Musculus-pectoralis-major-Rupturen: Verletzungsklassifikation und Ergebnisse der operativen Versorgung

Abstract

Classification of pectoralis major muscle injuries and results of operative treatment in the Sportsklinik Stuttgart between 1998 and 2004 are analysed. 10 sportsmen (2 judo, 8 body-building; 9 male, 1 female) with pectoralis major ruptures received operative treatment in this time period. After clinical examination we used ultrasound, in some cases MRI, for further diagnostics. The follow-up (1-5 years) included a clinical examination, ultrasound, sports level, cosmetics and an isokinetic strength assessment. In 4 cases we found a tear of the musculotendinous junction, 4 cases showed a tear at the humeral insertion and 2 other cases had tears of the muscle belly. There was no sports-specific injury. 6 ruptures underwent immediate (1 week) operative therapy and 4 ruptures had delayed (6 weeks to 4 years) repair of the injury. In 9 cases an anatomic repair was possible, in 1 delayed rupture only an extra-anatomic repair was possible. We had 1 complication with a post-operative wound infection. Based on injury localisation and operative treatment, we classified 3 types of pectoralis major ruptures. The follow-up evaluation showed in 7 cases very good and good results, 2 delayed cases still had a cosmetic defect with reduction of strength. From our results on pectoralis major muscle injuries there are 3 types of rupture: type 1: rupture at humeral insertion, type 2: rupture of musculotendinous junction, type 3: rupture of muscle belly. This classification is essential for planning the operative technique and the incision. We recommend, after classification of the rupture, primary operative reconstruction of the pectoralis major muscle.