Best Practice Case Studies-Pectoralis Muscle Tear

Pdf Summary

Pectoralis major (PM) injuries, although rare, have seen increased incidence due to the rising popularity of weightlifting and sports activities. Typically occurring during eccentric contraction, often during a bench press, the injuries lead to pain, an audible pop, swelling, and ecchymosis. Physical exam reveals weakness in arm adduction and internal rotation. Key diagnostic imaging is MRI of the chest, despite initial reliance on clinical examination.<br /><br />Treatment strategies depend on the severity and location of the tear. Nonoperative options are mainly suitable for the elderly or those with partial tears, focusing on maintaining basic function without rigorous activity. However, surgical intervention is recommended for complete tears, facilitating better recovery in terms of strength and cosmesis, and aiding faster return to sports.<br /><br />Surgical techniques vary. Commonly, tears at the tendo-osseus junction are treated through transosseous sutures, suture anchors, or cortical button fixation. While TOS, especially when paired with a bone trough, remains the gold standard, recent studies suggest that uni-cortical button fixation using large caliber sutures shows promising results in terms of strength and reduced displacement under cyclic loading. These repairs ideally occur within eight weeks of injury to prevent complications from fibrosis and scarring.<br /><br />For chronic tears or those occurring at the musculotendinous junction (27% of PM injuries), reconstruction may be necessary, using techniques involving allografts or autografts from tendons like the semitendinosus. These approaches have shown success in restoring functionality and cosmetic appearance, though less literature exists compared to acute repairs.<br /><br />Ultimately, the management strategy should be tailored to the individual's age, activity level, and specific characteristics of the injury to ensure the best possible outcomes in strength recovery and patient satisfaction.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 09

Topic Chest

Keywords

3rd Edition, CASE 09

3rd Edition

Chest

pectoralis major injuries

weightlifting

eccentric contraction

bench press

MRI chest

nonoperative treatment

surgical intervention

transosseous sutures

cortical button fixation

musculotendinous junction reconstruction