Pectoralis Major Muscle Injuries: Evaluation and Management

Petilon, Julio; Carr, Donald R.; Sekiya, Jon K.; Unger, Daniel V.

doi:10.5435/00124635-200501000-00008

Cited by 117 publications

(180 citation statements)

References 36 publications

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“…A critical consideration in repairing the pectoralis major tendon is to ensure that the sternal head is placed posterior and superior relative to the insertion of the clavicular head. 13 The literature describes several techniques for fixation of the ruptured pectoralis major tendon. A biomechanical study by Sherman et al 14 included 24 pectoralis major cadaveric specimens.…”

Section: Discussionmentioning

confidence: 99%

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Pectoralis Major Repair With Cortical Button Technique

Kang

Mahony

Cordasco

2014

Arthroscopy Techniques

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Pectoralis major tendon ruptures can lead to significant functional deficits that affect high-level athletic and labor-intensive activities. In active populations operative repair of the ruptured pectoralis major tendon has shown significant advantages over nonoperative treatment. We describe a novel surgical technique for pectoralis major repair with tension button fixation. This study included 12 recreational athletes and 2 professional athletes. The initial results were measured subjectively after a minimum of 6 months by the Single Assessment Numeric Evaluation score, the American Shoulder and Elbow Surgeons score, and the ability to return to the patient's sport at a preinjury level. Objectively, strength was measured with resisted horizontal adduction of the arm for both repaired and contralateral sides. Of the 12 recreational patients, 8 returned to their sport at preinjury levels, and the 2 professional athletes returned to their sport at full capacity in the National Football League. The mean Single Assessment Numeric Evaluation score was 87, and the mean American Shoulder and Elbow Surgeons scores were 99 for both the operative and contralateral sides. Isokinetic strength testing showed no significant differences between the operative and nonoperative sides. Patients with pectoralis major tendons repaired with the proposed tensioned cortical button technique had excellent results. This new technique provides a reliable method of repair in an efficient and safe manner.

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Section: Discussionmentioning

confidence: 99%

“…These techniques include transosseous sutures and bone troughs, suture anchors, and endosteal buttons. [13][14][15] A biomechanical study performed by Sherman et al 14 has shown no significant differences in the techniques just described. Moreover, there are no studies in the literature showing any differences in clinical outcome among these techniques.…”

mentioning

confidence: 99%

Pectoralis Major Repair With Cortical Button Technique

Kang

Mahony

Cordasco

2014

Arthroscopy Techniques

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“…23 Some authors divide the muscle into 2 portions, the clavicular and sternocostal, 14,23,40 and others propose 3 portions: the clavicular, sternocostal, and abdominal. 1,4,52 The fibers from all PM sections come together to form a broad tendon that attaches to the lateral lip of the intertubercular sulcus on the humerus.…”

Section: Supplemental Video Onlinementioning

confidence: 99%

“…The primary action of the entire PM muscle is adduction, internal rotation, and flexion of the shoulder. 20,23,40 But the 3 PM portions may also have distinct actions. 25,52 For instance, contraction of the clavicular portion brings the extended arm forward into flexion, in contrast to the contraction of the sternal portion, which brings the arm into extension against resistance from a flexed position.…”

Section: Supplemental Video Onlinementioning

confidence: 99%

Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery

Stegink-Jansen

Buford²,

Patterson³

et al. 2011

J Orthop Sports Phys Ther

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Early detection and successful cancer treatments have increased the number of long-term breast cancer survivors, 3,5 making optimal recovery and quality of life a primary goal. 8 Up to 50% of survivors have a loss of shoulder motion after completion of their treatments, 28,46 which often extends into a long-term impairment. 33,48 This loss of motion has been found to be predictive of reduced capability to perform functional activities 28 and has been shown to be related to depressive symptoms in a group of 183 older women. 13T T STUDY DESIGN: Descriptive study. T T OBJECTIVES:To quantify and rank the order of strain (length change in proportion to the resting length) of 3 portions of the pectoralis major (PM) muscle during various exercises. T T BACKGROUND:A biomechanical foundation on which to base exercise prescriptions for patients after breast cancer surgery is lacking. T T METHODS: An interactive, 3-D, computergraphic simulation system, developed to study biomechanical properties of the musculoskeletal system, was used to simulate movements of the glenohumeral, scapulothoracic, and scapuloclavicular joints of the shoulder, and to estimate strain in 3 portions of the pectoralis major (PM) muscle throughout the motions. The computed tomography scans of 2 male cadavers and literature review formed the basis for the estimations used in the model. Strains in the clavicular, midsternum, and abdominal regions of the PM were expressed as percent strain: [(change in muscle length/resting length) × 100]. Exercise motions were based on PM muscle anatomy and published breast cancer rehabilitation protocols. T T RESULTS:Strains of the PM regions ranged from -21% shortening of the clavicular region during flexion to 55% lengthening of the abdominal region during the overhead stretch. Strain between adjacent regions was most uniform for the movement of abduction with external rotation, and least uniform with flexion. T T CONCLUSION: PM muscle lengtheningestimates were not linearly proportioned to shoulder joint motions, and varied for 3 portions of the PM. This information may help clinicians and researchers to estimate lengthening of PM portions throughout measurable shoulder motions.

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“…20 The general principle however consists of anchoring in the remaining tendon stump to the bone therefore encouraging it to heal and regain strength.…”

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confidence: 99%

Case series of pectoralis major rupture requiring operative intervention sustained on the Royal Marines ‘Tarzan’ assault course

2014

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We present (with intra-operative imaging) four patients who sustained pectoralis major (PM) ruptures on the same piece of equipment of the 'Tarzan' assault course at the Commando Training Centre, Royal Marines (CTCRM). Recruits jump at running pace, carrying 21 lbs of equipment and a weapon (8 lbs) across a 6-feet gap onto a vertical cargo-net. The recruits punch horizontally through the net, before adducting their arm to catch themselves, and all weight, on their axilla. All patients presented with immediate pain and reduced function. Two had ruptures demonstrated on magnetic resonance imaging, one on an ultrasound scan and one via clinical examination. All four patients were found, at operation, to have sustained type IIIE injuries. All patients underwent PM repair using a unicortical button fixation and had an uneventful immediate postoperative course. Patient 1 left Royal Marines training after the injury (out of choice; not because of failure to rehabilitate). All other patients are under active rehabilitation, hoping to return to training. Review of 10 years of records at CTCRM reveal no documented PM rupture prior to our first case in October 2013. There has been no change to the obstacle or technique used and all patients deny the use of steroids.

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Pectoralis Major Muscle Injuries: Evaluation and Management

Cited by 117 publications

References 36 publications

Pectoralis Major Repair With Cortical Button Technique

Pectoralis Major Repair With Cortical Button Technique

Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery

Case series of pectoralis major rupture requiring operative intervention sustained on the Royal Marines ‘Tarzan’ assault course

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