Point-of-care Ultrasound for Suspected Pectoralis Major Rupture: A Case Report

Nathanael Franks,Jeremiah Gress,Ryan Joseph

doi:10.5811/cpcem.2020.10.50802

Abstract

IntroductionPectoralis major muscle injuries are relatively uncommon and occur secondary to weightlifting in nearly 50% of cases. Tendon tears occur almost exclusively in males between 20–40 years old and are heavily associated with anabolic androgenic steroid use. While magnetic resonance imaging is often considered the modality of choice, its availability is often limited in the emergency department (ED). In contrast, point-of-care ultrasound (POCUS) is commonly available in the ED and can be used to help confirm the diagnosis and hasten disposition.Case ReportWe report a case of a 28-year-old male competitive weightlifter with a history of chronic anabolic steroid use who presented to the ED with acute left shoulder pain after weightlifting. History and physical exam were concerning for pectoralis major rupture, and POCUS confirmed the diagnosis.ConclusionPrompt evaluation and radiographic confirmation is key in ensuring good patient outcomes in pectoralis major tears. Therefore, proficiency of emergency physicians in musculoskeletal POCUS as an adjunct to estimate the extent of injury is important for expediting disposition and and promptly involving orthopedic surgery evaluation.

Highlights

Pectoralis major muscle injuries are relatively uncommon and occur secondary to weightlifting in nearly 50% of cases
Case Report: We report a case of a 28-year-old male competitive weightlifter with a history of chronic anabolic steroid use who presented to the emergency department (ED) with acute left shoulder pain after weightlifting
Proficiency of emergency physicians in musculoskeletal point-of-care ultrasound (POCUS) as an adjunct to estimate the extent of injury is important for expediting disposition and and promptly involving orthopedic surgery evaluation. [Clin Pract Cases Emerg Med. 2021;5(1):93–96.]

Summary

Introduction

Pectoralis major muscle injuries are relatively uncommon and occur secondary to weightlifting in nearly 50% of cases. Tendon tears occur almost exclusively in males between 2040 years old and are heavily associated with anabolic androgenic steroid use. While magnetic resonance imaging is often considered the modality of choice, its availability is often limited in the emergency department (ED). Point-of-care ultrasound (POCUS) is commonly available in the ED and can be used to help confirm the diagnosis and hasten disposition. Case Report: We report a case of a 28-year-old male competitive weightlifter with a history of chronic anabolic steroid use who presented to the ED with acute left shoulder pain after weightlifting. History and physical exam were concerning for pectoralis major rupture, and POCUS confirmed the diagnosis

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INTRODUCTION

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CONCLUSION