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Sanchez Carbonel JF, Imhoff A. Rupturen des M. pectoralis major und minor. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-022-00569-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Guzman AJ, Rayos Del Sol SM, Dela Rueda T, Bryant SA, Jenkins S, Gardner B, McGahan PJ, Chen JL. Surgical repair of acute on chronic seven‐year pectoralis major rupture near the distal myotendinous junction: A case report. Clin Case Rep 2022; 10:e6118. [PMID: 35898730 PMCID: PMC9309739 DOI: 10.1002/ccr3.6118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/17/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alvarho J. Guzman
- Advanced Orthopaedics and Sports Medicine San Francisco California USA
| | | | | | - Stewart A. Bryant
- Advanced Orthopaedics and Sports Medicine San Francisco California USA
| | - Sarah Jenkins
- Advanced Orthopaedics and Sports Medicine San Francisco California USA
| | - Brandon Gardner
- Advanced Orthopaedics and Sports Medicine San Francisco California USA
| | | | - James L. Chen
- Advanced Orthopaedics and Sports Medicine San Francisco California USA
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Noufal A. A case report of a rupture of the musculotendinous junction of the pectoralis major in an athlete. Int J Surg Case Rep 2021; 87:106428. [PMID: 34563816 PMCID: PMC8479642 DOI: 10.1016/j.ijscr.2021.106428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The pectoralis major muscle (PM) is a large muscle on the anterior chest wall. The rupture of the PM is a rare entity in literature and most incidences had been reported frequently in weight lifting and contact sports. Acute repair of PM rupture yielded better outcome as compared to non-operative treatment in active individuals who wish to return to their sports. CASE REPORT We presented a case of a champion in bodybuilding who lifted a heavy weigh during his routine exercises, which caused a rupture in the musculotendinous junction of the left pectoralis major muscle. DISCUSSION As it is rare to meet ruptures in this site of pectoralis major, we decided to insert anchors into the humeral bone (as in avulsions and tendon's tears), and to duplicate the suturing levels in multiple directions (as in muscular belly ruptures). CONCLUSION Our aim here is to confirm that the rupture of the musculotendinous junction of the pectoralis major muscle is rare and difficult to deal, but the acute surgical treatment by inserting anchors into the humerus, and duplicating the suturing layers in multiple directions can give good results especially in athletes.
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Affiliation(s)
- Abdullah Noufal
- Pediatric Orthopedic Surgery, AUHD (Al-Assad University Hospital Damascus), Syria.
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Bodendorfer BM, McCormick BP, Wang DX, Looney AM, Conroy CM, Fryar CM, Kotler JA, Ferris WJ, Postma WF, Chang ES. Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment. Orthop J Sports Med 2020; 8:2325967119900813. [PMID: 32083144 PMCID: PMC7005984 DOI: 10.1177/2325967119900813] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Blake M Bodendorfer
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA
| | | | - David X Wang
- Georgetown University School of Medicine, Washington, DC, USA
| | - Austin M Looney
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA
| | | | - Caroline M Fryar
- Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, USA
| | - Joshua A Kotler
- Bone & Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | | | - William F Postma
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - Edward S Chang
- Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, USA
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Pectoralis Major Injuries: Return to Play Potential. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Samitier GS, Marcano AI, Farmer KW. Pectoralis major transosseous equivalent repair with knotless anchors: Technical note and literature review. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2015; 9:20-3. [PMID: 25709241 PMCID: PMC4325386 DOI: 10.4103/0973-6042.150219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Rupture of the pectoralis major (PM) tendon was initially described almost 2 centuries ago, but most of the reported injuries have occurred within the last 30 years. Options for repair have varied widely. The most common methods for repair depend on either transosseous sutures or suture anchors for fixation. Transosseous suture repair allows for docking the tendon into a trough at its anatomic insertion, but risks cortical breakage during suture passing. Our experience has confirmed the value and potential advantages of anchors for a secure fixation. Aims: To describe a variation of repair using knotless suture anchors and a burred trough to dock the tendon into its anatomic insertion. Conclusion: We describe a technique of a transosseous equivalent PM repair technique. To our knowledge, this is the first paper describing such a repair technique for PM rupture.
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Affiliation(s)
- Gonzalo S Samitier
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Alejandro I Marcano
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin W Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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Tarity TD, Garrigues GE, Ciccotti MG, Zooker CC, Cohen SB, Frederick RW, Williams GR, DeLuca PF, Dodson CC. Pectoralis major ruptures in professional American football players. PHYSICIAN SPORTSMED 2014; 42:131-5. [PMID: 25295775 DOI: 10.3810/psm.2014.09.2084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pectoralis major injuries are an infrequent shoulder injury that can result in pain, weakness, and deformity. These injuries may occur during the course of an athletic competition, including football. The purpose of this study was to determine the incidence of pectoralis major ruptures in professional football players and time lost from the sport following injury. We hypothesized that ruptures most frequently occur during bench-press strength training. METHODS The National Football League Injury Surveillance System was reviewed for all pectoralis major injuries in all players from 2000 to 2010. Details regarding injury setting, player demographics, method of treatment, and time lost were recorded. RESULTS A total of 10 injuries-complete ruptures-were identified during this period. Five of the 10 were sustained in defensive players, generally while tackling. Nine occurred during game situations, and 1 occurred during practice. Specific data pertinent to the practice injury was not available. No rupture occurred during weight lifting. Eight ruptures were treated operatively, and 2 cases did not report the method of definitive treatment. The average days lost was 111 days (range, 42-189). The incidence was 0.004 pectoralis major ruptures during the 11-year study period. CONCLUSIONS Pectoralis major injuries are uncommon while playing football. In the National Football League, these injuries primarily occur not during practice or while bench pressing but rather during games. When pectoralis major ruptures do occur, they are successfully treated operatively. Surgery may allow for return to full sports participation. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- T David Tarity
- Department of Orthopaedic Surgery, Sports Medicine Service/Shoulder and Elbow Service, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Kakwani RG, Matthews JJ, Kumar KM, Pimpalnerkar A, Mohtadi N. Rupture of the pectoralis major muscle: surgical treatment in athletes. INTERNATIONAL ORTHOPAEDICS 2006; 31:159-63. [PMID: 16847645 PMCID: PMC2267574 DOI: 10.1007/s00264-006-0171-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 02/26/2006] [Accepted: 02/27/2006] [Indexed: 11/24/2022]
Abstract
Pectoralis major tendon rupture is a relatively rare injury, resulting from violent, eccentric contraction of the muscle. Over 50% of these injuries occur in athletes, classically in weight-lifters during the 'bench press' manoeuvre. We present 13 cases of distal rupture of the pectoralis major muscle in athletes. All patients underwent open surgical repair. Magnetic resonance imaging was used to confirm the diagnosis in all patients. The results were analysed using (1) the visual analogue pain score, (2) functional shoulder evaluation and (3) isokinetic strength measurements. At the final follow-up of 23.6 months (14-34 months), the results were excellent in six patients, good in six and one had a poor result. Eleven patients were able to return to their pre-injury level of sports. The mean time for a return to sports was 8.5 months. The intraoperative findings correlated perfectly with the reported MRI scans in 11 patients and with minor differences in 2 patients. We wish to emphasise the importance of accurate clinical diagnosis, appropriate investigations, early surgical repair and an accelerated rehabilitation protocol for the distal rupture of the pectoralis major muscle as this allows complete functional recovery and restoration of full strength of the muscle, which is essential for the active athlete.
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Affiliation(s)
| | - J. J. Matthews
- Sports Medicine Centre, 2500 University Drive NW, Calgary, T2N1N4 Canada
| | | | | | - N. Mohtadi
- Sports Medicine Centre, 2500 University Drive NW, Calgary, T2N1N4 Canada
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Beloosesky Y, Grinblat J, Weiss A, Rosenberg PH, Weisbort M, Hendel D. Pectoralis major rupture in elderly patients: a clinical study of 13 patients. Clin Orthop Relat Res 2003:164-9. [PMID: 12897606 DOI: 10.1097/01.blo.0000076803.53006.12] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to analyze and describe circumstances and clinical aspects of pectoralis major rupture in elderly patients compared with younger patients. Eleven patients were nursing home residents and two were community residents. All had severe pain with a large pectoral ecchymosis extending to the lateral chest wall and arm. Twelve patients experienced substantial blood loss (average, 2.3 g/dL hemoglobin), which resulted in hemodynamic decompensation in two of the patients, necessitating a blood transfusion. The most probable mechanism of injury was indirect, caused by a brisk tearing movement applied to stiff, atrophic muscle during commonly used nursing procedures for transferring, positioning, and dressing the patients. The authors suspect this injury to be more common than reported. Although surgical repair is not required in the elderly, a proper diagnosis is imperative because the injury has a severe clinical impact necessitating care and followup.
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Affiliation(s)
- Yichayaou Beloosesky
- Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel.
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Beloosesky Y, Grinblat J, Katz M, Hendel D, Sommer R. Pectoralis major rupture in the elderly: clinical and sonographic findings. Clin Imaging 2003; 27:261-4. [PMID: 12823922 DOI: 10.1016/s0899-7071(02)00548-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We describe clinical and sonographic features of pectoralis major rupture in the elderly, which is relatively rare and unknown. Patients presented with a large pectoral ecchymosis extending to the axilla, chest wall, breast and arm. The pectoral area was sensitive, sometimes with a visible and palpable defect in the axilla. Ultrasound examination showed a large hypoechoic, well-circumscribed structure representing a hematoma within the pectoralis major muscle, partially replacing the normal echo muscle pattern. Ultrasonography is a useful, low cost diagnostic tool, and is recommended in the investigation of pectoralis major rupture in the elderly.
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Affiliation(s)
- Yichayaou Beloosesky
- Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
Athletic injuries in the shoulder range from a routine strain or sprain to a potentially disabling fracture or tendon rupture. The level of sports participation plays an important role in diagnosis and treatment. The nonprofessional athlete may be more likely to sustain injuries secondary to under-training or improper technique. The professional athlete may be capable of play under much higher velocities and applied loads and, therefore, may be subject to higher energy trauma than the amateur athlete. In addition to standard treatment considerations, return to play time must also be decided. Decisions regarding definitive treatment may be modulated depending on an athlete's desire to return to his or her previous level of competition.
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Affiliation(s)
- Michael P Brunelli
- Orthopedic Surgery, Metrowest Medical Center, 115 Lincoln St., Framingham, MA 01701, USA.
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Beloosesky Y, Hendel D, Weiss A, Rosenberg PH, Grinblat J. Rupture of the pectoralis major muscle in nursing home residents. Am J Med 2001; 111:233-5. [PMID: 11530035 DOI: 10.1016/s0002-9343(01)00805-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Y Beloosesky
- Department of Geriatrics, Rabin Medical Center, Golda Campus, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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