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Pectoralis Tendon Rupture
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Pectoralis Tendon Rupture | ||
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Related narrative: Pectoralis Major Tendon Rupture Rupture of the pectoralis major is an uncommon occurrence and seen nearly entirely in athletic males in the third to fourth decades of life. Fewer than 180 cases of pectoralis major rupture have been reported in the world literature since the initial description by French surgeons in 1822. The mechanism of rupture is usually a forceful eccentric tension load or direct trauma and injuries range from a sprain or contusion, partial rupture to complete rupture. The pectoralis major arises in a broad sheet with an upper clavicular head and a lower sternocostal head. The confluence of these tendons forms a "U" shaped tendon that inserts on the lateral lip of the bicipital groove. Injury may occur within the muscle, at the myotendinous junction, within the tendon itself or at the insertion of the tendon on the humerus (most common). Diagnosis can be quite difficult and physical findings depend on chronicity of the injury and the site of rupture. Acute ruptures are diagnosed by knowledge of injury mechanism and physical findings including a prominent bulge in the proximal muscle belly, loss of the normal contour and structure of the tendon passing laterally and weakness in resisted adduction and internal rotation of the arm. Although not necessary for diagnosis, MRI has been extremely beneficial in decision making for acute ruptures as it assists in determining the site of the tear and potential for successful surgical treatment. These injuries are not limb-threatening and have successfully been managed with conservative non-surgical treatment, especially in cases of partial ruptures and tears involving the muscle or myotendinous junction. Icing and an initial period of rest is followed by a progressive stretching and conditioning period. Resistance activity is usually delayed for 6 - 10 weeks. Physical therapy modalities and ultrasound may be of assistance in both the early and late phases of rehabilitation. Early surgical treatment is advocated in very active athletes and high performance individuals (competitive weightlifters, bodybuilders, military forces, law enforcement personnel, etc.). Complete tendon ruptures may be repaired primarily through drill holes in the humerus or end-to-end repair if sufficient tendon cuff remains laterally. Injuries within the muscle or myotendinous junction may be repaired primarily, as well, but results are much less satisfactory. Reported improvement in isokinetic strength testing with operative repair has varied in the literature from 80-100%, and from 60-75% with nonoperative treatment. Subjective satisfaction ratings are also somewhat higher with 90% in the operative groups and 50% in the nonoperative groups. Nevertheless, there are reports of high-level athletes returning to complete activity and successful careers following non-operative treatment. References: Berson BL. Surgical Repair of Pectoralis Major Rupture in an Athlete. Am J Sports Med 1979;7:348-351. Caughey MA, Welsh P. Muscle Ruptures Affecting the Shoulder Girdle. In Rockwood CA and Matsen FA (eds): The Shoulder, 2nd ed. Philadelphia: WB Saunders,1998, p 1114 - 1126. Schepsis AA, Grafe MW, Jones HP, Lemos MJ. Rupture of the Pectoralis Major Muscle. Outcome after Repair of Acute and Chronic Injuries. Am J Sports Med 2000 Jan-Feb;28(1):9-15. Zeman SC, Rosenfeld RT, Lipsomb PR. Tears of the Pectoralis Major Muscle: Am J of Sports Med 1979;7:343-347.
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