Chest Wall Injury-CrossFit

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HISTORY: 21 y/o M RHD CrossFit Coach sustained an injury to his R upper extremity while performing the “muscle up” exercise on a high bar about six weeks prior to presentation. He felt a painful pop in his shoulder/arm area after which he experienced bruising near his axilla/chest wall then unable to complete his workout. He continued to have pain/weakness along with difficulty working out with his usual gym routine, especially exercises involving pushing maneuvers. He was initially seen by another Orthopaedist, an MRI obtained, then referred to our Sports clinic. Other than a history of rapid weight loss of over 100 pounds a couple of years prior to the traumatic episode, he denies any supplement usage. PHYSICAL EXAMINATION: Ventral Trunk/R upper extremity: loss of R chest wall contour in the “hands on hips” position/asymmetric axillary fold; TTP at bicipital groove; shoulder-painful ROM arc upon extreme abduction/elevation; weakness/pain with resisted IR/horizontal adduction. DIFFERENTIAL DIAGNOSIS: 1. R LH biceps tendon rupture 2. R pectoralis muscle tear 3. R pectoralis tendon rupture TEST AND RESULTS: R shoulder XR plain films without abnormality MRI show signal changes in pectoralis major tendon consistent with rupture of humeral detachment/retraction into chest wall; posterior glenoid labral tear FINAL WORKING DIAGNOSIS: R pectoralis major tendon rupture TREATMENT AND OUTCOMES: 1. Patient underwent subacute repair with Achilles allograft augmentation 2 months post-injury. 2. He was placed in a shoulder immobilizer for 6 weeks and formal PT started at 2 weeks. 3. At his last visit 5 months post-op he was doing very well, progressing with self PT rehab exercises in the gym, no pain with daily activities and pleased with cosmesis/symmetrical chest muscle contour. He started working out again and back to approximately 80% muscle strength/endurance with push-ups/pull-ups but avoiding explosive movements that would put him at risk of reinjury.