Pectoralis Major Tendon Tears Research Articles

No difference in load to failure or stiffness between transosseous tunnels, suture anchors, and cortical buttons for pectoralis major tendon repair: a systematic review & meta-analysis

PurposeSurgical options for pectoralis major tendon tears include primary repair, though there is no consensus as to which constructs are biomechanically superior for repair.MethodsA systematic review was performed by searching PubMed, the Cochrane library, and Embase using PRISMA guidelines to identify studies that analyzed the biomechanical properties of bone tunnels (BT), cortical buttons (CB) and suture anchors (SA) techniques for pectoralis major tendon repair. The search phrase implemented was ‘pectoralis major tendon repair biomechanics’. Studies that did not evaluate biomechanical outcome data, evaluated partial pectoralis major tendon tears, and non-English articles were excluded. Evaluated outcomes included ultimate load to failure (N) and stiffness (N/mm).ResultsSix studies met inclusion criteria, including a total of 124 cadaveric specimens, for pectoralis major tendon repair comparing BT with SA and CB. Pooled analysis from four studies reporting on ultimate load to failure between BT and SA failed to reveal a difference between BT and SA (p = 0.489). Pooled analysis from two studies reporting on stiffness failed to reveal a difference in favor of BT compared to SA (p = 0.705). Pooled analysis from four studies reporting on ultimate load to failure between BT and CB failed to reveal a difference between BT and CB (p = 0.567). Pooled analysis from two studies reporting on stiffness failed to reveal a difference in favor of BT compared to CB (p = 0.701).ConclusionsThere was no difference in load to failure or stiffness when using BT, CB, or SA in pectoralis major tendon repairs. This review reveals that clinical outcomes may better inform which fixation construct to implement in pectoralis major tendon repairs.Level of evidenceI.

Pectoralis Major Tendon Repair: Transosseous Suture Technique

Background: Pectoralis major ruptures are rare injuries that occur in young men between 20 and 40 years of age, typically during resistance training in the eccentric phase of muscle contraction. As the incidence of these ruptures increases with increasing activity levels and use of anabolic steroids, it is important to understand effective repair techniques. Indications: Repair of the ruptured pectoralis major tendon is indicated for young, active patients seeking to regain full functionality of the affected upper extremity. Technique Description: In short, after the pectoralis major is identified, the insertion site is revealed just lateral to the biceps tendon. The site for the bone trough is then exposed through cauterization of superficial tissue, and a cortical bone trough is drilled vertically using a small round burr. The location of 3 pilot holes is identified just lateral to the cortical bone trough, and then the holes are drilled to allow for placement of the anchors later in the procedure. The tendon itself is then identified, and sutures are placed in the bulk of the muscle tendon in a Krackow fashion. After the tendon is properly sutured, it is placed under tension to test the structural integrity of the suture pattern and ensure proper load capacity. The sutures are then passed through the pilot holes, the tendon is pulled down into the trough, and the sutures are tied down to the bone. Results: After an appropriate rehabilitation protocol is followed for up to 6 months postoperatively, the transosseous suture technique in the context of pectoralis major tendon repairs allows for adequate tissue to bone healing and near-complete restoration of patient functionality and strength. Conclusion: Acute repair of pectoralis major tendon tears using a transosseous suture technique is effective in restoring upper extremity strength and functionality and is associated with high patient satisfaction. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Pectoralis Major Tendon Tears During Airborne Operations: Are These Injuries Isolated?

Pectoralis major tendon tears are an injury pattern often treated in military populations. Although the majority of pectoralis major tendon tears occur during eccentric loading as in bench press weightlifting, military service members may also experience this injury from a blunt injury and traction force produced by static line entanglement during airborne operations. Although these injuries rarely occur in isolation, associated injury patterns have not been investigated previously. After obtaining institutional review board approval, medical records were reviewed for all patients who underwent surgical repair of a pectoralis major tendon tear sustained during static line parachuting at a single institution. Radiology imaging, operative notes, and outpatient medical records were examined to determine concomitant injury patterns for each patient identified over a 4-year study period. Twenty-five service members met the study inclusion criteria. All patients underwent presurgical magnetic resonance imaging. Of these 25 service members, 10 (40%) presented with a total of 13 concomitant injuries identified on physical exams or imaging studies. The most common associated injuries were injuries to the biceps brachii and a partial tear of the anterior deltoid. Biceps brachii injuries consisted of muscle contusion proximal long head tendon rupture, proximal short head tendon rupture, partial muscle laceration, and complete muscle transection. Additional concomitant injuries included transection of coracobrachialis, a partial tear of the inferior subscapularis tendon, antecubital fossa laceration, an avulsion fracture of the sublime tubercle, and an avulsion fracture of the coracoid process. Military static line airborne operations pose a unique risk of pectoralis major tendon tear. Unlike the more common bench press weightlifting tear mechanism, pectoralis major tendon tears associated with static line mechanism present with a concomitant injury in 40% of cases, with the most common associated injury occurring about the biceps brachii. Treating providers should have a high index of suspicion for concomitant injuries when treating pectoralis major tendon tears from this specific mechanism of injury.

Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-Analysis of Operative and Nonoperative Treatment

Objectives:The incidence of pectoralis major tendon tears is rising, and repair is generally considered, but there is a paucity of comparative data to demonstrate the superiority of operative treatment. We sought to compare the outcomes of operative and nonoperative treatment of pectoralis major tendon tears. We hypothesized that repair would result in superior outcomes compared to nonoperative treatment.Methods:In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was completed using MEDLINE, SPORTDiscus, CINAHL, Cochrane, Embase and Web of Science databases. English-language studies were included with a minimum of 6 months average follow-up and 5 cases per study. Methodological Index for Nonrandomized Studies was utilized to assess the quality of the existing literature. Meta-analysis of pooled mechanisms of injury and outcomes was completed. Pooled effect-sizes were calculated from random effects models. Continuous variables were assessed using mixed model analysis with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data was transformed using the Freeman-Tukey log-linear transformation for variance stabilization and then assessed using a mixed model with a study-level random effect and subsequently back-transformed. Significance was set at P<.05.Results:Twenty-three articles with 664 injuries met the inclusion criteria for comparison (Figure 1). All patients were male with 63.2% of injuries occurring during weight training, with an average age of 31.48 years and follow-up of 37.02 months. Included studies had moderately high methodological quality. Operative treatment was significantly superior to nonoperative treatment with a relative improvement of functional outcome by 0.70 (P=.027), full isometric strength by 77.07% (P<.001), isokinetic strength by 28.86% (P<.001) compared to the uninjured arm, cosmesis satisfaction by 13.79% (P=.037), and resting deformity by 98.85% (P<.001) (Table 1). There was an overall complication rate of 14.21%, including a 3.08% rate of rerupture, for operative treatment.Conclusion:Pectoralis major tendon repair resulted in significantly superior outcomes as compared to nonoperative treatment with an associated 14.21% complication rate. There was a statistically significant improvement in functional outcome, isokinetic strength, isometric strength, cosmesis, and resting deformity.Figure 1.Table 1.Comparison of Outcomes between Operative and Nonoperative TreatmentOutcome MeasurementOperativeNo.NonoperativeNo.P-valueFunctional Outcome Score3.66; SE=0.15CI=3.36-3.954672.96, SE=0.28CI=2.41-3.5039<0.027Full ROM97.09%CI=84.17%-100%9398.53%CI=72.30%-100%140.862Full Isometric Strength97.50%CI=88.09%-100%6120.43%CI=0%-58.07%9<0.001Isokinetic Strength Change(-)8.64%; SE=5.35CI=(-)19.12%-(+)1.85%95(-)37.50%; SE=6.28;CI=(-)49.81%-(-)25.19%35<0.001Cosmesis: Resting Deformity1.15%CI=0%-9.43%38100%CI=70.23-100%6<0.001Cosmesis: Satisfaction91.60%CI=86.63%-94.18%46577.81%CI=60.03%-92.17%390.037

Magnetic Resonance Imaging of Pectoralis Major Injuries in an Active Duty Military Cohort: Mechanism Affects Tear Location.

Background:Pectoralis major (PM) tendon tears are common injuries in athletic patient populations, where operative repair is largely recommended for maximum functional recovery. The repair varies in difficulty and technique based on the location of the tear within the muscle-tendon unit. Magnetic resonance imagining (MRI) has been reported to be sensitive and specific for identifying the tear location, but the effect of injury mechanism on tear pattern has not been previously investigated.Purpose:To examine PM tears in a military patient population and assess the effect of injury mechanism (weightlifting vs high-energy trauma) on the tear pattern and accuracy of MRI interpretation.Study Design:Cohort study; Level of evidence, 3.Methods:Active duty military servicemembers undergoing operative repair of PM tendon tears with corresponding preoperative MRIs from 2 medical centers were identified. Two musculoskeletal fellowship–trained radiologists reviewed imaging studies, reporting the location of the tear within the muscle-tendon unit and the severity of the tear (sternal head vs clavicular head vs both). Radiographic findings were compared against intraoperative findings. Mechanism of injury and timing from injury to imaging and surgery were assessed to determine whether they affected the accuracy of MRI interpretations.Results:A total of 72 patients were included (mean ± SD age, 33.7 ± 7.0 years; 100% male). Mechanisms of injury consisted of 46 weightlifting injuries and 26 high-energy injuries. Interrater reliability was poor for tear location (kappa, 0.162; P = .003) but substantial for extent of tear (kappa, 0.637; P < .0001). MRI had a 51.3% sensitivity and 63.6% specificity for identifying complete tears. MRI had a sensitivity of 73.9% and specificity of 72.2% for avulsion injuries and sensitivity of 75% and specificity of 79.3% for musculotendinous injuries. Mechanism of injury had no effect on extent of the tear but did affect the location of the tear, with a higher rate of avulsion injuries in the high-energy mechanism cohort (81% vs 40%; P = .02).Conclusion:The mechanism of injury was found to significantly affect the location of tendon tears. A higher rate of avulsion injuries was found in high-energy injuries than weightlifting injuries. MRI appeared to be less sensitive and specific than previous reports for traumatic PM tendon injuries.

Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Repair Timing and Fixation Methods

Background: Repair of torn pectoralis major tendons is generally considered superior to nonoperative management, but there is a paucity of comparative data to demonstrate ideal repair timing and fixation methods. Purpose/Hypothesis: The purpose was to compare the outcomes between acute and chronic repair and among the various methods of fixation (transosseous tunnels, cortical buttons, suture anchors, screws with washers, and direct repair). It was hypothesized that acute repair would have superior outcomes and there would be similar outcomes among the various methods of fixation. Study Design: Meta-analysis. Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review of the literature was completed through MEDLINE, SPORTDiscus, CINAHL, Cochrane, Embase, and Web of Science databases. English-language studies were included with a minimum of 6 months’ mean follow-up and 5 cases per study. MINORS (Methodological Index for Nonrandomized Studies) was utilized to assess the quality of the existing literature. Analysis of mechanisms of injury and meta-analysis of pooled outcomes were completed. Pooled effect sizes were calculated from random effects models. Continuous variables were assessed via mixed model analysis, with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data were transformed through Freeman-Tukey log-linear transformation for variance stabilization and then assessed through a mixed model with a study-level random effect and subsequently back-transformed. Significance was set at P < .05. Results: Twenty articles with 384 injuries met the inclusion criteria for comparison. All patients were male, with 61.9% of injuries occurring during weight training, at a mean age of 31.53 years, and with a mean follow-up of 30.12 months. Included studies scored a mean (SD) 15.53 ± 4.26 (range, 7.0-23.3) by MINORS criteria. Acute repair was significantly superior to chronic repair, with a relative improvement of functional outcome by 0.85 (P = .004) and satisfaction with cosmesis by 20.50% (P = .003). There was a trend toward acute repair having a higher proportion of patients who were pain-free (34.47%, P = .064). There were no significant differences among the methods of fixation for repair. Conclusion: Acute repair of pectoralis major tendon tears resulted in significantly superior functional outcomes and cosmesis satisfaction with a trend toward a higher proportion of patients who were pain-free. There were no significant differences among the methods of fixation for repair.

Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment.

Background:The incidence of pectoralis major tendon tears is increasing, and repair is generally considered; however, a paucity of comparative data are available to demonstrate the superiority of operative treatment.Purpose/Hypothesis:The purpose of this study is to compare the outcomes of operative and nonoperative treatment of pectoralis major tendon tears. We hypothesized that repair would result in superior outcomes compared with nonoperative treatment.Methods:In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review of the literature was completed by use of MEDLINE, SPORTDiscus, CINAHL, Cochrane, EMBASE, and Web of Science databases. We included English-language studies that had a minimum of 6 months of average follow-up and 5 cases per study. The MINORS (Methodological Index for Non-Randomized Studies) was used to assess the quality of the existing literature. Meta-analysis of pooled mechanisms of injury and outcomes was completed. Pooled effect sizes were calculated from random-effects models. Continuous variables were assessed by use of mixed-model analysis, with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data were transformed via the Freeman-Tukey log-linear transformation for variance stabilization and then assessed through use of a mixed model with a study level random effect and subsequently back-transformed. Significance was set at P < .05.Results:A total of 23 articles with 664 injuries met the inclusion criteria for comparison. All patients were male, with an average age of 31.48 years; 63.2% of injuries occurred during weight training, and the average follow-up was 37.02 months. Included studies had moderately high methodological quality. Operative treatment was significantly superior to nonoperative treatment, with relative improvements of functional outcome by 23.33% (0.70 improvement by Bak criteria which is scored 1-4; P = .027), full isometric strength 77.07% (P < .001), isokinetic strength 28.86% (P < .001) compared with the uninjured arm, cosmesis satisfaction 13.79% (P = .037), and resting deformity 98.85% (P < .001). The overall complication rate for operative treatment was 14.21%, including a 3.08% rate of rerupture.Conclusion:Pectoralis major tendon repair resulted in significantly superior outcomes compared with nonoperative treatment, with an associated 14.21% complication rate. Statistically significant improvements were noted in functional outcome, isokinetic strength, isometric strength, cosmesis, and resting deformity.

Outcomes After Dermal Allograft Reconstruction of Chronic or Subacute Pectoralis Major Tendon Ruptures.

Background:Avoiding delay in the surgical management of pectoralis major (PM) ruptures optimizes outcomes. However, this is not always possible, and when a tear becomes chronic or when a subacute tear has poor tissue quality, a graft can facilitate reconstruction.Purpose:The primary aim was to evaluate the clinical outcomes of PM reconstruction with dermal allograft augmentation for chronic tears or for subacute tears with poor tissue quality. A second aim was to determine patient and surgical factors affecting outcome.Study Design:Case series; Level of evidence, 4.Methods:Nineteen consecutive patients (19 PM ruptures) with a mean ± SD age of 39.1 ± 8.4 years were retrospectively reviewed at 26.4 ± 16.0 months following PM tendon reconstruction with dermal allograft. Surgery was performed at 19.2 ± 41.2 months after injury (median, 7.6 months; range, 1.1-185.4 months). Several outcome scores were recorded pre- and postoperatively, including Disabilities of the Arm, Shoulder, and Hand (DASH), as well as visual analog scale (VAS) (range, 0-10; 0 = no pain) and Single Assessment Numeric Evaluation (SANE). Range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and complications/reoperations were recorded postoperatively.Results:Scores improved significantly for the DASH (preoperative, 34.9; postoperative, 8.0; P < .001) and VAS (preoperative, 5.0; postoperative, 1.5; P = .011). There was a trend toward improved SANE scores (preoperative, 15.0; postoperative, 80.0; P = .097), but the difference was not statistically significant, likely because of the small number of patients having preoperative SANE scores for review. Increased age was associated with higher VAS scores (r = 0.628, P = .016) and less forward flexion (r = –0.502, P = .048) and external rotation (r = –0.654, P = .006). Patients with workers’ compensation had lower scores for 3 measures: SANE (75.8 vs 88.4, P = .040), Constant (86.7 vs 93.4, P = .019), and ASES (81.9 vs 97.4, P = .016). Operating on the dominant extremity resulted in lower Constant scores (87.8 vs 95.4, P = .012). A 2-head tendon tear (107.5° vs 123.3°, P = .033) and the use of >1 graft (105.0° vs 121.3°, P = .040) resulted in decreased abduction.Conclusion:This was the first large series to observe patients with chronic or subacute PM tendon tears treated with dermal allograft reconstruction. PM tendon reconstruction with dermal allografts resulted in good objective and subjective patient-reported outcomes.

Pectoralis Major Tendon Repair With Acellular Dermal Matrix Augmentation

Pectoralis major tendon tears were historically an uncommon injury, but prevalence has increased with increased awareness and increase in high contact and heavy lifting sports. Operative management of pectoralis tendon tears is complicated by a short tendon stump, frequently requiring sutures to be placed well into the muscle belly, leaving them susceptible to pull-out and failure of the repair. We present a technique of pectoralis major tendon repair augmented by the use of an acellular dermal matrix. Acellular dermal matrices or allografts are used elsewhere in orthopedics and have been proven both clinically and biomechanically to lead to increased suture pull-out strength. This repair technique increases the “effective” length and increases the suture pull-out strength. As a result, patients are allowed to rehabilitate rapidly in the postoperative period and the surgeon can have more confidence in the strength of the repair.

Outcomes of Pectoralis Major Tendon Repair: Does Study Design Matter?: Commentary on an article by Drew W. Nute, MD, et al.: "Return to Function, Complication, and Reoperation Rates Following Primary Pectoralis Major Tendon Repair in Military Service Members".

Nute et al. are to be congratulated for this retrospective study comprising a large cohort of 257 U.S. active-duty military patients following primary pectoralis major tendon repair performed by 152 surgeons at 57 medical treatment facilities between 2008 and 2013, with a minimum follow-up of 2 years. The patients were identified from the Military Health System utilizing the Management Analysis and Reporting Tool (M2). Historically, pectoralis major tendon tears have occurred infrequently. A systematic review identified only 365 cases in the literature since Patissier’s description of the injury in 1822 through 20101. Pectoralis major tendon tears have occurred with increasing frequency in more recent years. Changing demographic characteristics with increased participation in contact sports and weight-training activities are likely responsible. Previous studies have demonstrated that improved outcomes can be anticipated with surgical repair compared with nonoperative treatment and that acute repair is preferable2-4. Recent publications have begun to provide more information on anticipated functional outcomes, adduction strength following surgical repair, complications, and second surgical procedure rates5. The strengths of this study from Nute et al. include the large cohort of patients and the information provided with regard to functional outcomes, complications, reoperation rates, and risk factors for failure. A total of 242 patients (94%) were able to return to full duty at a mean time of 7.1 months following the surgical …

Life Lessons, Leadership, and Enduring Friendships

Life Lessons, Leadership, and Enduring Friendships

Pectoralis major tendon tears: functional outcomes and return to sport in a consecutive series of 40 athletes

There are limited data on the outcomes of surgically repaired pectoralis major tendon (PMT) tears. The purpose of this study was to report the functional outcomes, return to sport, and second surgery rates in a consecutive series of PMT tears. Forty patients with acutely repaired PMT tears were retrospectively identified. Follow-up was conducted with functional outcome scores and adduction strength testing at final follow-up. Return to sport and incidence of subsequent surgery were also recorded. The average age of the patients was 34.4 years (range, 23-59 years). Average follow-up was 2.5 years (range, 2-7.0 years). Twenty-three injuries (58%) occurred in the nondominant extremity. Bench press (n = 26) and contact sport participation (n = 14) were the most common mechanisms. Postoperative Single Assessment Numeric Evaluation scores averaged 93.6 (range, 62-100), with patient satisfaction of 9.6 of 10 (range, 6-10). All athletes returned to preinjury level of function approximately 5.5 months postoperatively (range, 4.5-6.5 months); 23.1% and 2.6% described mild or moderate difficulties with sport participation. Isokinetic strength evaluation revealed an average decrease of 9.9% (range, -18% to 41%). Application of the Bak criteria revealed 37% excellent, 26% good, and 37% fair outcomes, with most in the fair group reporting cosmetic concerns. Removing cosmesis, 46% scored excellent, 37% good, and only 17% fair. Three athletes required a second surgical procedure (7.5%). Surgical repair of PMT tears resulted in high patient satisfaction, with excellent restoration of function and adduction strength, early return to sport, and few reoperations, albeit with the potential for mild cosmetic concerns.

Latissimus and Pectoralis Tendon Injuries in the Overhead Athlete: Evaluation and Management

Latissimus dorsi (LD) and pectoralis major (PM) tendon injuries are uncommon injuries in overhead athletes. The unique anatomical and biomechanical characteristics predispose the LD and PM to injuries during overhead activity. Although each overhead sport has different mechanics and phases of overhead activity, many similarities affecting the LD and PM are seen in each sport. Although a thorough history of the athlete’s symptoms and overhead activity is paramount, a keen understanding of each sport’s overhead mechanics may help with establishing the right diagnosis. A physical examination is important to identify these injuries given their low incidence and need for appropriate imaging during the clinical workup. Standard shoulder magnetic resonance imaging techniques may not be sufficiently caudal to demonstrate LD or PM pathology. Operative management is usually recommended for LD and PM tendon tears in other athletes. However, overhead athletes represent a unique population who commonly sustain only partial tears where nonoperative management has demonstrated excellent results. However, in throwing athletes with complete tears and extensive retraction, LD and PM tears may require surgical repair. Rehabilitation should progress with caution to minimize reinjury, which is common in athletes returning too quickly. Although overuse is the most likely reason for LD and PM injuries in overhead athletes, proper mechanics are essential to help reduce the chance of injury.

Allograft Reconstruction of Chronic Pectoralis Major Tendon Ruptures

In chronic pectoralis tendon tears, primary repair may not be possible and allograft reconstruction may be required. The goal of this study was to report the authors' experience with chronic pectoralis major tendon reconstructions using an Achilles tendon allograft in three military patients. Three consecutive patients presenting with chronic, complete pectoralis major tendon tears underwent reconstruction by a single surgeon using the same described technique at a mean of 22.2 months after initial injury. Final outcomes were assessed at a mean of 24.5 months postoperatively, yielding one excellent and two good results. All patients were satisfied. All patients returned to full active duty military service and recreational weight lifting by 6 months. Achilles allograft reconstruction of chronic pectoralis major tendon ruptures is a viable treatment option. Good to excellent results can be achieved in active patients, even when reconstruction is performed nearly 2 years from the time of injury.

Examen clinique des ruptures du muscle grand pectoral

The pectoralis major tendon tears are rare pathologies but not exceptional and probably under diagnosed. Clinically, severe lesions of the pectoralis major's tendon can cause conformational changes of the fossa axillaris whose for understanding requires a perfect knowledge of the tendon's anatomy. Through our three cases experience, we present in this article the detailed methods of the inspection of the pectoralis major and explain the sometimes-surprising modifications of the fossa axillaris’ anterior wall conformation. While traditionally, only total or subtotal tears are considered as surgical, it appears more pertinent to describe total rupture, major partial tears and minor partial tears. As in the majority of tendinous ruptures, the diagnosis is mainly clinical and based primarily on the inspection of the fossa axillaris. A well-conducted inspection, while respecting a delayed time after the event, could help to classify the tears in these three categories without multiplying investigations. This attitude could have significant impacts and facilitate the following management.

Isolated Tear of the Pectoralis Minor Tendon in a High School Football Player

Multiple pectoralis major tendon tears have been reported in the literature; however, isolated rupture of the pectoralis minor tendon is rare and has been reported 3 times (4 patients).This article describes a case of an isolated pectoralis minor tendon tear in a male high school football player after a traumatic injury. The patient was injured while making a tackle and leading with his arm and chest. He presented with left anterior shoulder and chest wall pain with direct tenderness on palpation over the coracoid. Magnetic resonance imaging of the chest revealed an isolated tear of the pectoralis minor tendon with slight retraction and significant edema in the muscle belly. The patient returned to full activities after conservative management.Although rare, the diagnosis of pectoralis minor tendon rupture should be considered in patients who sustain a contact injury to the shoulder with tenderness on palpation over the coracoid. The mechanism of injury can be related to a direct anterior force to the shoulder, forced external rotation of the arm in slight abduction, or with the arm in extension and shoulder in flexion (eg, blocking in football). The diagnosis can be confirmed with magnetic resonance imaging when edema exists on the medial aspect of the coracoid and extends into the muscle belly. Physical therapy with scapular stabilization exercises and avoidance of abduction and active adduction can be successful in returning these patients to their previous activity levels.

Repair of Chronic Pectoralis Major Ruptures

Traumatic ruptures of the pectoralis major tendon were once thought to be an extremely rare injury. Over the last 20 years the number of reported cases has risen significantly. Weightlifting is by far the most common sport associated with pectoralis major ruptures. In the past, these injuries were generally treated non-operatively. However, most authors now agree that surgical repair of pectoralis major tendon tears is the treatment of choice in order to regain full strength in the young, active patient. Although most surgeons prefer to repair the ruptured tendon in the acute setting, outcomes of surgical repair of chronic ruptures have shown excellent results with regard to appearance, function and strength.