACT Motlagh, JG and Lipps, DB. The contribution of muscular fatigue and shoulder biomechanics to shoulder injury incidence during the bench press exercise: A narrative review. J Strength Cond Res 38(12): 2147-2163, 2024-Participation in competitive powerlifting has rapidly grown over the past two decades. As a result, powerlifting-related injury incidence has likely increased proportionally. Consistent high-load training places excess strain on the multiple joints involved during the squat, bench press, and deadlift. This literature review provides a comprehensive overview of all necessary considerations for evaluating the relationship between training methods, muscular fatigue, shoulder biomechanics, and shoulder injury risk in experienced powerlifters performing the bench press. Training methods such as velocity-based training, rate of perceived exertion/repetitions in reserve, and autoregulatory progressive resistance training should be prioritized over the repetitions until failure method to minimize the risk of overexertion. Despite the high risk of shoulder injury, these findings often lack robust insights into shoulder joint biomechanics during the bench press. Assessing shoulder joint angles and moments can provide valuable insight into an athlete's bench press form and technique to minimize injury risk. With a more robust methodology (e.g., motion capture, ultrasound imaging), alterations in shoulder biomechanics can be assessed during fatiguing training sessions, leading to more generalizable findings on the impact of sex, age, training experience, and bench press form on the shoulder injury risk. This research will improve individualized programming for peak powerlifting performance and optimal shoulder injury prevention.
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Affiliation(s)
- Jodi G Motlagh
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
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7
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Aljasim N, Alkhalifa F. Pectoralis Major Rupture: A Case Report of a 34-Year-Old Rugby Player. Cureus 2024; 16:e73506. [PMID: 39669856 PMCID: PMC11635956 DOI: 10.7759/cureus.73506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2024] [Indexed: 12/14/2024] Open
Abstract
Pectoralis major injuries are not commonly seen; this type of injury occurs mainly due to weightlifting and bench pressing. The majority of cases occur in men between the ages of 20 to 40 years. We present a case of a previously healthy 34-year-old male who presented to the emergency department after sustaining an injury to the left shoulder and loin while playing rugby. Physical examination revealed a swelling over the deltopectoral region, with a large hematoma noted over the left loin. The patient had mild pain over the left shoulder, chest, and loin. He then went to an orthopedic surgeon seven days later, and an ultrasound was performed, revealing a partial pectoralis muscle rupture. The patient underwent surgical repair on the same day, and an intraoperative examination showed a complete pectoralis major tear, which was successfully repaired.
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Affiliation(s)
- Nawara Aljasim
- Internal Medicine, King Hamad University Hospital, Busaiteen, BHR
| | - Fahad Alkhalifa
- Orthopedic Surgery, Bahrain Defence Force Hospital, Riffa, BHR
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8
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AlAbbasi KK, AlRawi M, Elmaraghy A. Repair of an Isolated Sternal Head Tear of the Myotendinous Junction of the Pectoralis Major Using Knotless Suture Anchors: Case Report and Literature Review. Cureus 2024; 16:e65806. [PMID: 39219965 PMCID: PMC11362632 DOI: 10.7759/cureus.65806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Although considered a relatively uncommon sports injury, publications on pectoralis major (PM) injuries have increased in the last couple of decades. Knowledge of the complex anatomy of the PM muscle is important in diagnosing, understanding the complexity of the injury, and determining the suitable modality of management of these injuries. Despite the increase in publications, there is no consensus on the superiority of any proposed surgical management. We present a case of a recreational body builder who presented to our clinics with a rare pattern of isolated musculotendinous junction of the lower fibers of the PM muscle and proposed a new technique of surgical management of such injuries using knotless suture anchors and running locked suture pattern in different directions. We then conducted a comprehensive review of literature of these injuries and presented a review on the pathophysiology, the various patterns of these injuries, and the available described modalities of surgical management. Understanding the complex anatomy of the PM, the various pattens of injury, and the aid of an MRI read by an expert musculoskeletal radiologist is crucial before managing these injuries. We believe that acute surgical repair of musculotendinous junction injuries using running Krackow/Brunnell locked configuration and the use of knotless suture and anchors will provide adequate and practicable surgical repair of these injuries.
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Affiliation(s)
- Khaled K AlAbbasi
- Department of Orthopedic Surgery, King Fahad Medical City, Riyadh, SAU
| | - Mustafa AlRawi
- Department of Orthopedic Surgery, King Fahad Medical City, Riyadh, SAU
| | - Amr Elmaraghy
- Department of Orthopaedic Surgery, University of Toronto, Toronto, CAN
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9
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Saito RR, Panwar KS, Huish EG. Biomechanical comparison of pectoralis major repair techniques: A systematic review and meta-regression. Shoulder Elbow 2024; 16:145-151. [PMID: 38655408 PMCID: PMC11034462 DOI: 10.1177/17585732231152251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 04/26/2024]
Abstract
Background There are many surgical techniques when repairing pectoralis major tears. However, there is no clear consensus on which repair technique is biomechanically superior. Our purpose was to perform a systematic review and meta-regression to evaluate the most biomechanically superior pectoralis major repair technique. Methods We performed a systematic review and meta-regression of six human cadaveric biomechanical studies evaluating fixation techniques for pectoralis major repairs. The primary outcome was the ultimate failure load. Covariates included cadaveric age, bone mineral density, implants, suture, and stitch method. Meta-regression accounted for differences in variables. Results Compared with Krackow/Bunnell stitch method, the modified Mason-Allen stitch demonstrated a decrease in ultimate failure load by 220.6 N (95% CI, -273.0 to -168.2; p = <0.001). No differences were found between Krackow/Bunnell and whipstitch. There was an increase in ultimate failure load when utilizing suture tape by 206.6 N (95% CI, 139.5-273.7, p < 0.001). Suture anchors had a decrease in ultimate failure load by 88.1 N (95% CI, -153.4 to -22.8, p = 0.008) when compared to transosseous sutures. No differences were found between transosseous sutures and unicortical buttons. Discussion We found the combination of suture tape in a whipstitch or Krackow/Bunnell stitch utilizing transosseous sutures or unicortical buttons is the most biomechanically superior construct for pectoralis major repairs.
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Affiliation(s)
- Rex R Saito
- Department of Orthopedic Surgery, Valley Orthopedic Surgery Residency, Modesto, CA, USA
| | - Kunal S Panwar
- Department of Orthopedic Surgery, Valley Orthopedic Surgery Residency, Modesto, CA, USA
| | - Eric G Huish
- Department of Orthopedic Surgery, Valley Orthopedic Surgery Residency, Modesto, CA, USA
- Department of Orthopedic Surgery, San Joaquin General Hospital, French Camp, CA, USA
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10
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Saeed R, Hardy SE, Khan A. Pectoralis Major Tendon Rupture in an Occupational Medicine Setting: A Case Report. Cureus 2024; 16:e55569. [PMID: 38576666 PMCID: PMC10994649 DOI: 10.7759/cureus.55569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Pectoralis major (PM) rupture is a rare injury, commonly misdiagnosed, that affects mostly young male athletes aged 20-40 years. This type of injury is typically associated with weight lifting, especially bench pressing. In an occupational medicine setting, it is extremely rare and not much reported in the literature. We present the case of a 30-year-old trauma technician male who presented with right shoulder and chest pain following a popping sensation while pushing in full momentum a patient on a gurney accidentally set on break mode. PM rupture was suspected clinically. Magnetic resonance imaging confirmed the diagnosis and revealed a complete rupture of the sternal head of PM. Surgical reconstruction was performed to restore the anatomy and functionality of the shoulder girdle.
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Affiliation(s)
- Rasha Saeed
- Occupational Medicine, University of California, Irvine, Irvine, USA
| | - Scott E Hardy
- Medicine/Occupational Medicine/Medical Toxicology, University of California, Irvine Medical Center, Irvine, USA
| | - Alya Khan
- Medicine/Occupational and Environmental Medicine, University of California, Irvine, Irvine, USA
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11
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Manske RC, Wolfe C, Page P, Voight M. MSK Ultrasound: A Powerful Tool for Evaluating and Diagnosing Pectoralis Major Injuries in Healthcare Practice. Int J Sports Phys Ther 2024; 19:366-371. [PMID: 38439770 PMCID: PMC10909317 DOI: 10.26603/001c.94157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Accurately diagnosing pectoralis major injuries, particularly in athletes, often presents a challenge for healthcare practitioners. Although pectoralis muscle injuries are relatively uncommon, the diagnosis of a tear may be overlooked without careful screening by a thorough physical examination of both the injured and uninjured sides. While magnetic resonance imaging (MRI) has traditionally held the gold standard, musculoskeletal ultrasound (MSKUS) has emerged as a viable alternative. This article delves into the power of MSKUS in evaluating and diagnosing pectoralis major injuries, highlighting its dynamic capabilities, real-time visualization, and cost-effectiveness in comparison to MRI. By equipping healthcare professionals with a thorough understanding of MSKUS's potential, this article aims to empower them to confidently diagnose and manage pectoralis major injuries, ultimately improving patient outcomes and facilitating a faster return to function.
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12
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de Castro Pochini A, Ejnisman B, Andreoli CV, Yamada AF, Godoy IRB, Cohen M, Seixas MT, Belangero PS, Hipolide DC. Surgical treatment of patients with chronic rupture of the pectoralis major muscle tendon. Prospective comparative study with 2 years of follow-up. J Surg Case Rep 2024; 2024:rjae093. [PMID: 38495048 PMCID: PMC10943627 DOI: 10.1093/jscr/rjae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 02/04/2024] [Indexed: 03/19/2024] Open
Abstract
To compare outcomes between autologous fascia lata and autologous hamstring grafts for chronic pectoralis major muscle (PMM) rupture repair, and perform histological, and imaging analyses. Forty male patients with chronic PMM ruptures (time since injury ranging from >3 months to 5 years) and a mean age of 37.3 years (SD = 9.7 years) were evaluated. One group (20 patients) received an autologous semitendinosus graft, and another group (20 patients) received an autologous fascia lata graft for PMM reconstruction. These patients with fascia lata grafts by Bak 2criterium 60% of the patients presented excellent results, 20% presented good results, 15% presented fair results, and 5% presented poor results. In the hamstring group 65% of the patients presented excellent results, 30% presented good results, and 5% presented fair results. In this comparative study, no difference was observed regarding the functional result, image, and histology between groups.
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Affiliation(s)
| | - Benno Ejnisman
- Orthopaedic Department, Federal University of Sao Paulo, Brazil
| | | | - Andre F Yamada
- Orthopaedic Department, Federal University of Sao Paulo, Brazil
| | - Ivan R B Godoy
- Orthopaedic Department, Federal University of Sao Paulo, Brazil
| | - Moises Cohen
- Orthopaedic Department, Federal University of Sao Paulo, Brazil
| | - Maria T Seixas
- Pathology Department, Federal University of Sao Paulo, Brazil
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13
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de Castro Pochini A, Ejnisman B, Andreoli CV, Lara PHS, Godoy IRB, Ribeiro LM, Seixas MT, Belangero PS, Hipolide DC. Anabolic steroids and the evaluation of patients with acute PM tendon rupture using microscopy and MRI. J Surg Case Rep 2024; 2024:rjae126. [PMID: 38524673 PMCID: PMC10958144 DOI: 10.1093/jscr/rjae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/14/2024] [Indexed: 03/26/2024] Open
Abstract
This study presented a pioneering investigation of the changes in the magnetic resonance imaging images of pectoralis major muscle (PMM) tendon rupture. In all, 26 men were evaluated with acute total PMM rupture (<3 months since injury) with a mean age of 37.3 years (SD = 9.7 years) and 10 control patients with a mean age of 32.6 years (SD = 4.2 years). The evaluation of the tendon PMM injuries was based on the magnetic resonance imaging exam and the histological analysis. The magnetic resonance imaging of the surgically showed two (7.1%) contralateral sides were normal, 16 (57.1%) showed superior tendinopathy, and 10 (35.7%) had total tendinopathy. Inferior tendinopathy was not observed. The tendon histology revealed degenerative changes in 16 (66.7%) fragments, with 12 (50.0%) considered as mild (<25%), and four considered as (16.7%) high (>50.0%) tendinopathy. Total acute rupture of the PMM tendon among weightlifters might be associated with tendinous degeneration prior to injury.
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Affiliation(s)
| | - Benno Ejnisman
- Department of Orthopaedic, Federal University of Sao Paulo, São Paulo 04022-000, Brazil
| | - Carlos V Andreoli
- Department of Orthopaedic, Federal University of Sao Paulo, São Paulo 04022-000, Brazil
| | - Paulo H S Lara
- Department of Orthopaedic, Federal University of Sao Paulo, São Paulo 04022-000, Brazil
| | - Ivan R B Godoy
- Department of Orthopaedic, Federal University of Sao Paulo, São Paulo 04022-000, Brazil
| | - Leandro M Ribeiro
- Department of Orthopaedic, Federal University of Sao Paulo, São Paulo 04022-000, Brazil
| | - Maria T Seixas
- Department of Pathology, Federal University of Sao Paulo, São Paulo 04023-062, Brazil
| | - Paulo S Belangero
- Department of Orthopaedic, Federal University of Sao Paulo, São Paulo 04022-000, Brazil
| | - Debora C Hipolide
- Department of Psychobiology, Federal University of Sao Paulo, São Paulo 04724-000, Brazil
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14
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Tong S, Sun Y, Kuang B, Wang M, Chen Z, Zhang W, Chen J. A Comprehensive Review of Muscle-Tendon Junction: Structure, Function, Injury and Repair. Biomedicines 2024; 12:423. [PMID: 38398025 PMCID: PMC10886980 DOI: 10.3390/biomedicines12020423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
The muscle-tendon junction (MTJ) is a highly specific tissue interface where the muscle's fascia intersects with the extracellular matrix of the tendon. The MTJ functions as the particular structure facilitating the transmission of force from contractive muscle fibers to the skeletal system, enabling movement. Considering that the MTJ is continuously exposed to constant mechanical forces during physical activity, it is susceptible to injuries. Ruptures at the MTJ often accompany damage to both tendon and muscle tissues. In this review, we attempt to provide a precise definition of the MTJ, describe its subtle structure in detail, and introduce therapeutic approaches related to MTJ tissue engineering. We hope that our detailed illustration of the MTJ and summary of the representative research achievements will help researchers gain a deeper understanding of the MTJ and inspire fresh insights and breakthroughs for future research.
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Affiliation(s)
- Siqi Tong
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
| | - Yuzhi Sun
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Baian Kuang
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
| | - Mingyue Wang
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
| | - Zhixuan Chen
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
| | - Wei Zhang
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
- Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, Nanjing 210096, China
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou 310058, China
| | - Jialin Chen
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
- Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, Nanjing 210096, China
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou 310058, China
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15
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Zhu K, Vuong T, Pastor A, Reynolds P. Complete Pectoralis Major Tendon Rupture With Bony Avulsion in an Adolescent Male: A Case Report and Literature Review. Cureus 2024; 16:e51616. [PMID: 38313965 PMCID: PMC10837368 DOI: 10.7759/cureus.51616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 02/06/2024] Open
Abstract
Pectoralis major (PM) tendon ruptures are rare. Typically, they are caused by eccentric contractions from weight lifting. Due to the rarity of pectoralis major tendon ruptures, clinicians might misdiagnose this condition. We report a 16-year-old male with a right pectoralis major tendon rupture and an avulsion fracture after falling on a grass field playing soccer. He was initially misdiagnosed with biceps tendonitis, which highlights the importance of including pectoralis major tendon ruptures in one's differential diagnoses.
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Affiliation(s)
- Kai Zhu
- Orthopedics, Washington State University Elson S. Floyd College of Medicine, Everett, USA
| | - Trisha Vuong
- Orthopedics, Washington State University Elson S. Floyd College of Medicine, Everett, USA
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16
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de Castro Pochini A, Ejnisman B, Andreoli CV, Lara PHS, Ribeiro LM, Cohen M, Belangero PS, Hipolide DC. Rupture of the bilateral and simultaneous tendon of the pectoralis major muscle. Description of three cases. J Surg Case Rep 2023; 2023:rjad531. [PMID: 38223468 PMCID: PMC10641291 DOI: 10.1093/jscr/rjad531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/08/2023] [Indexed: 01/16/2024] Open
Abstract
Pectoralis major muscle tendon ruptures associated with physical activity or effort are no longer uncommon in the medical literature. Treatment has also evolved significantly in the last 20 years. However, simultaneous bilateral rupture has only been described in a few cases. This article reports three cases with simultaneous bilateral rupture and describes the examinations and treatment performed. Bilateral lesions, although infrequent, also require early diagnosis and treatment in the acute phase. The chronic phase requires tendon grafting for full correction and a slow rehabilitation process.
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Affiliation(s)
| | - Benno Ejnisman
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos V Andreoli
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo H S Lara
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Leandro M Ribeiro
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Moises Cohen
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo S Belangero
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Debora C Hipolide
- Department of Psychobiology, Federal University of Sao Paulo, Sao Paulo, Brazil
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17
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Carlos NBT, Drain NP, Fatora GC, Nazzal EM, Herman ZJ, Hughes JD, Rodosky MW, Lin A, Lesniak BP. Myotendinous junction tears of the pectoralis major are occurring more frequently and discrepancies exist between intraoperative and radiographic assessments. JSES Int 2023; 7:2311-2315. [PMID: 37969514 PMCID: PMC10638570 DOI: 10.1016/j.jseint.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Pectoralis major (PM) tears have been shown to occur most frequently at the tendinous humeral insertion. However, no substantial updates on tear location have been published in 20 years or are based on relatively small sample sizes. The primary purpose of this study was to evaluate PM tear location based on magnetic resonance imaging (MRI). A secondary purpose was to evaluate agreement between MRI and intraoperative assessments of tear characteristics. We hypothesized that PM tears at the myotendinous junction (MTJ) occur at a higher rate than previously reported and that intraoperative and MRI assessments would demonstrate agreement in at least 80% of cases. Materials and methods An observational study of consecutive patients evaluated for a PM tear at a single institution between 2010 and 2022 was conducted. Patient demographics as well as MRI and intraoperative assessments of tear location, extent of tear, and muscle head involvement were collected from the electronic medical record. Agreement was calculated by comparing radiographic and intraoperative assessments per variable and reported as percentages. Data and statistical analysis were performed with SPSS software with a significance level set to P < .05. Results A total of 102 patients were included for analysis. Mean age was 35.8 ± 10.5 years and mean body mass index was 29.4 ± 4.8 kg/m2. 60.4% of the study population had tears of the MTJ, 34.9% of the tendinous humeral insertion, and 4.7% within the muscle belly, as determined intraoperatively. Complete tears had significantly higher agreement between MRI and intraoperative assessments relative to partial tears (83.9% and 62.5%, respectively; P ≤ .01). Discussion The majority of PM tears occurred at the MTJ. Preoperative MRI and intraoperative assessments agreed in 80% of cases, a value that was significantly higher for complete over partial tears. These findings demonstrate that tears of the MTJ are increasingly more common and support the use of MRI in preoperative planning for complete PM tears.
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Affiliation(s)
| | - Nicholas P. Drain
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gabrielle C. Fatora
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ehab M. Nazzal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zachary J. Herman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- The Pittsburgh Shoulder Institute, Pittsburgh, PA, USA
| | - Mark W. Rodosky
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- The Pittsburgh Shoulder Institute, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- The Pittsburgh Shoulder Institute, Pittsburgh, PA, USA
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- The Pittsburgh Shoulder Institute, Pittsburgh, PA, USA
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18
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Whittamore T, Funk L. Surgical repair and rehabilitation of a ruptured pectoralis major muscle in a professional footballer - A case report. J Bodyw Mov Ther 2023; 36:291-299. [PMID: 37949574 DOI: 10.1016/j.jbmt.2023.04.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/11/2023] [Accepted: 04/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Pectoralis Major ruptures normally occur in activities and sports such as powerlifting and American football or rugby. It is a rarely reported phenomena in professional footballers. Surgery is normally considered the choice of management to enable a safe return to play with conservatively managed ruptures often resulting in significant strength deficits. This case report highlights the management of a pectoralis major rupture in a professional footballer. CASE PRESENTATION A 27-year-old professional footballer sustained a left pectoralis major rupture after falling to the floor. A subsequent MRI reported a 5cm retraction of the pectoralis major tendon from its attachment at the humerus. Following a consultation with an orthopaedic surgeon the player underwent a pectoralis major surgical repair. Following surgery, the player underwent a rehabilitation programme under the care of the club physiotherapist. Return to play testing included a handheld dynamometer test, closed kinetic chain upper extremity test and progressive falling activities. The player returned to full contact training after 87 days. CONCLUSION This case study demonstrates a successful return to professional football following a pectoralis major rupture and supports the notion that surgical repair of these injuries produces a favourable outcome in professional athletes when returning to sport.
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Affiliation(s)
- Tom Whittamore
- Mansfield Town Football Club, Radford and Hymas Academy, Woburn Lane, Mansfield, NG19 7RT, UK.
| | - Lennard Funk
- The Arm Clinic, The Wilmslow Hospital, Wilmslow, SK9 1NY, UK.
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19
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Chadwick N, Weaver JS, Shultz C, Morag Y, Patel A, Taljanovic MS. High-resolution ultrasound and MRI in the evaluation of pectoralis major injuries. J Ultrason 2023; 23:e202-e213. [PMID: 38020504 PMCID: PMC10668934 DOI: 10.15557/jou.2023.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
The pectoralis major muscle is the largest muscle of the anterior chest wall. The primary function of the muscle is to adduct and internally rotate the arm at the shoulder. The pectoralis major muscle is broken down into two main components or "heads" based upon muscle fiber origin: clavicular and sternal. Pectoralis major muscle injury results from direct trauma or indirect force overload. The inferior sternal head fibers are the most commonly torn. The pectoralis major tendon most commonly is torn at the humeral insertion. Magnetic resonance imaging and high-resolution ultrasound have value in diagnosing pectoralis major muscle injury and help guide clinical and surgical management. Non-operative versus operative management of pectoralis major tears is dependent upon accurate diagnosis of tear location and severity on imaging. Operative management is recommended for tears at the humeral insertion and for musculotendinous junction tears with severe cosmetic/functional deformity. The indications for surgical intervention have been further expanded to complete intra-tendinous tears, defined as the mid-tendon substance between the myotendinous junction and humeral insertion, and those located at the sternal head/posterior lamina. This paper reviews normal pectoralis major anatomy and the spectrum of injury on magnetic resonance imaging and ultrasound. The importance of regional anatomical landmarks in assessing for pectoralis major muscle injury will be described. Other pathologies, such as tumor and infection, can also affect the pectoralis major muscle and key imaging features will be discussed to help differentiate these entities. Operative and non-operative management of pectoralis major muscle injury is described with examples of pectoralis major repair on post-operative imaging.
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Affiliation(s)
- Nicholson Chadwick
- Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Jennifer S. Weaver
- Department of Radiology, University of Texas Health San Antonio, San Antonio, USA
| | - Christopher Shultz
- Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, USA
| | - Yoav Morag
- Department of Radiology, University of Michigan, Ann Arbor, USA
| | - Arjun Patel
- Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Mihra S. Taljanovic
- Departments of Medical Imaging and Orthopedic Surgery, Banner University Medical Center, Tucson, Arizona, USA
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20
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Giordano JR, Klein B, Hershfeld B, Gruber J, Trasolini R, Cohn RM. A review of chronic pectoralis major tears: what options are available? Clin Shoulder Elb 2023; 26:330-339. [PMID: 37607861 PMCID: PMC10497927 DOI: 10.5397/cise.2023.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 08/24/2023] Open
Abstract
Rupture of the pectoralis major muscle typically occurs in the young, active male. Acute management of these injuries is recommended; however, what if the patient presents with a chronic tear of the pectoralis major? Physical exams and magnetic resonance imaging can help identify the injury and guide the physician with a plan for management. Nonoperative management is feasible, but is recommended for elderly, low-demand patients whose functional goals are minimal. Repair of chronic tears should be reserved for younger, healthier patients with high functional demands. Although operative management provides better functional outcomes, operative treatment of chronic pectoralis tears can be challenging. Tendon retraction, poor tendinous substance and quality of tissue, muscle atrophy, scar formation, and altered anatomy make direct repairs complicated, often necessitating auto- or allograft use. We review the various graft options and fixation methods that can be used when treating patients with chronic pectoralis major tears.
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Affiliation(s)
- Joshua R. Giordano
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Orthopedic Surgery, Northwell Health Huntington Hospital, Huntington, NY, USA
| | - Brandon Klein
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Benjamin Hershfeld
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Joshua Gruber
- Nova Southeastern University College of Osteopathic Medicine, Davie, FL, USA
| | - Robert Trasolini
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Orthopedic Surgery, Northwell Health Huntington Hospital, Huntington, NY, USA
| | - Randy M. Cohn
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Valley Stream, Valley Stream, NY, USA
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21
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Apostolakos JM, Brusalis CM, Uppstrom T, R Thacher R, Kew M, Taylor SA. Management of Common Football-Related Injuries About the Shoulder. HSS J 2023; 19:339-350. [PMID: 37435133 PMCID: PMC10331269 DOI: 10.1177/15563316231172107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 07/13/2023]
Affiliation(s)
- John M Apostolakos
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | | | - Tyler Uppstrom
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Ryan R Thacher
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Michelle Kew
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A Taylor
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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22
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Bartlett LE, Klein BJ, Daley A, Goodwillie A, Cohn RM. Functional Considerations in Bilateral, Simultaneous Tendon Injuries of the Upper Extremity: A Narrative Review of Current Literature. JBJS Rev 2023; 11:01874474-202306000-00008. [PMID: 37307343 DOI: 10.2106/jbjs.rvw.23.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
» Bilateral, simultaneous same-tendon injuries of the upper extremity are rarely encountered, yet their unique complexity poses a substantial challenge for treating orthopaedic surgeons.» In general, extremities with more tendon retraction should be repaired acutely while contralateral injuries can be treated in a staged or simultaneous manner depending on injury morphology, location, and anticipated functional impairment.» Combinations of accelerated and conventional rehabilitation protocols can be used for individual extremities to minimize the length of functional impairment.
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Affiliation(s)
- Lucas E Bartlett
- Department of Orthopedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntinton, New York
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23
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Stefanou N, Karamanis N, Bompou E, Vasdeki D, Mellos T, Dailiana ZH. Pectoralis major rupture in body builders: a case series including anabolic steroid use. BMC Musculoskelet Disord 2023; 24:264. [PMID: 37016399 PMCID: PMC10071695 DOI: 10.1186/s12891-023-06382-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Rupture of the pectoralis major (PM) muscle is a rare injury, with increasing incidence over the last decades, mainly due to participation in weightlifting and contact sports. Surgical management of PM injuries has been related with superior functional outcome, faster return to activities, better cosmesis and higher level of patients' satisfaction. The aim of the study is to present our experience in the management of this rare clinical entity and to correlate the use of anabolic steroids in the occurrence of the injury and the impact of type of injury, method of reconstruction and anabolic steroids on the post-operative outcome. CASES We present a series of six male bodybuilding athletes who sustained PM rupture during weightlifting. We recorded the location & type of injury, the history and type of anabolic steroids use, the method of repair and the post-operative outcome. TREATMENT AND OUTCOMES The mean follow-up period was 16 (12-24) months. All patients treated surgically had excellent results according to Bak criteria and returned to full activity within 5.4 (5-7) months following surgical reconstruction. No post-operative complications were recorded, despite the continued use of anabolic steroids, however one patient died from myocardial infarction within a year of surgical treatment. CONCLUSIONS PM rupture is an injury with increasing incidence within bodybuilding athletes probably not related to the dominance of the limb. Fixation of the tendon with suture anchors results in excellent clinical outcome and patient's satisfaction postoperatively regardless the chronicity of the repair. Our observations in these cases suggest that anabolic steroids use may contribute to the injury due to an excessive upward adjustment of the athlete's goals in lifting weights and moreover the continuation of administration even in the recovery period does not seem to have a negative effect either on the time or on the level of adequate functional recovery postoperatively.
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Affiliation(s)
- Nikolaos Stefanou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 3 Panepistimiou St, 41500, Biopolis, Larissa, Greece
| | - Nikolaos Karamanis
- Department of Hand, Upper Extremity Surgery and Microsurgery, IASO Thessalias, 41500, Larissa, Greece
| | - Effrosyni Bompou
- Department of General Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 3 Panepistimiou St, 41500, Biopolis, Larissa, Greece
| | - Dionysia Vasdeki
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 3 Panepistimiou St, 41500, Biopolis, Larissa, Greece
| | - Thomas Mellos
- B' Department of Orthopaedic Surgery-Sports Medicine, IASO Thessalias, 41500, Larissa, Greece
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 3 Panepistimiou St, 41500, Biopolis, Larissa, Greece.
- Department of Hand, Upper Extremity Surgery and Microsurgery, IASO Thessalias, 41500, Larissa, Greece.
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24
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Forrester JD, Chona DV, McAdams TR. Pectoralis Major Tendon Rupture While Bouldering. Wilderness Environ Med 2023; 34:96-99. [PMID: 36400648 DOI: 10.1016/j.wem.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
Abstract
Pectoralis major tendon ruptures are rare injuries. We present a case of a pectoralis major tendon rupture incurred while bouldering that required surgical repair. The diagnosis of pectoralis major tendon rupture relies predominantly on clinical examination. Among athletes, outcomes after surgical repair are superior to those after nonoperative therapy in most cases of complete tendon rupture. Although infrequent, pectoralis major tendon ruptures can occur while climbing, and early recognition and expedited surgical treatment are paramount to maximize functional recovery.
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Affiliation(s)
| | - Deepak V Chona
- Department of Orthopedic Surgery, Stanford University, Stanford, CA
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25
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Sanchez Carbonel JF, Imhoff A. Rupturen des M. pectoralis major und minor. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-022-00569-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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26
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Belk JW, Bravman JT, Frank RM, Seidl AJ, McCarty EC. Pectoralis Major Tendon Repair: Transosseous Suture Technique. VIDEO JOURNAL OF SPORTS MEDICINE 2023; 3:26350254221131058. [PMID: 40308544 PMCID: PMC11930917 DOI: 10.1177/26350254221131058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/16/2022] [Indexed: 05/02/2025]
Abstract
Background Pectoralis major ruptures are rare injuries that occur in young men between 20 and 40 years of age, typically during resistance training in the eccentric phase of muscle contraction. As the incidence of these ruptures increases with increasing activity levels and use of anabolic steroids, it is important to understand effective repair techniques. Indications Repair of the ruptured pectoralis major tendon is indicated for young, active patients seeking to regain full functionality of the affected upper extremity. Technique Description In short, after the pectoralis major is identified, the insertion site is revealed just lateral to the biceps tendon. The site for the bone trough is then exposed through cauterization of superficial tissue, and a cortical bone trough is drilled vertically using a small round burr. The location of 3 pilot holes is identified just lateral to the cortical bone trough, and then the holes are drilled to allow for placement of the anchors later in the procedure. The tendon itself is then identified, and sutures are placed in the bulk of the muscle tendon in a Krackow fashion. After the tendon is properly sutured, it is placed under tension to test the structural integrity of the suture pattern and ensure proper load capacity. The sutures are then passed through the pilot holes, the tendon is pulled down into the trough, and the sutures are tied down to the bone. Results After an appropriate rehabilitation protocol is followed for up to 6 months postoperatively, the transosseous suture technique in the context of pectoralis major tendon repairs allows for adequate tissue to bone healing and near-complete restoration of patient functionality and strength. Conclusion Acute repair of pectoralis major tendon tears using a transosseous suture technique is effective in restoring upper extremity strength and functionality and is associated with high patient satisfaction.The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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27
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Kuechly HA, Figueras JH, Figueras J, Gordon G, Johnson BM, West JW, Grawe BM. Pectoralis Major Muscle Belly Rupture in a 17-Year-Old Female Softball Player: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00043. [PMID: 36795910 DOI: 10.2106/jbjs.cc.22.00592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/20/2022] [Indexed: 02/18/2023]
Abstract
CASE We report the case of a healthy 17-year-old female softball player with a subacute full-thickness intramuscular tear of the pectoralis major (PM) muscle. A successful muscle repair was obtained using a modified Kessler technique. CONCLUSIONS Despite initially being a rare injury pattern, the incidence of PM muscle rupture is likely to increase as interest in sports and weight training increases, and although this injury pattern is more common in men, it is becoming more common in women as well. Furthermore, this case presentation provides support for operative treatment of intramuscular ruptures of the PM muscle.
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Affiliation(s)
- Henry A Kuechly
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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28
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Long MK, Ward T, DiVella M, Enders T, Ruotolo C. Injuries of the Pectoralis Major: Diagnosis and Management. Orthop Rev (Pavia) 2022; 14:36984. [PMID: 36589511 PMCID: PMC9797018 DOI: 10.52965/001c.36984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/21/2022] [Indexed: 12/05/2022] Open
Abstract
Pectoralis major ruptures are uncommon injuries that have become more prevalent over the past 20 years due to increased participation in weight lifting. Patients often present with localized swelling and ecchymosis, muscular deformity, thinning of the anterior axillary fold, and weakness in adduction and internal rotation of the affected arm. History and physical is often augmented with radiology, magnetic resonance imaging of the chest being the gold standard. Nonoperative management is reserved for old patients with low functional demands. Operative intervention is the treatment of choice with improved functional outcomes, cosmesis, and patient satisfaction.
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Affiliation(s)
| | - Taylor Ward
- Department of Osteopathic MedicineNassau University Medical Center
| | | | - Tyler Enders
- Orthopaedic SurgeryNassau University Medical Center
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29
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Jacob J, O'Connor P, Pass B. Muscle Injury Around the Shoulder. Semin Musculoskelet Radiol 2022; 26:535-545. [DOI: 10.1055/s-0042-1756687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractAcute shoulder tendon and intra-articular injuries are common and their imaging well described. However, a subset of patients present with more unusual acute shoulder muscle injury. Of these, pectoralis major muscle injuries are encountered the most often and are increasingly prevalent due to a focus on personal fitness, particularly bench-press exercises. Other muscle injuries around the shoulder are rare. This article reviews the anatomy, mechanism of injury, and the imaging findings in relation to injuries of these muscles around the shoulder. We focus on pectoralis major injury but also review proximal triceps, latissimus dorsi, teres major, and deltoid muscle injuries, providing imaging examples.
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Affiliation(s)
- J. Jacob
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - P. O'Connor
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - B. Pass
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
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30
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Abstract
Pectoralis major (PM) ruptures are relatively rare injuries occurring mostly in men 20 to 40 years of age. Weightlifting or bench pressing is the most common mechanism of injury. Although an uncommon injury, a high degree of clinical suspicion should be maintained since early surgical treatment has been shown to be beneficial. We present a case of a 51-year-old male with no known past medical history, who presented to the emergency department with sudden onset right chest pain after bench pressing (approximately 180kg). Physical examination revealed PM rupture with ecchymosis and loss of shoulder contour, as well as bulking over the right chest. He was otherwise neurovascularly intact. The right shoulder x-ray showed no fracture, dislocation or other bony abnormality. The diagnosis was confirmed by an urgent MRI scan which revealed a complete rupture of the sternal head of the PM, and the patient underwent right PM tendon repair nine days after the injury.
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31
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Ganokroj P, Midtgaard K, Elrick BP, Hazra ROD, Douglass BW, Nolte PC, Peebles AM, Fossum BW, Brown JR, Millett PJ, Provencher MT. Qualitative and Quantitative Anatomy of the Humeral Attachment of the Pectoralis Major Muscle and Structures at Risk: A Cadaveric Study. Orthop J Sports Med 2022; 10:23259671221121333. [PMID: 36157089 PMCID: PMC9502243 DOI: 10.1177/23259671221121333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Surgical pectoralis major (PM) repair can offer improved functional outcomes over nonoperative treatment. However, there is a lack of literature on consensus of the anatomical site of the humeral attachment. Purpose: To provide qualitative and quantitative anatomic analysis of the PM by focusing on humeral insertion and relevant structures at risk. Study Design: Descriptive laboratory study. Methods: Eight fresh-frozen male cadavers were dissected. The relevant landmarks that were collected and measured included (1) PM footprint length at the humeral insertion (total, sternal head, and clavicular head insertions); (2) PM tendon length from the humeral insertion to the musculotendinous junction; (3) distance from the PM humeral insertion to the lateral (LPN) and medial (MPN) pectoral nerves; and (4) distance from the coracoid process to the musculocutaneous nerve (MCN) in anatomical position. Results: The total PM footprint length was 81.4 mm (95% CI, 71.4-91.3). The sternal and clavicular heads that make up the PM had footprint lengths of 42.1 mm (95% CI, 32.9-51.4) and 56.6 mm (95% CI, 46.5-66.7), respectively. The PM tendon was wider at the clavicular head (74.7 mm; 95% CI, 67.5-81.7) than the sternal head insertions (43.0 mm; 95% CI, 40.1-45.9). The distances from the PM humeral insertion to LPN and MPN were 93.2 mm (95% CI, 83.1-103.3) and 103.8 mm (95% CI, 98.3-109.4), respectively. The coracoid process to MCN distance was 68.5 mm (95% CI, 60.2-76.8). Conclusion: This study successfully quantifies anatomic dimensions of the PM tendon, its sternal and clavicular head insertions, and its location relative to nearby vital structures. Such knowledge can provide surgeons with a better understanding of the PM in relation to nearby neurovascular structures during anatomic PM repair and reconstruction to avoid debilitating complications. Clinical Relevance: Knowledge of the quantitative anatomy of the PM at the humeral footprint along structures at risk may aid surgeons with identifying the injured part of the PM and improve outcomes for anatomic repair and reconstruction.
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Affiliation(s)
- Phob Ganokroj
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kaare Midtgaard
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Bryant P Elrick
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | - Philip C Nolte
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Brad W Fossum
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Justin R Brown
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Clinical Outcomes of Pectoralis Major Tendon Repair with and without Platelet-Rich Plasma. Arthrosc Sports Med Rehabil 2022; 4:e1739-e1746. [DOI: 10.1016/j.asmr.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022] Open
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Godoy IRB, Rodrigues TC, Skaf AY, de Castro Pochini A, Yamada AF. Bilateral pectoralis major MRI in weightlifters: findings of the non-injured side versus age-matched asymptomatic athletes. Skeletal Radiol 2022; 51:1829-1836. [PMID: 35303115 DOI: 10.1007/s00256-022-04031-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate magnetic resonance imaging (MRI) features of the contralateral side in weightlifting athletes with pectoralis major (PM) tears. We hypothesized that MRI of the non-injured side may present increased pectoralis major tendon (PMT) length and thickness and greater pectoralis major muscle (PMM) volume and cross-sectional area when compared with the control group. METHODS We retrospectively identified MRI cases with unilateral PM injury and reviewed imaging findings of the contralateral side. Also, we evaluated MRI from ten asymptomatic control weightlifting athletes, with PM imaging from both sides. Two musculoskeletal radiologists independently reviewed MRI and measured PMT length, PMT thickness, PMM volume (PMM-vol) and PMM cross-sectional area (PMM-CSA), as well as humeral shaft cross-sectional area (Hum-CSA) and the ratio between PMM-CSA and Hum-CSA (PMM-CSA/Hum-CSA). Data were compared between the non-injured side and controls. The MRI protocol from both groups was the same and included T1 FSE and T2 FATSAT axial, coronal, and sagittal images, one side at a time. RESULTS We identified 36 male subjects with unilateral PM injury with mean age 35.7 ± 8 years and 10 age- and gender-matched controls (p = 0.45). A total of 36 PM MRI with non-injured PM and 20 PM MRI studies were included in this study. PMT length and PMT thickness were significantly higher in contralateral PM injury versus control subjects (both P < 0.001). Also, PM-CSA and Hum-CSA were greater in the contralateral PM injury group (P = 0.032 and P < 0.001, respectively). PMT thickness > 2.95 mm had 80.6% sensitivity and 90.0% specificity to differentiate the non-injured PM group from controls. CONCLUSION Non-injured side MR imaging of patients with previous contralateral PM lesion demonstrates greater PMT thickness and length as well as PM-CSA and Hum-CSA than controls.
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Affiliation(s)
- Ivan Rodrigues Barros Godoy
- Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, Rua Napoleão de Barros, 800, São Paulo, SP, 04024-002, Brazil. .,Department of Radiology, Hospital Do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.
| | | | - Abdalla Youssef Skaf
- Department of Radiology, Hospital Do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.,ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Alberto de Castro Pochini
- Department of Orthopedics and Traumatology, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - André Fukunishi Yamada
- Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, Rua Napoleão de Barros, 800, São Paulo, SP, 04024-002, Brazil.,Department of Radiology, Hospital Do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.,ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
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Schwab L, Warby S, Davis K, Campbell P, Hoy S, Zbeda R, Hoy G. Video Analysis of Pectoralis Major Injuries in Professional Australian Football Players. Orthop J Sports Med 2022; 10:23259671221117826. [PMID: 36051979 PMCID: PMC9425905 DOI: 10.1177/23259671221117826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background: There is little evidence regarding the mechanisms of pectoralis major (PM) injury and player outcomes in Australian Football League (AFL) players. Purposes/Hypothesis: The study aims were to investigate (1) the mechanisms of PM muscle injury in elite AFL players via video analysis and (2) the player profile, method of management, and clinical outcomes of the PM injuries sustained. We hypothesized that the majority of PM tears would occur in outer-range PM positions (hyperextension of the glenohumeral joint). Study Design: Case series; Level of evidence, 4. Methods: We analyzed video of the precipitating event for traumatic PM injuries during AFL competition or training over a 20-year period (2002-2021). The footage was analyzed by 4 experienced assessors, and the following were evaluated: mechanism of injury, injury variables (arm position, initial contact point, visual awareness, and use of taping), player characteristics (age at the time of injury, hand dominance, and history of injury), injury profile (location and size of tear), method of management (operative vs nonoperative), patient outcomes (time to return to full senior training/match play), and complication rates. Results: The mean ± standard deviation age of the players was 26.5 ± 3.1 years (range, 21-32 years). Overall, 22 PM injuries were identified in the AFL injury database for a rate of 1.1 per year; 16 of these injuries had accompanying video footage. We identified 3 mechanisms for PM injury: horizontal hyperextension (62.5%), hyperflexion-abduction (25.0%), and horizontal adduction (sustained tackling; 12.5%). The most common site of the tear was the insertion point of the sternocostal head (91.0%). Twenty players (91.0%) required surgical repair, with 75% undergoing surgery within 1 week (range, 0-26 weeks). The mean return to competition for the surgical repair group was 11.1 weeks (range, 8-15 weeks). The rerupture rate was 5.0% (1 repair; <4 weeks postoperatively in 2004). Conclusion: PM tears in elite male AFL players were due to 1 of 3 distinct mechanisms: horizontal hyperextension, hyperflexion-abduction, and horizontal adduction (sustained tackling). Players returned to play on average 11 weeks after injury. Knowledge regarding mechanisms of injury, player profile, and return-to-sport timelines is important for appropriate medical management and provides potential areas to target for prevention of PM injuries.
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Affiliation(s)
- Laura Schwab
- Faculty of Science, Medicine and Health, University of Wollongong, Keiraville, Australia
| | - Sarah Warby
- Melbourne Shoulder Group, Prahran, Australia.,Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Australia
| | - Katherine Davis
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Australia
| | | | - Simon Hoy
- Melbourne Orthopaedic Group, Windsor, Australia
| | | | - Gregory Hoy
- Melbourne Orthopaedic Group, Windsor, Australia
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Haeberle HS, Ramkumar PN, Frantz TL, Jones GL, Curriero FC, Corrigan A, Soloff L, Schickendantz MS, Frangiamore SJ. Pectoralis muscle injuries in Major and Minor League Baseball. J Shoulder Elbow Surg 2022; 31:e363-e368. [PMID: 35183743 DOI: 10.1016/j.jse.2022.01.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although shoulder and elbow injuries in professional baseball players have been thoroughly studied, little is known about the frequency and impact of pectoralis muscle injuries in this population. The purpose of this study was to use the official league injury surveillance system to describe pectoralis muscle injuries in professional baseball players in Major League Baseball (MLB) and Minor League Baseball (MiLB). Specifically, (1) player demographic characteristics, (2) return to play (RTP), (3) injury mechanism, (4) throwing- and batting-side dominance, and (5) injury rate per athlete exposure (AE) were characterized to guide future injury prevention strategies. METHODS The MLB Health and Injury Tracking System database was used to compile all pectoralis muscle injuries in MLB and MiLB athletes in the 2011-2017 seasons. Injury-related data including diagnosis (tear or rupture vs. strain), player demographic characteristics, injury timing, need for surgical intervention, RTP, and mechanism of injury were recorded. Subanalyses of throwing- and batting-side dominance, as well as MLB vs. MiLB injury frequency, were performed. RESULTS A total of 138 pectoralis muscle injuries (32 MLB and 106 MiLB injuries) were reported in the study period (5 tears or ruptures and 133 strains), with 5 of these being recurrent injuries. Operative intervention was performed in 4 athletes (2.9%). Of the 138 injuries, 116 (84.1%) resulted in missed days of play, with a mean time to RTP of 19.5 days. Starting pitchers sustained the greatest proportion of pectoralis injuries (48.1%), with pitching being the most common activity at the time of injury (45.9%). A majority of injuries (86.5%) were sustained during non-contact play. Overall, 87.5% of injuries occurred on the player's dominant throwing side and 81.3% occurred on the player's dominant batting side. There was no significant difference in the rate of pectoralis injuries in the MLB regular season (0.584 per 10,000 AEs) vs. the MiLB regular season (0.425 per 10,000 AEs) (P = .1018). CONCLUSION Pectoralis muscle injuries are most frequently non-contact injuries, most commonly sustained by pitchers. An understanding of these injuries can guide athletic trainers and management in expectation management and decision making, in addition to directing future efforts at injury prevention.
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Affiliation(s)
| | | | - Travis L Frantz
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Grant L Jones
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Frank C Curriero
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Corrigan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lonnie Soloff
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Guzman AJ, Rayos Del Sol SM, Dela Rueda T, Bryant SA, Jenkins S, Gardner B, McGahan PJ, Chen JL. Surgical repair of acute on chronic seven-year pectoralis major rupture near the distal myotendinous junction: A case report. Clin Case Rep 2022; 10:e6118. [PMID: 35898730 PMCID: PMC9309739 DOI: 10.1002/ccr3.6118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/17/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022] Open
Abstract
The surgical fixation of an acute on chronic pectoralis major rupture with inciting injury 7 years prior has never been reported in the literature. Thus, we report the first case of an acute on chronic pectoralis major rupture repair in an active male patient who underwent successful surgical intervention and review the pathophysiology and treatment of pectoralis major tears.
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Affiliation(s)
| | | | | | | | - Sarah Jenkins
- Advanced Orthopaedics and Sports MedicineSan FranciscoCaliforniaUSA
| | - Brandon Gardner
- Advanced Orthopaedics and Sports MedicineSan FranciscoCaliforniaUSA
| | | | - James L. Chen
- Advanced Orthopaedics and Sports MedicineSan FranciscoCaliforniaUSA
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da Silva LG, Ferrer RM, de Souza JR, Gracitelli MEC, Secchi LLB. Rehabilitation After Surgical Treatment of Pectoralis Major Rupture in a CrossFit® Practitioner: A Case Report. Int J Sports Phys Ther 2022; 17:724-731. [PMID: 35693859 PMCID: PMC9159717 DOI: 10.26603/001c.35720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose The upper limbs are frequently injured during CrossFit® practice, and in some cases, surgical repair is recommended. The purpose of this case report was to describe the rehabilitation process performed after the surgical repair of a pectoralis major rupture in a CrossFit® practitioner. Design Case report. Case Description The subject was a 26-year-old man, with 1.75m and 69kg, who practiced CrossFit® for five years and sustained the injury during the execution of the ring dip. The rehabilitation protocol was of 16 weeks duration. Passive modalities and exercises focusing on range of motion, muscle strength, and CrossFit®-specific movements were performed. Shoulder range of motion was assessed through goniometry, and muscle strength was assessed through isometric dynamometry. Outcomes At week seven the subject had full range of motion, and at week fourteen achieved limb symmetry (Limb Symmetry Index - 84.78 - Abduction; 97.58 - Adduction; 86.15 - Internal Rotation; 85.06 - External Rotation) in muscle strength. The subject returned to his previous level of athletic activities. Conclusions: A 16-week protocol performed with exercises focusing on range of motion, muscle strength, and CrossFit®-specific movements was abe to promote the return to sport at the pre-injury level in a CrossFit® practitioner.
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Affiliation(s)
- Lucas Gomes da Silva
- Physical Therapy Department, Centro Universitário Sudoeste Paulista (UNIFSP) - Campus Itapetininga - Itapetininga - Brazil
| | - Rafael Marques Ferrer
- Brazilian National Society of Sports Physical Therapy (SONAFE-Brazil) - São Paulo - Brazil
| | - José Roberto de Souza
- Sciences and Technologies in Health Post-Graduation Program, University of Brasília (UNB)
| | - Mauro E C Gracitelli
- Institute of Orthopedics and Traumatology, School of Medicine,, University of São Paulo - São Paulo - Brazil
| | - Leonardo Luiz Barretti Secchi
- Physical Therapy Department, Federal University of São Carlos (UFSCar) - Post-Graduate Program in Physical Therapy - Laboratory of Analysis and Intervention of the Shoulder Complex - São Carlos - Brazil., Federal University of São Carlos (UFSCar)
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Beck P, Reinecke F, Polan C, Meyer HL, Schoepp C, Burggraf M, Dudda M, Mester B. [Rupture of the pectoralis major muscle in amateur athletes: a rare injury or often overlooked?]. SPORTVERLETZUNG-SPORTSCHADEN 2022; 36:155-159. [PMID: 35413736 DOI: 10.1055/a-1754-4524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION A rupture of the pectoralis major muscle is a rare injury pattern overall, but it is frequently described in athletes, particularly in weightlifting. The risk of sustaining this type of injury is present especially during the eccentric phase of muscle loading. An association between such injuries and the abuse of anabolic steroids is described in the literature, but there is no coherent evidence to support this. We report the case of a young patient with a normal habitus who suffered a humeral rupture of the pectoralis major muscle during recreational sports. There was no history of excessive weight training or use of anabolic steroids. CASE HISTORY This 33-year-old patient reported a sudden onset of left pectoral pain during training on the chest fly machine as well as a whip-like popping sound, followed by an immediate painful restriction of movement in the left arm. A clinical examination revealed a mild haematoma located on the left medial upper arm with localised tenderness and a discrete asymmetry of the contour of the pectoral muscles. Due to the typical medical history, we established the indication for surgical exploration although the clinical picture was rather discrete and only an incomplete rupture was seen in an MRI scan. Intraoperatively, we detected a complete rupture of the sternocostal part of the pectoralis major muscle with marked retraction and haematoma. Reinforcement and reinsertion were performed at the "footprint" using titanium anchors (2 x 5.5mm Corkscrew FT, Arthrex, Florida). The patient was able to resume his sports activities at the pre-traumatic level four months after surgery. CONCLUSION A rupture of the insertion of the pectoralis major muscle must also be considered in amateur athletes with a typical history. The characteristic clinical symptoms described in the literature mostly refer to competitive athletes and bodybuilders, but these injuries can also be diagnosed in amateur athletes with lower muscle mass by subtle clinical examination. Nevertheless, there is a considerable risk of underestimating the extent of the injury. In case of doubt, surgical exploration should be performed promptly in amateur athletes. Surgical refixation of the humeral rupture of the pectoralis major muscle is the gold standard and should not be reserved to high-performance athletes.
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Affiliation(s)
- Paula Beck
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Felix Reinecke
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Christina Polan
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Heinz-Lothar Meyer
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Christian Schoepp
- Klinik für Arthroskopische Chirurgie, Sporttraumatologie und Sportmedizin, BG Klinikum Duisburg, Duisburg, GERMANY
| | - Manuel Burggraf
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Marcel Dudda
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Bastian Mester
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
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Pectoralis Major Rupture: Evaluation and Management. J Am Acad Orthop Surg 2022; 30:e617-e627. [PMID: 35025841 DOI: 10.5435/jaaos-d-21-00541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/10/2021] [Indexed: 02/01/2023] Open
Abstract
Pectoralis major tendon ruptures are being reported with increasing frequency and primarily occur in young, high demand, male patients. The injury results from an eccentric contracture of the muscle most commonly while performing the bench press maneuver during weight training. In the setting of both acute and chronic injury, physical examination is critical for a timely and accurate diagnosis. During physical examination, comparison with the opposite side is imperative, and findings may include swelling, ecchymosis, loss of the anterior axillary fold, and a decreased pectoralis major index. Surgical treatment of acute ruptures is superior to nonsurgical treatment and results in improved functional outcomes and high levels of return to work and sport. Repair of chronic tears is more challenging and may require reconstruction with autograft or allograft tissue. Despite advances in surgical technique, tendon rerupture, persistent pain, and wound infection remain a concern.
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Agarwalla A, Gowd AK, Liu JN, Garcia GH, Nicholson GP, Forsythe B, Romeo AA, Verma NN. Return to Work After Pectoralis Major Repair. Orthop J Sports Med 2021; 9:23259671211045635. [PMID: 34950740 PMCID: PMC8689630 DOI: 10.1177/23259671211045635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pectoralis major repair (PMR) is an infrequent injury that occurs during resistance training, most commonly during the eccentric phase of muscle contraction. As the incidence of weight training continues to increase, it is important to understand the outcomes after PMR. PURPOSE To evaluate the rate and duration of return to work in patients undergoing PMR. STUDY DESIGN Case series; Level of evidence, 4. METHODS Consecutive patients undergoing PMR from 2010 to 2016 at a single institution were retrospectively reviewed at a minimum of 1 year postoperatively. Patients completed a standardized and validated work questionnaire, as well as a visual analog scale for pain, American Shoulder and Elbow Surgeons survey, Single Assessment Numerical Evaluation, and a satisfaction survey. RESULTS Of the 60 eligible patients who had a PMR, 49 (81.7%) were contacted at the final follow-up. Of the 49 patients, 46 (93.9%) had been employed within 3 years before surgery (mean ± SD age, 40.4 ± 8.2 years; follow-up, 3.9 ± 2.8 years). Of these, 45 (97.8%) returned to work by 1.6 ± 2.1 months postoperatively, and 41 (89.1%) returned to the same level of occupational intensity. Patients who held sedentary, light-, medium-, or high-intensity occupations returned to work at a rate of 100.0%, 100.0%, 83.3%, and 66.7% by 0.8 ± 1.0, 0.8 ± 1.0, 1.3 ± 2.7, and 3.3 ± 2.7 months, respectively. Five of 6 patients (83.3%) with workers' compensation returned to their previous occupations by 5.0 ± 1.6 months, while 100% of those without workers' compensation returned to work by 1.1 ± 1.7 months (P < .001). Overall, 44 patients (95.7%) were satisfied with the procedure, and 40 (87.0%) would have the operation again if presented the opportunity. A single patient (2.2%) required revision PMR. CONCLUSION Approximately 98% of patients who underwent PMR returned to work by 1.6 ± 2.1 months postoperatively. Patients with higher-intensity occupations took longer to return to their preoperative levels of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Anirudh K. Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Joseph N. Liu
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | | | - Gregory P. Nicholson
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Anthony A. Romeo
- Musculoskeletal Institute, DuPage Medical Group, Westmont, Illinois, USA
| | - Nikhil N. Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Decker KJ, Ghobrial PG, Chudik SC. Pectoralis major tendon reconstruction using an iliotibial band autograft. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:389-392. [PMID: 37588698 PMCID: PMC10426577 DOI: 10.1016/j.xrrt.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Kyle J. Decker
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | | | - Steven C. Chudik
- Hinsdale Orthopaedics, Westmont, IL, USA
- Orthopaedic Surgery and Sports Medicine Teaching and Research Foundation, Westmont, IL, USA
- Illinois Bone and Joint Institute, Chicago, IL, USA
- AMITA Health, La Grange, IL, USA
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Abbas MJ, Buckley P, Shah S, Okoroha KR. Simultaneous repair of bilateral pectoralis major tendons: A case report. World J Orthop 2021; 12:802-810. [PMID: 34754836 PMCID: PMC8554350 DOI: 10.5312/wjo.v12.i10.802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/20/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Injuries to the pectoralis major are infrequent, with only a few hundred cases currently recorded in the literature.
CASE SUMMARY We report a case of a patient who sustained bilateral pectoralis major tendon ruptures. While other cases of bilateral pectoralis major tears have been reported in the literature, the operative management in this report differs. Due to delayed presentation of the patient right and left pectoralis major repairs were performed simultaneously.
CONCLUSION Patients with delayed presentation of bilateral pectoralis major tendon ruptures can undergo simultaneous repair of both tendon with a good postoperative outcome and high patient satisfaction.
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Affiliation(s)
- Muhammad J Abbas
- Department of Orthopedic Surgery, Henry Ford Health System, Dearborn, MI 48124, United States
| | - Patrick Buckley
- Department of Orthopedic Surgery, Henry Ford Health System, Dearborn, MI 48124, United States
| | - Sabin Shah
- Department of Orthopedic Surgery, Henry Ford Health System, Dearborn, MI 48124, United States
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Mayo Clinic, Minneapolis, MN 55403, United States
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Noufal A. A case report of a rupture of the musculotendinous junction of the pectoralis major in an athlete. Int J Surg Case Rep 2021; 87:106428. [PMID: 34563816 PMCID: PMC8479642 DOI: 10.1016/j.ijscr.2021.106428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The pectoralis major muscle (PM) is a large muscle on the anterior chest wall. The rupture of the PM is a rare entity in literature and most incidences had been reported frequently in weight lifting and contact sports. Acute repair of PM rupture yielded better outcome as compared to non-operative treatment in active individuals who wish to return to their sports. CASE REPORT We presented a case of a champion in bodybuilding who lifted a heavy weigh during his routine exercises, which caused a rupture in the musculotendinous junction of the left pectoralis major muscle. DISCUSSION As it is rare to meet ruptures in this site of pectoralis major, we decided to insert anchors into the humeral bone (as in avulsions and tendon's tears), and to duplicate the suturing levels in multiple directions (as in muscular belly ruptures). CONCLUSION Our aim here is to confirm that the rupture of the musculotendinous junction of the pectoralis major muscle is rare and difficult to deal, but the acute surgical treatment by inserting anchors into the humerus, and duplicating the suturing layers in multiple directions can give good results especially in athletes.
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Affiliation(s)
- Abdullah Noufal
- Pediatric Orthopedic Surgery, AUHD (Al-Assad University Hospital Damascus), Syria.
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Functional Shoulder Outcome and Quality of Life Following Modified Muscle-Sparing Pectoralis Major Flap Surgery. Healthcare (Basel) 2021; 9:healthcare9091158. [PMID: 34574932 PMCID: PMC8467859 DOI: 10.3390/healthcare9091158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The pedicled pectoralis major muscle flap (PMMF) is a well established flap for fistula prophylaxis after salvage laryngectomy. To reduce donor site morbidity, we established a modified muscle-sparing harvesting technique. We herein investigate postoperative shoulder function and health-related quality of life (HRQOL). METHODS A chart review of patients receiving the modified muscle-sparing pectoralis major muscle flap between 2013-2020 was performed. Nineteen patients (male = 18, female = 1) were potentially eligible and six male patients were ultimately enrolled. Postoperative shoulder function was assessed on both sides (flap side versus non-flap side) using the Constant Murley Score and the Bak criteria. Health-related quality of life was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire in cancer patients (EORTC QLQ-C30) and head and neck cancer patients (EORTC H&N35). RESULTS No Constant Murley Score subscale was statistically significant (p ≥ 0.180). Bak criteria was overall rated "Good". Solely upper extremity adduction force was significantly altered on the flap side (p = 0.039). Median EORTC QLQ-C30 score was 82.2 (IQR 11.1) on the functional scale and 10.3 (IQR 2.6) on the symptomatic scale. Median quality of life score was 75.0 (IQR 33.3) and median EORTC QLQ-H&N35 was 20.6 (IQR 9.8). CONCLUSIONS Postoperative shoulder function after modified muscle-sparing pectoralis major muscle flap surgery is comparable to function of the healthy side with a significant deficiency in adduction force not compromising daily life in this small study cohort.
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Bodendorfer BM, DeFroda SF, Shu HT, Knapik DM, Yang DS, Verma NN. Incidence of Pectoralis Major Injuries Has Increased 40% Over the Last 22 National Football League Seasons. Arthrosc Sports Med Rehabil 2021; 3:e1113-e1118. [PMID: 34430891 PMCID: PMC8365205 DOI: 10.1016/j.asmr.2021.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To examine trends in the incidence of pectoralis major (PM) injuries over the last 22 National Football League (NFL) seasons and identify risk factors for injuries requiring operative management. Methods Publicly available data from the 1998-1999 through 2019-2020 NFL seasons were reviewed to identify PM injuries, demographics, injury mechanisms, and management. Injury incidence was calculated using linear regression per 10,000 athlete-exposures, while risk factors for operative management were identified through multivariate logistic regression. Results There were 258 PM injuries. Mean athlete age at the time of injury was 27.1 years (range: 21-37) with a mean body mass index of 32.6 (range: 24.8-43.1). Overall incidence was 0.603 per 10,000 athlete-exposures, which was found to significantly increase with time by 0.039 per athlete-exposures per year (R2 = .787, P < .001). Defensive athletes accounted for 64.7% of PM injuries. Repair was performed in 48.8% of athletes, with defensive linemen (odds ratio [OR] 3.78, CI 1.42-10.60, P = .009), defensive backs (OR 12.20, CI 2.13-76.60, P = .006), linebackers (OR 8.98, CI 2.58-33.60, P < .001), more recent time of injury (OR 1.11, CI 1.05-1.17, P < .001), and shorter NFL experience (OR .77 for older athletes, CI .59-.99), P = .047) at significant risk for operative treatment. Conclusion A total of 258 PM injuries were identified over 22 NFL seasons, with an overall incidence of 0.603 per 10,000 athlete-exposures, which was found to increase by 0.039 injuries per 10,000 athlete-exposures per year. Repair was performed in 48.8% of athletes, with more recent time of injury, shorter NFL experience, defensive linemen, defensive backs and linebackers at significantly higher risk for operative treatment. Study Design Cohort study; Level of evidence, 3
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Affiliation(s)
| | | | - Henry T Shu
- School of Medicine, The Johns Hopkins University, Baltimore, Maryland, U.S.A
| | | | - Daniel S Yang
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
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Magone K, Ben-Ari E, Gyftopoulos S, Virk M. Pectoralis Major Tendon Tear: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202108000-00004. [PMID: 34415856 DOI: 10.2106/jbjs.rvw.20.00224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
» Pectoralis major (PM) tendon tears are predominantly seen in young men, and the majority of tears occur as tendon avulsions involving the sternal head. Weightlifting, specifically bench-pressing, and sporting activities with eccentric overloading of the PM tendon are the 2 most common activities that result in PM injury. » Early surgical repair or reconstruction should be offered to younger, active patients with a complete PM tear; the majority of the patients undergoing surgical repair achieve good-to-excellent outcomes. » Nonsurgical treatment of a complete PM tear is an option but will result in cosmetic deformity and a deficit in adduction strength of the arm. Outcomes after nonsurgical treatment of complete PM tears are less satisfactory than those obtained after surgical treatment. » Currently, there is no consensus on the chronological definition of PM tears (acute versus chronic), the critical time limit for performing surgical repair, the ideal fixation device (cortical button, bone tunnel, or suture anchors), the indications for allograft use, and the ideal rehabilitation protocol after treatment of PM tears.
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Affiliation(s)
- Kevin Magone
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
- Shoulder and Elbow Surgery, CHI Saint Joseph Medical Group-Orthopedic Associates, CHI Saint Joseph Health, London, Kentucky
| | - Erel Ben-Ari
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
- Division of Orthopaedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Soterios Gyftopoulos
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Mandeep Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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Bodendorfer BM, DeFroda SF, Shu HT, Knapik DM, Yang DS, Verma NN. Performance and Survivorship of National Football League Players with Pectoralis Major Injuries. Arthrosc Sports Med Rehabil 2021; 3:e1097-e1104. [PMID: 34430889 PMCID: PMC8365217 DOI: 10.1016/j.asmr.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this study was to determine return-to-play (RTP), performance and career survivorship for National Football League (NFL) athletes sustaining pectoralis major (PM) injuries with comparison among grades of injury and between nonoperative and operative management. METHODS Publicly available data from the 1998-2020 NFL seasons were reviewed to identify athletes with PM injuries. Athlete characteristics were collected 1 season before and 2 seasons after injury. Percent of total games played in a season, player efficiency rating (PER), and Pro Football Focus (PFF) grades were compared for the preinjury season and 2 postinjury seasons. Kaplan-Meier survivorship plots were computed for RTP and postinjury career length, whereas a log-rank test was used to compare survivorship differences. RESULTS In total, 258 PM injuries were reported at a mean age of 27.1 ± 3.3 years. A total of 126 surgical repairs occurred in 48.8% (n = 126) of injuries, with athletes undergoing repair possessing a lower RTP rate and longer time to RTP compared to athletes treated conservatively (P < .001). Survival analysis revealed shorter career length for athletes sustaining PM tears compared to strains (P < .001), although no difference in career length was appreciated on the basis of injury management (P = .980). Defensive linemen and wide receivers had lower PER during their second postinjury seasons (P = .019 and .030, respectively), whereas defensive linemen had lower PFF grades during their second post-injury seasons (P = .044). CONCLUSION NFL athletes requiring PM repair may experience a lower likelihood of RTP, and longer RTP timing, likely because of higher-grade injuries. Defensive linemen and wide receivers experiencing PM injuries are at risk for diminished performance post-injury. Career length does not appear to be affected based on injury management. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
| | | | - Henry T. Shu
- School of Medicine, The Johns Hopkins University, Baltimore, MD
| | | | - Daniel S. Yang
- Warren Alpert Medical School, Brown University, Providence, RI
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Abstract
» In the past 20 years, there has been a substantial increase in the prevalence of pectoralis major injuries, largely related to the rising popularity of weight-lifting and participation in contact sports. » Treatment options are influenced by the severity of the injury, patient age, and the amount and type of physical activity. » Although there is no consensus as to which treatment method is most effective, previous studies have demonstrated increased satisfaction among patients who undergo operative treatment. » The average length of time from surgery to return to activity ranges from 6 to 24 months.
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Isokinetic Strength and Functional Scores after Rehabilitation in Jiu-Jitsu Fighter with Repair Surgery of Pectoralis Major Muscle Rupture: A Case Report. Healthcare (Basel) 2021; 9:healthcare9050527. [PMID: 33946161 PMCID: PMC8145385 DOI: 10.3390/healthcare9050527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022] Open
Abstract
A pectoralis major muscle rupture is a rare injury that mainly occurs during exercise. This study examined the application of rehabilitation, strength and passive range of motion (ROM) change, and subjective assessment for 1 year undertaken after repair surgery of pectoralis major muscle rupture in a Jiu-Jitsu fighter. We hypothesized that the application of ROM exercises and rehabilitation strategies contributed to muscle recovery and successful return to sports. The patient was a 34-year-old man who was injured after falling during a competitive event. The patient had pain and swelling in the front of the chest and shoulder, and the distal chest was deformed. Imaging revealed a complete rupture of the pectoralis major muscle. Reparative surgery was performed by a specialist. Immobilization was performed one week after the surgery. Passive ROM exercises began with the forward flexion 2 weeks after the surgery; abduction and external rotation ROM exercises at 4 weeks; low-intensity muscle strength exercises using tube bands at 6 weeks; machine-based pectoralis major muscle exercises at 3 months. Isokinetic equipment was used to measure horizontal adduction and internal rotation strengths, and the subjective shoulder functional and ROM scores were evaluated. Recovery of shoulder function and ROM occurred at 3 months and muscle recovery at 6 months. The participant was able to return to sports at 5 months and compete at 7 months. Although this study explored only one patient's post-operative recovery, it suggests that ROM and strength exercises may be effective post-operative strategies for restoring function and strength to enable a return to sports.
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Umehara J, Sato Y, Ikezoe T, Yagi M, Nojiri S, Nakao S, Yanase K, Hirono T, Ichihashi N. Regional differential stretching of the pectoralis major muscle: An ultrasound elastography study. J Biomech 2021; 121:110416. [PMID: 33894472 DOI: 10.1016/j.jbiomech.2021.110416] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 11/28/2022]
Abstract
Pectoralis major (PMa) muscle injuries are becoming more prevalent, and their incidence differs among the PMa regions, i.e., the clavicular, sternal, and abdominal regions. Therefore, identifying the position for effectively lengthening each PMa region is critical in preventing PMa injuries. The purpose of this study was to determine the effective stretching position for each PMa region through shear wave elastography, which can indirectly assess individual muscle lengthening. Fifteen men participated in this study. Twelve stretching positions were compounded with shoulder abductions (45°, 90°, and 135°), pelvic rotation (with or without), shoulder external rotation (with or without), and shoulder horizontal abductions. The shear modulus of each PMa region was measured through shear wave elastography in the stretching positions mentioned above. At the clavicular region, the shear modulus was higher for three stretching positions: shoulder horizontal abduction at 45° abduction during pelvic rotation and shoulder external rotation, shoulder horizontal abduction at 90° abduction, and shoulder horizontal abduction at 90° abduction while considering shoulder external rotation. For the sternal region, the shear modulus was higher in two stretching positions: shoulder horizontal abduction at 90° abduction while adding external rotation, and combination of pelvic rotation and external rotation. For the abdominal region, the shear modulus was higher in the shoulder horizontal abduction at 135° abduction with pelvic and external rotation. These results indicated that the effective stretching position was different for each PMa region.
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Affiliation(s)
- Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Center for Information and Neural Networks (CiNet), National Institute of Information and Communications Technology, Suita, Japan; Research Fellow of Japan Society for the Promotion of Science, Chiyoda-ku, Japan.
| | - Yusaku Sato
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tome Ikezoe
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shusuke Nojiri
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Nakao
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Rehabilitation, Kansai Medical University Hospital, Hirakata, Japan
| | - Ko Yanase
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Research Fellow of Japan Society for the Promotion of Science, Chiyoda-ku, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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