Isolated Pectoralis Minor Rupture - Case Report and Systematic Review

Abstract

Background: Isolated Pectoralis Minor ruptures are rare and comprehensive review of its presentation and management is lacking. Our objective is to describe a case of an isolated pectoralis minor rupture and systematically review the literature for its prevalence, mechanism of injury, presentation, appropriate investigations and treatment. Methods: After presenting the case, we performed a systematic review of the English literature on PUBMED and MEDLINE from inception to June 2018 with the MeSH search terms of “pectoralis minor” AND “isolated” AND “rupture” OR “tear”. Results: Our case was a healthy non-elite male who sustained the injury from forced shoulder abduction and extension while playing rugby league. He presented with anterior shoulder and chest pain, with sub-pectoral swelling. An MRI confirmed the diagnosis and he was successfully treated non-operatively with resolution of symptoms and return to full work activities within nine weeks. The systematic review identified six cases of isolated ruptures. Most injuries were sustained during contact sport with a forced shoulder abduction and extension or direct impact to the chest wall causing anterior shoulder pain. MRI confirmed the diagnosis in all cases and non-operative treatment successfully resulted in symptom resolution within three months. Conclusions Isolated pectoralis minor injuries are rare. Affected patients are usually young fit individuals who sustain the injury following a direct blow to the shoulder or hyper-abduction and extension injury of the arm. They typically present with tenderness over the anterior shoulder with limitation in shoulder ROM. MRI is the optimal diagnostic modality and the treatment is non-operative.