Simultaneous Rupture Of Pectoralis Major And Triceps Tendons

Abstract

HISTORY: A 50 year old Caucasian Male presents with right elbow and shoulder pain. Pt had reported ongoing right elbow pain over the past two months since he began to bench pressing. Pt states he has a h/o heavy weight lifting and had not lifted for the past year d/t recent back surgery. Over the course of the past two months as he started to increase his weights he began to develop right elbow pain. Pt was evaluated several times by his PCP and was given several rounds of prednisone. After each taper, pt did notice symptom improvement and this allowed him to become more aggressive in his weight lifting, he started at 135# but soon was lifting 200#, with ongoing right elbow pain. Pt did experience a fall during this time and landed on his right elbow, he was evaluated at the local ER and xrays taken and was given his third course of steroids and several days later, he decided to lift 300#. On the third bench press lift, he felt sharp severe pain and a cracking sensation in his elbow and his right arm gave out and dropped below his chest forcefully. He felt a searing pain in his right upper chest. PHYSICAL EXAMINATION: Healthy appearing male in obvious discomfort. Significant swelling of the right pectoral region and ecchymosis extending over the entire right half of his chest and proximal part of his anterior arm. Significant swelling and ecchymosis at the posterior aspect of the elbow. Palpable defect in the triceps tendon distally. ROM was decreased due to pain in both the elbow and right shoulder. Strength was decreased to forward flexion and internal rotation of the right shoulder and extension of the right elbow. DIFFERENTIAL DIAGNOSIS:Pectoralis major muscle or tendon tear/ avulsion and Avulsion of the Triceps tendon, TEST RESULTS: MRI of the right shoulder: Pectoralis major tendon avulsion from its humeral attachment with complex myotendon and peritendinous hematoma and diffuse muscle and myofascial strain and swelling. MRI of the right elbow without contrast: Triceps tendon avulsion from its olecranon insertion. FINAL/WORKING DIAGNOSIS: Simoultaneous tendon avulsions of Pectoralis Major tendon and Triceps Tendon TREATMENT AND OUTCOMES: Pt was scheduled for surgery for surgical repair on two separate dates for the Triceps tendon repair followed by repair of the Pectoralis Major tendon