Muscle grand pectoral : une nouvelle classification des lésions tendineuses et musculaires distales

Abstract

BackgroundDifferent classifications for pectoralis major tears have been reported in the literature. However, none of the current classifications has been fully accepted and they do not explain all the encountered lesions. The objective of this study was to propose a novel classification of pectoralis major tears. MethodsThrough anatomical dissection works using 6 cadaveric shoulders from 3 subjects, and an ultrasonic imaging protocol on 25 healthy subjects, we have studied the relationship between the clavicular head of the pectoralis major, the distal tendon and the remaining portion of the muscle. ResultsThe tendon of the pectoralis major consists of two thin aponeurotic layers which are continuous at their lower extremities: the anterior layer comes from the upper sternal muscular segments and the posterior layer from the lower sternal and abdominal muscular segments. The clavicular head is purely muscular. It comes over the anterior layer and its part is very minimal in the actual tendon as it is mostly fascia prolonged by the brachial fascia. DiscussionThese findings have implications for understanding traumatic pathology and allow us to offer a new classification of the anatomy of tears of the distal tendon and muscle body of the pectoralis major. It thus seems essential to us to consider that the clavicular head can remain inserted on the tendon stump and be fully or partially intact in the event of complete tendon rupture. The persistence of a clavicular head should therefore not be misinterpreted as a partial tendon injury.