Rupture of the pectoralis major muscle in a collegiate football player

Abstract

We have reported an unusual case of pectoralis major muscle rupture and repair. There were three interesting aspects of this case. First, the injury occurred in a football player with an unusual mechanism of injury. Second, MRI using special techniques was valuable in confirming the diagnosis acutely and in planning treatment. Finally, we reported on the use of suture anchors to secure the avulsed tendon. We recommend the early use of MRI for diagnosis and in planning treatment of suspected pectoralis major muscle ruptures.

Complete Avulsion of the Pectoralis Major Tendon: a Case Report

“…In typical cases, there is a marked asymmetry of the anterior axillary fold with a visible defect on the affected side (Figure 1), due to retraction of the proximal part of the muscle when the rupture is complete. However, absence of such a defect offers no guarantee of an intact muscle or tendon; either edema, hematoma or an intact overlying fascia of the pectoral muscle could obscure this finding [4,5,12].…”

“…Additional investigations like roentgenography and ultrasonography can be helpful, but are usually inconclusive in determining the extent and site of injury. Recent data have shown that MRI can accurately differentiate between partial and complete ruptures of the major pectoral muscle [12,[14][15][16][17]. In two studies where MRI images were compared to intraoperative findings, no false positives were found in the case of complete ruptures [15,16].…”

Rupture of the Pectoralis Major: A Case Report and Review

“…Cases of pectoralis major rupture with accompanying anterior glenohumeral dislocation and proximal humerus fracture have been reported in the literature (23,30). Additionally, in isolated pectoralis tendon avulsions, the avulsed fragment may be visualized on plain films (9,13). The characteristic finding of a pectoralis major muscle rupture is soft tissue swelling and absence of the pectoralis major shadow, but this finding is very subtle and difficult to detect (5,7,8,19).…”

Pectoralis major rupture: Presentation of two cases and review of 74 cases

“…Each of the cases was subsequently treated by surgery, and each was effectively relieved of pain and weakness. However, surgical repair of chronic complete ruptures is more difficult than surgical repair of acute cases because of adhesions, muscle retraction and atrophy (6). Two of the six cases of chronic complete rupture reported by Kretzler et al (3), cases 14 and 15, were The literature supports surgical repair of acute partial ruptures as effective treatment.…”

“…However, fascial tissue may mask complete ruptures on inspection and palpation. In these cases, magnetic resonance imaging is useful in defining the extent of injury (6). Differentiation between complete musculotendinous junction ruptures (class IIIC) and ruptures at the humeral insertion (Class IIID) may be difficult.…”