Introduction Epidemiology demographics exclusively seen in males often occurs in weightlifters location most commonly occurs as a tendinous avulsion Pathophysiology mechanism excessive tension on a maximally eccentrically contracted muscle may be an iatrogenic injury caused during open rotator cuff repair Anatomy Pectoralis major innervation lateral (C5-C7) and medial (C8-T1) pectoral nerves origin (two heads) clavicular head: medial clavicle and proximal sternum sternocostal head: distal sternum, costal cartilage ribs 1-6, external oblique aponeurosis insertion humeral shaft just lateral to the bicipital groove one of four muscles connecting the upper limb to the thoracic wall other muscles include pectoralis minor subclavius serratus anterior Biomechanics inferior fibers of sternal head at maximal stretch during final 30 degrees of humeral extension position at which pectoralis major is most vulnerable to rupture (as with bench pressing) Presentation History patient may report a sharp tearing sensation with resisted adduction and internal rotation Symptoms pain and weakness of shoulder Physical exam swelling and ecchymosis if localized to the anterior arm, then humeral attachment rupture is more likely than a musculotendinous junction rupture palpable defect and deformity of the anterior axillary fold weakness with adduction and internal rotation Imaging Radiographs recommended views standard shoulder trauma series (true AP, scapular Y, and axillary lateral) findings often normal MRI useful in identifying the site and extent of the rupture may show avulsion of the pectoralis major tendon from the humerus Treatment Nonoperative initial sling immobilization, rest, ice, NSAIDs indications may be indicated for partial ruptures tears in the muscle or musculotendinous junction low-demand patients Operative open exploration and repair of tendon avulsion indications tendon avulsion from the bone (will see ecchymosis down arm) treatment of choice for high level athletes outcomes may show improvement regardless of location of tear
QUESTIONS 1 of 10 1 2 3 4 5 6 7 8 9 10 Previous Next (OBQ07.249) At which of the following points during a bench press is the pectoralis major insertion at greatest risk of rupture? Review Topic QID: 910 1 Middle portion of upward motion 19% (350/1845) 2 Point of maximum elevation 1% (26/1845) 3 During downward deceleration 74% (1374/1845) 4 When bar is touching chest 4% (77/1845) 5 No difference in rupture rate is seen 1% (12/1845) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ05UE.11) A 24-year-old bodybuilder reports shoulder pain after an injury while bench pressing. Physical exam reveals ecchymosis and swelling in his right upper arm as shown in Figure A. He has weakness in internal rotation but has good strength in external rotation and abduction; his apprehension test is negative. When he puts his hands on his hips, his upper chest is asymmetrical. When is surgery indicated for this injury? Review Topic QID: 1796 FIGURES: A 1 Surgery is not indicated; conservative management including ice, rest and NSAIDs are recommended 4% (109/2746) 2 After a period of immobilization, followed by physical therapy, has failed 6% (177/2746) 3 When the pectoralis major has avulsed from its humeral insertion 86% (2368/2746) 4 Asymmetry of the upper chest wall without functional deficits 2% (66/2746) 5 If swelling and ecchymosis are primarily located on the chest wall rather than the upper arm 1% (15/2746) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 3 (OBQ07.49) A weightlifter feels a pop in his anterior left shoulder while doing a bench press exercise. Which nerve innervates the muscle that is disrupted as seen on the MRI shown in Figure A? Review Topic QID: 710 FIGURES: A 1 Axillary 1% (12/859) 2 Musculocutaneous 4% (34/859) 3 Upper and lower subscapularis 9% (74/859) 4 Suprascapular nerve 3% (25/859) 5 Lateral and medial pectoral nerves 83% (713/859) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 5
Pectoralis Major Tendon Repair - Dr. Anthony Frisella Shoulder & Elbow - Pectoralis Major Rupture - Treatment Consult Dr. Frisella performs a repair of a pectoralis major tendon tear in a 19 year ol... 12/22/2016 411 views Pectoralis Major Tendon Repair: Brief Review and Surgical Technique - Dr. Andrew Rokito Shoulder & Elbow - Pectoralis Major Rupture - Treatment Consult Pectoralis Major Tendon Repair: Brief Review and Surgical Technique - Dr. Andrew... 12/22/2016 363 views Pectoralis Major Tendon Repair - Dr. Carlos Guanche Shoulder & Elbow - Pectoralis Major Rupture - Surgical Techniques This video demonstrates the surgical repair of an acute pectoralis major tendon... 5/9/2012 2717 views