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Whittamore T, Funk L. Surgical repair and rehabilitation of a ruptured pectoralis major muscle in a professional footballer - A case report. J Bodyw Mov Ther 2023; 36:291-299. [PMID: 37949574 DOI: 10.1016/j.jbmt.2023.04.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/11/2023] [Accepted: 04/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Pectoralis Major ruptures normally occur in activities and sports such as powerlifting and American football or rugby. It is a rarely reported phenomena in professional footballers. Surgery is normally considered the choice of management to enable a safe return to play with conservatively managed ruptures often resulting in significant strength deficits. This case report highlights the management of a pectoralis major rupture in a professional footballer. CASE PRESENTATION A 27-year-old professional footballer sustained a left pectoralis major rupture after falling to the floor. A subsequent MRI reported a 5cm retraction of the pectoralis major tendon from its attachment at the humerus. Following a consultation with an orthopaedic surgeon the player underwent a pectoralis major surgical repair. Following surgery, the player underwent a rehabilitation programme under the care of the club physiotherapist. Return to play testing included a handheld dynamometer test, closed kinetic chain upper extremity test and progressive falling activities. The player returned to full contact training after 87 days. CONCLUSION This case study demonstrates a successful return to professional football following a pectoralis major rupture and supports the notion that surgical repair of these injuries produces a favourable outcome in professional athletes when returning to sport.
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Affiliation(s)
- Tom Whittamore
- Mansfield Town Football Club, Radford and Hymas Academy, Woburn Lane, Mansfield, NG19 7RT, UK.
| | - Lennard Funk
- The Arm Clinic, The Wilmslow Hospital, Wilmslow, SK9 1NY, UK.
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Mardani-Kivi M, Maddahi A, Leili EK, Asadi K, Darabipour Z, Haghparast Ghadim-Limudahi Z. Pectoralis major rupture repair with Achilles tendon allograft in 22 bodybuilding athletes. J Orthop Sci 2023; 28:1118-1123. [PMID: 36064490 DOI: 10.1016/j.jos.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 06/11/2022] [Accepted: 07/08/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Pectoralis major tendon rupture rate is increasing due to increased tendency to bodybuilding exercises, specially the bench press workout, and weight-lifting. The aim of this study was to determine the results of pectoralis major rupture repair with Achilles tendon allograft in bodybuilding athletes. METHODS In this case series study, 22 bodybuilding athlete patients (24 pectoralis major ruptures) were undergone open surgical repair during January 2016 till December 2020. 21 ruptures were chronic (2 ruptures were revision) and 3 ruptures were acute. Surgical method was based on Achilles tendon allograft used to augment the ruptured site for lengthening the shortened tendon.The results were analyzed using Bak's criteria and Constant score in pre operation visit and 6th and 12th months and in the last follow up. RESULTS All cases were male with the mean age of 32.1 ± 5.4. The mean duration time between injuries to surgery was 37 ± 46 month (1-182 months). Return to professional sport began at 10.9 ± 2.8 months after surgery in which 16 cases (66.7%) have returned to their pre surgery bench press workout records. No infection or hematoma occurred. At the final follow-up, Bak criteria demonstrated excellent, good and fair in 4, 18 and 2 shoulders respectively. The constant score increased from 87.9 ± 7.9 in pre operation visit to 92.7 ± 6.4 in the last follow up (P < 0.001). CONCLUSIONS It seems that our surgical method is an effective approach in cases with acute or chronic pectoralis major ruptures. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Mohsen Mardani-Kivi
- Orthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amirhossein Maddahi
- Orthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnejad Leili
- Statistics Department, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Kamran Asadi
- Orthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Zohre Darabipour
- Orthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Apostolakos JM, Brusalis CM, Uppstrom T, R Thacher R, Kew M, Taylor SA. Management of Common Football-Related Injuries About the Shoulder. HSS J 2023; 19:339-350. [PMID: 37435133 PMCID: PMC10331269 DOI: 10.1177/15563316231172107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 07/13/2023]
Affiliation(s)
- John M Apostolakos
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | | | - Tyler Uppstrom
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Ryan R Thacher
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Michelle Kew
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A Taylor
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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Stefanou N, Karamanis N, Bompou E, Vasdeki D, Mellos T, Dailiana ZH. Pectoralis major rupture in body builders: a case series including anabolic steroid use. BMC Musculoskelet Disord 2023; 24:264. [PMID: 37016399 PMCID: PMC10071695 DOI: 10.1186/s12891-023-06382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Rupture of the pectoralis major (PM) muscle is a rare injury, with increasing incidence over the last decades, mainly due to participation in weightlifting and contact sports. Surgical management of PM injuries has been related with superior functional outcome, faster return to activities, better cosmesis and higher level of patients' satisfaction. The aim of the study is to present our experience in the management of this rare clinical entity and to correlate the use of anabolic steroids in the occurrence of the injury and the impact of type of injury, method of reconstruction and anabolic steroids on the post-operative outcome. CASES We present a series of six male bodybuilding athletes who sustained PM rupture during weightlifting. We recorded the location & type of injury, the history and type of anabolic steroids use, the method of repair and the post-operative outcome. TREATMENT AND OUTCOMES The mean follow-up period was 16 (12-24) months. All patients treated surgically had excellent results according to Bak criteria and returned to full activity within 5.4 (5-7) months following surgical reconstruction. No post-operative complications were recorded, despite the continued use of anabolic steroids, however one patient died from myocardial infarction within a year of surgical treatment. CONCLUSIONS PM rupture is an injury with increasing incidence within bodybuilding athletes probably not related to the dominance of the limb. Fixation of the tendon with suture anchors results in excellent clinical outcome and patient's satisfaction postoperatively regardless the chronicity of the repair. Our observations in these cases suggest that anabolic steroids use may contribute to the injury due to an excessive upward adjustment of the athlete's goals in lifting weights and moreover the continuation of administration even in the recovery period does not seem to have a negative effect either on the time or on the level of adequate functional recovery postoperatively.
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Affiliation(s)
- Nikolaos Stefanou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 3 Panepistimiou St, 41500, Biopolis, Larissa, Greece
| | - Nikolaos Karamanis
- Department of Hand, Upper Extremity Surgery and Microsurgery, IASO Thessalias, 41500, Larissa, Greece
| | - Effrosyni Bompou
- Department of General Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 3 Panepistimiou St, 41500, Biopolis, Larissa, Greece
| | - Dionysia Vasdeki
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 3 Panepistimiou St, 41500, Biopolis, Larissa, Greece
| | - Thomas Mellos
- B' Department of Orthopaedic Surgery-Sports Medicine, IASO Thessalias, 41500, Larissa, Greece
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 3 Panepistimiou St, 41500, Biopolis, Larissa, Greece.
- Department of Hand, Upper Extremity Surgery and Microsurgery, IASO Thessalias, 41500, Larissa, Greece.
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Forrester JD, Chona DV, McAdams TR. Pectoralis Major Tendon Rupture While Bouldering. Wilderness Environ Med 2023; 34:96-99. [PMID: 36400648 DOI: 10.1016/j.wem.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
Abstract
Pectoralis major tendon ruptures are rare injuries. We present a case of a pectoralis major tendon rupture incurred while bouldering that required surgical repair. The diagnosis of pectoralis major tendon rupture relies predominantly on clinical examination. Among athletes, outcomes after surgical repair are superior to those after nonoperative therapy in most cases of complete tendon rupture. Although infrequent, pectoralis major tendon ruptures can occur while climbing, and early recognition and expedited surgical treatment are paramount to maximize functional recovery.
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Affiliation(s)
| | - Deepak V Chona
- Department of Orthopedic Surgery, Stanford University, Stanford, CA
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Cobb TE, Alexander S, Reynolds AP, Wallace AL. The 'Cruciform Test': A diagnostic tool to detect pectoralis major rupture. Shoulder Elbow 2022; 14:574-577. [PMID: 36199501 PMCID: PMC9527479 DOI: 10.1177/17585732211058457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
Introduction Pectoralis major (PM) rupture is a severe injury that untreated can lead to a profound functional deficit. Early surgical repair can greatly improve outcomes and give a more predictable timetable for recovery, making this the goal of current treatment. Surgical intervention is also essential to return professional athletes to their previous level of competition. However, there is no single, reliable and easily reproducible test that can be used to establish the diagnosis. We describe 'The Cruciform Test'; a method of identifying PM rupture that can be used for initial diagnosis either in clinic or a pitch-side environment, or to assess restoration of normal anatomy and function post-operatively. Methods We studied a series of 14 patients who underwent open PM repair in order to evaluate this method of assessment. Results All patients had a positive test pre-operatively. 5 were formally tested at post-operative follow-up and all had a negative result. Discussion The Cruciform Test is a simple and reproducible diagnostic tool that has potential as a clinical indicator of both PM rupture and successful repair. It can therefore contribute to earlier diagnosis, prompt surgical intervention and facilitate return to play at the earliest opportunity.
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Clinical Outcomes of Pectoralis Major Tendon Repair with and without Platelet-Rich Plasma. Arthrosc Sports Med Rehabil 2022; 4:e1739-e1746. [DOI: 10.1016/j.asmr.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022] Open
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Schwab L, Warby S, Davis K, Campbell P, Hoy S, Zbeda R, Hoy G. Video Analysis of Pectoralis Major Injuries in Professional Australian Football Players. Orthop J Sports Med 2022; 10:23259671221117826. [PMID: 36051979 PMCID: PMC9425905 DOI: 10.1177/23259671221117826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background: There is little evidence regarding the mechanisms of pectoralis major (PM) injury and player outcomes in Australian Football League (AFL) players. Purposes/Hypothesis: The study aims were to investigate (1) the mechanisms of PM muscle injury in elite AFL players via video analysis and (2) the player profile, method of management, and clinical outcomes of the PM injuries sustained. We hypothesized that the majority of PM tears would occur in outer-range PM positions (hyperextension of the glenohumeral joint). Study Design: Case series; Level of evidence, 4. Methods: We analyzed video of the precipitating event for traumatic PM injuries during AFL competition or training over a 20-year period (2002-2021). The footage was analyzed by 4 experienced assessors, and the following were evaluated: mechanism of injury, injury variables (arm position, initial contact point, visual awareness, and use of taping), player characteristics (age at the time of injury, hand dominance, and history of injury), injury profile (location and size of tear), method of management (operative vs nonoperative), patient outcomes (time to return to full senior training/match play), and complication rates. Results: The mean ± standard deviation age of the players was 26.5 ± 3.1 years (range, 21-32 years). Overall, 22 PM injuries were identified in the AFL injury database for a rate of 1.1 per year; 16 of these injuries had accompanying video footage. We identified 3 mechanisms for PM injury: horizontal hyperextension (62.5%), hyperflexion-abduction (25.0%), and horizontal adduction (sustained tackling; 12.5%). The most common site of the tear was the insertion point of the sternocostal head (91.0%). Twenty players (91.0%) required surgical repair, with 75% undergoing surgery within 1 week (range, 0-26 weeks). The mean return to competition for the surgical repair group was 11.1 weeks (range, 8-15 weeks). The rerupture rate was 5.0% (1 repair; <4 weeks postoperatively in 2004). Conclusion: PM tears in elite male AFL players were due to 1 of 3 distinct mechanisms: horizontal hyperextension, hyperflexion-abduction, and horizontal adduction (sustained tackling). Players returned to play on average 11 weeks after injury. Knowledge regarding mechanisms of injury, player profile, and return-to-sport timelines is important for appropriate medical management and provides potential areas to target for prevention of PM injuries.
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Affiliation(s)
- Laura Schwab
- Faculty of Science, Medicine and Health, University of Wollongong, Keiraville, Australia
| | - Sarah Warby
- Melbourne Shoulder Group, Prahran, Australia.,Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Australia
| | - Katherine Davis
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Australia
| | | | - Simon Hoy
- Melbourne Orthopaedic Group, Windsor, Australia
| | | | - Gregory Hoy
- Melbourne Orthopaedic Group, Windsor, Australia
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Haeberle HS, Ramkumar PN, Frantz TL, Jones GL, Curriero FC, Corrigan A, Soloff L, Schickendantz MS, Frangiamore SJ. Pectoralis muscle injuries in Major and Minor League Baseball. J Shoulder Elbow Surg 2022; 31:e363-e368. [PMID: 35183743 DOI: 10.1016/j.jse.2022.01.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although shoulder and elbow injuries in professional baseball players have been thoroughly studied, little is known about the frequency and impact of pectoralis muscle injuries in this population. The purpose of this study was to use the official league injury surveillance system to describe pectoralis muscle injuries in professional baseball players in Major League Baseball (MLB) and Minor League Baseball (MiLB). Specifically, (1) player demographic characteristics, (2) return to play (RTP), (3) injury mechanism, (4) throwing- and batting-side dominance, and (5) injury rate per athlete exposure (AE) were characterized to guide future injury prevention strategies. METHODS The MLB Health and Injury Tracking System database was used to compile all pectoralis muscle injuries in MLB and MiLB athletes in the 2011-2017 seasons. Injury-related data including diagnosis (tear or rupture vs. strain), player demographic characteristics, injury timing, need for surgical intervention, RTP, and mechanism of injury were recorded. Subanalyses of throwing- and batting-side dominance, as well as MLB vs. MiLB injury frequency, were performed. RESULTS A total of 138 pectoralis muscle injuries (32 MLB and 106 MiLB injuries) were reported in the study period (5 tears or ruptures and 133 strains), with 5 of these being recurrent injuries. Operative intervention was performed in 4 athletes (2.9%). Of the 138 injuries, 116 (84.1%) resulted in missed days of play, with a mean time to RTP of 19.5 days. Starting pitchers sustained the greatest proportion of pectoralis injuries (48.1%), with pitching being the most common activity at the time of injury (45.9%). A majority of injuries (86.5%) were sustained during non-contact play. Overall, 87.5% of injuries occurred on the player's dominant throwing side and 81.3% occurred on the player's dominant batting side. There was no significant difference in the rate of pectoralis injuries in the MLB regular season (0.584 per 10,000 AEs) vs. the MiLB regular season (0.425 per 10,000 AEs) (P = .1018). CONCLUSION Pectoralis muscle injuries are most frequently non-contact injuries, most commonly sustained by pitchers. An understanding of these injuries can guide athletic trainers and management in expectation management and decision making, in addition to directing future efforts at injury prevention.
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Affiliation(s)
| | | | - Travis L Frantz
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Grant L Jones
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Frank C Curriero
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Corrigan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lonnie Soloff
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Beck P, Reinecke F, Polan C, Meyer HL, Schoepp C, Burggraf M, Dudda M, Mester B. [Rupture of the pectoralis major muscle in amateur athletes: a rare injury or often overlooked?]. SPORTVERLETZUNG-SPORTSCHADEN 2022; 36:155-159. [PMID: 35413736 DOI: 10.1055/a-1754-4524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION A rupture of the pectoralis major muscle is a rare injury pattern overall, but it is frequently described in athletes, particularly in weightlifting. The risk of sustaining this type of injury is present especially during the eccentric phase of muscle loading. An association between such injuries and the abuse of anabolic steroids is described in the literature, but there is no coherent evidence to support this. We report the case of a young patient with a normal habitus who suffered a humeral rupture of the pectoralis major muscle during recreational sports. There was no history of excessive weight training or use of anabolic steroids. CASE HISTORY This 33-year-old patient reported a sudden onset of left pectoral pain during training on the chest fly machine as well as a whip-like popping sound, followed by an immediate painful restriction of movement in the left arm. A clinical examination revealed a mild haematoma located on the left medial upper arm with localised tenderness and a discrete asymmetry of the contour of the pectoral muscles. Due to the typical medical history, we established the indication for surgical exploration although the clinical picture was rather discrete and only an incomplete rupture was seen in an MRI scan. Intraoperatively, we detected a complete rupture of the sternocostal part of the pectoralis major muscle with marked retraction and haematoma. Reinforcement and reinsertion were performed at the "footprint" using titanium anchors (2 x 5.5mm Corkscrew FT, Arthrex, Florida). The patient was able to resume his sports activities at the pre-traumatic level four months after surgery. CONCLUSION A rupture of the insertion of the pectoralis major muscle must also be considered in amateur athletes with a typical history. The characteristic clinical symptoms described in the literature mostly refer to competitive athletes and bodybuilders, but these injuries can also be diagnosed in amateur athletes with lower muscle mass by subtle clinical examination. Nevertheless, there is a considerable risk of underestimating the extent of the injury. In case of doubt, surgical exploration should be performed promptly in amateur athletes. Surgical refixation of the humeral rupture of the pectoralis major muscle is the gold standard and should not be reserved to high-performance athletes.
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Affiliation(s)
- Paula Beck
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Felix Reinecke
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Christina Polan
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Heinz-Lothar Meyer
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Christian Schoepp
- Klinik für Arthroskopische Chirurgie, Sporttraumatologie und Sportmedizin, BG Klinikum Duisburg, Duisburg, GERMANY
| | - Manuel Burggraf
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Marcel Dudda
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
| | - Bastian Mester
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, GERMANY
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Maier J, Oak SR, Soloff L, Schickendantz M, Frangiamore S. Management of common upper extremity injuries in throwing athletes: a critical review of current outcomes. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:295-300. [PMID: 37588704 PMCID: PMC10426540 DOI: 10.1016/j.xrrt.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Given the rising incidence and prevalence of shoulder injuries in throwing athletes, this review aims to evaluate management options and outcomes of common shoulder injuries in overhead throwers. Laxity of the glenohumeral joint is often adaptive for overhead athletes to achieve the velocity necessary to compete in the professional ranks. Surgical repair of the stabilizers of the humeral head-specifically the labrum and rotator cuff-often causes inflammation, scarring, and overtensioning of the glenohumeral joint which lead to poor postoperative performance. Thus, nonsurgical management should be exhausted in this population before considering surgical intervention.
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Affiliation(s)
- Jacob Maier
- University of Toledo College of Medicine, Toledo, OH, USA
| | | | - Lonnie Soloff
- Cleveland Indians Baseball Organization, Cleveland, OH, USA
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Bodendorfer BM, DeFroda SF, Shu HT, Knapik DM, Yang DS, Verma NN. Performance and Survivorship of National Football League Players with Pectoralis Major Injuries. Arthrosc Sports Med Rehabil 2021; 3:e1097-e1104. [PMID: 34430889 PMCID: PMC8365217 DOI: 10.1016/j.asmr.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose The purpose of this study was to determine return-to-play (RTP), performance and career survivorship for National Football League (NFL) athletes sustaining pectoralis major (PM) injuries with comparison among grades of injury and between nonoperative and operative management. Methods Publicly available data from the 1998-2020 NFL seasons were reviewed to identify athletes with PM injuries. Athlete characteristics were collected 1 season before and 2 seasons after injury. Percent of total games played in a season, player efficiency rating (PER), and Pro Football Focus (PFF) grades were compared for the preinjury season and 2 postinjury seasons. Kaplan-Meier survivorship plots were computed for RTP and postinjury career length, whereas a log-rank test was used to compare survivorship differences. Results In total, 258 PM injuries were reported at a mean age of 27.1 ± 3.3 years. A total of 126 surgical repairs occurred in 48.8% (n = 126) of injuries, with athletes undergoing repair possessing a lower RTP rate and longer time to RTP compared to athletes treated conservatively (P < .001). Survival analysis revealed shorter career length for athletes sustaining PM tears compared to strains (P < .001), although no difference in career length was appreciated on the basis of injury management (P = .980). Defensive linemen and wide receivers had lower PER during their second postinjury seasons (P = .019 and .030, respectively), whereas defensive linemen had lower PFF grades during their second post-injury seasons (P = .044). Conclusion NFL athletes requiring PM repair may experience a lower likelihood of RTP, and longer RTP timing, likely because of higher-grade injuries. Defensive linemen and wide receivers experiencing PM injuries are at risk for diminished performance post-injury. Career length does not appear to be affected based on injury management. Level of Evidence Level III, cohort study.
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Affiliation(s)
| | | | - Henry T Shu
- School of Medicine, The Johns Hopkins University, Baltimore, MD
| | | | - Daniel S Yang
- Warren Alpert Medical School, Brown University, Providence, RI
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Magone K, Ben-Ari E, Gyftopoulos S, Virk M. Pectoralis Major Tendon Tear: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202108000-00004. [PMID: 34415856 DOI: 10.2106/jbjs.rvw.20.00224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
» Pectoralis major (PM) tendon tears are predominantly seen in young men, and the majority of tears occur as tendon avulsions involving the sternal head. Weightlifting, specifically bench-pressing, and sporting activities with eccentric overloading of the PM tendon are the 2 most common activities that result in PM injury. » Early surgical repair or reconstruction should be offered to younger, active patients with a complete PM tear; the majority of the patients undergoing surgical repair achieve good-to-excellent outcomes. » Nonsurgical treatment of a complete PM tear is an option but will result in cosmetic deformity and a deficit in adduction strength of the arm. Outcomes after nonsurgical treatment of complete PM tears are less satisfactory than those obtained after surgical treatment. » Currently, there is no consensus on the chronological definition of PM tears (acute versus chronic), the critical time limit for performing surgical repair, the ideal fixation device (cortical button, bone tunnel, or suture anchors), the indications for allograft use, and the ideal rehabilitation protocol after treatment of PM tears.
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Affiliation(s)
- Kevin Magone
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
- Shoulder and Elbow Surgery, CHI Saint Joseph Medical Group-Orthopedic Associates, CHI Saint Joseph Health, London, Kentucky
| | - Erel Ben-Ari
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
- Division of Orthopaedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Soterios Gyftopoulos
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Mandeep Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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Chronic Pectoralis Major Rupture Reconstruction With Interpositional Acellular Dermal Allograft. Ochsner J 2021; 21:217-223. [PMID: 34239387 PMCID: PMC8238110 DOI: 10.31486/toj.20.0003] [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] [Indexed: 11/25/2022] Open
Abstract
Background: Pectoralis major tendon (PMT) rupture commonly occurs in males 20 to 39 years of age. PMT rupture is most often associated with gym-based exercise, with attempted bench press being the most common causative event, but it is also associated with contact or impact sports. Delayed presentation, misdiagnoses, and chronic PMT rupture can result in a therapeutic dilemma. Case Series: We present 2 cases of chronic PMT rupture that were operatively managed using acellular dermal allograft as an interposition graft. Patients’ final follow-ups were at 20 and 30 months, respectively. Strength in their pectoralis major muscle was well preserved on the contralateral side: 88% for patient 1 and 110% for patient 2. Conclusion: Our reported technique using an interpositional acellular dermal allograft is a good option to treat chronic PMT rupture.
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Shaw KA, Brown S, Moreland CM, Antosh IJ, Parada SA. Parachute-Induced Pectoralis Major Tears in Military Servicemembers: What Is the Functional Recovery? Orthop J Sports Med 2021; 9:23259671211014494. [PMID: 34189148 PMCID: PMC8212380 DOI: 10.1177/23259671211014494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Although the most common injury mechanism for pectoralis major (PM) tears is an eccentric loading mechanism typically caused by bench pressing, within the military, there is a unique injury mechanism associated with airborne operations. The results of operative repair for these parachute-induced PM tears have not been previously reported. Purpose/Hypothesis To assess the functional outcomes in military servicemembers undergoing operative repair of parachute-induced PM tears. We hypothesized that functional recovery would be impaired with delayed surgical intervention. Study Design Cohort study; Level of evidence, 3. Methods Included were active duty military servicemembers who underwent operative repair for PM tears caused by a parachute-induced mechanism. Charts were reviewed to identify characteristic, injury, and surgical variables. Patients completed the functional outcome assessment with the Disabilities of the Arm, Shoulder and Hand (DASH) and the American Shoulder and Elbow Surgeons (ASES) questionnaires. Outcomes were compared between patients treated within 6 weeks of injury and those treated beyond 6 weeks. Results Of the 68 identified PM tears, 25 were the result of parachute-induced mechanisms. A total of 13 patients consented and completed the functional outcome assessment. The mean patient age was 30.6 ± 6.4 years, and the mean follow-up period was 5.46 ± 1.26 years. Ten patients underwent repair within 6 weeks of injury, and the remaining 3 patients underwent repair at a mean of 338 days after injury (95% CI, -42.8 to 718.8 days), a significant difference between groups (P = .006). All 13 patients were able to return to military duties at a mean of 6 months from injury. Patients treated within 6 weeks of injury had significantly higher functional outcomes (DASH score, 6.17 vs 26.67; P = .018; ASES score, 85.97 vs 49.5; P = .008), with greater strength performance compared with preinjury (bench press, 90.58% vs 38.95%; P = .0057; push-ups, 81.9% vs 23.8%; P = .023) compared with patients treated beyond 6 weeks of injury. Conclusion Operative repair of parachute-induced PM tears within 6 weeks of injury provided a superior functional and strength recovery when compared with delayed surgical repair. Acute repair should be recommended for military servicemembers who experience this unique injury mechanism.
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Affiliation(s)
- K Aaron Shaw
- Department of Orthopaedic Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Scott Brown
- Department of Orthopaedic Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Colleen M Moreland
- Department of Orthopaedic Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Ivan J Antosh
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Stephen A Parada
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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16
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Isokinetic Strength and Functional Scores after Rehabilitation in Jiu-Jitsu Fighter with Repair Surgery of Pectoralis Major Muscle Rupture: A Case Report. Healthcare (Basel) 2021; 9:healthcare9050527. [PMID: 33946161 PMCID: PMC8145385 DOI: 10.3390/healthcare9050527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022] Open
Abstract
A pectoralis major muscle rupture is a rare injury that mainly occurs during exercise. This study examined the application of rehabilitation, strength and passive range of motion (ROM) change, and subjective assessment for 1 year undertaken after repair surgery of pectoralis major muscle rupture in a Jiu-Jitsu fighter. We hypothesized that the application of ROM exercises and rehabilitation strategies contributed to muscle recovery and successful return to sports. The patient was a 34-year-old man who was injured after falling during a competitive event. The patient had pain and swelling in the front of the chest and shoulder, and the distal chest was deformed. Imaging revealed a complete rupture of the pectoralis major muscle. Reparative surgery was performed by a specialist. Immobilization was performed one week after the surgery. Passive ROM exercises began with the forward flexion 2 weeks after the surgery; abduction and external rotation ROM exercises at 4 weeks; low-intensity muscle strength exercises using tube bands at 6 weeks; machine-based pectoralis major muscle exercises at 3 months. Isokinetic equipment was used to measure horizontal adduction and internal rotation strengths, and the subjective shoulder functional and ROM scores were evaluated. Recovery of shoulder function and ROM occurred at 3 months and muscle recovery at 6 months. The participant was able to return to sports at 5 months and compete at 7 months. Although this study explored only one patient's post-operative recovery, it suggests that ROM and strength exercises may be effective post-operative strategies for restoring function and strength to enable a return to sports.
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Obourn PJ, Benoit J, Brady G, Campbell E, Rizzone K. Sports Medicine-Related Breast and Chest Conditions-Update of Current Literature. Curr Sports Med Rep 2021; 20:140-149. [PMID: 33655995 DOI: 10.1249/jsr.0000000000000824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT This article reviews the most up-to-date evidence-based recommendations pertaining to breast and upper chest conditions, specifically for the sports medicine physician. Because of the unique circumstances of the team physician, they can see a wide breadth of pathology. Athletes may not have a primary care physician and may prefer to present to their team physician for breast and upper chest conditions. It is often more comfortable and convenient for athletes to seek treatment in the team setting. Therefore, it is important that the medical professional be aware of not only common pathology but also of that which is rarer. Any delay in evaluation can result in unnecessary morbidity and lead to complications or extended time lost from sport. Consequently, it also is important to facilitate an atmosphere encouraging early presentation and workup.
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Affiliation(s)
- Peter J Obourn
- Department of Orthopaedics, Division of Sports Medicine, University of Rochester Medical Center, Rochester, NY
| | - Janeeka Benoit
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN
| | - Geena Brady
- Sports and Spine Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Elisabeth Campbell
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN
| | - Katherine Rizzone
- Department of Orthopaedics, Division of Sports Medicine, University of Rochester Medical Center, Rochester, NY
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18
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Bodendorfer BM, Wang DX, McCormick BP, 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 Repair Timing and Fixation Methods. Am J Sports Med 2020; 48:3376-3385. [PMID: 32109153 DOI: 10.1177/0363546520904402] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Blake M Bodendorfer
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - David X Wang
- School of Medicine Georgetown University, 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 and 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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19
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Marsh NA, Calcei JG, Antosh IJ, Cordasco FA. Isolated tears of the sternocostal head of the pectoralis major muscle: surgical technique, clinical outcomes, and a modification of the Tietjen and Bak classification. J Shoulder Elbow Surg 2020; 29:1359-1367. [PMID: 32089403 DOI: 10.1016/j.jse.2019.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/03/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We aimed to describe a modified surgical technique to treat isolated sternocostal head tears using cortical button fixation while preserving the intact clavicular head tendon, to outline a new classification of pectoralis major injuries, and to present the clinical outcomes and return-to-sport data of a cohort of 21 athletes who underwent surgical repair. METHODS We reviewed prospectively collected data of patients who underwent surgical repair with the described technique for isolated sternocostal head tears from 2008 to 2014. Two-year postoperative clinical outcomes including the Single Assessment Numeric Evaluation score, isokinetic strength, patient satisfaction, and return to sport, as well as preinjury and postoperative bench-press weight, were collected, and descriptive statistics were used for analysis. RESULTS Twenty-one patients who underwent repair of isolated sternocostal head tears were included. The majority of the isolated tears of the sternocostal head of the pectoralis major (57%) occurred during the bench press. Of the ruptures, 81% were Tietjen type IIIC and 19% were type IIID. Postoperative Single Assessment Numeric Evaluation scores averaged 90.1 (standard deviation, 8.4), and patient satisfaction was 9.5 of 10 (standard deviation, 0.9). All athletes returned to sport approximately 5.5 months postoperatively. The isokinetic strength deficit averaged 8% compared with the contralateral arm, whereas the average preinjury bench-press weight of 134 kg (range 88-227 kg) was restored to 117 kg (range 61-250 kg) postoperatively. CONCLUSION We propose a new classification of pectoralis major injury. In addition, we present a biomechanically sound repair technique for isolated tears of the sternocostal head of the pectoralis with favorable outcomes. The technique takes the specific anatomy of the sternocostal and clavicular heads into account for the approach.
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Affiliation(s)
| | - Jacob G Calcei
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Ivan J Antosh
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Frank A Cordasco
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
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20
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Synovec J, Shaw KA, Hattaway J, Wilson AM, Chabak M, Parada SA. Magnetic Resonance Imaging of Pectoralis Major Injuries in an Active Duty Military Cohort: Mechanism Affects Tear Location. Orthop J Sports Med 2020; 8:2325967120925019. [PMID: 32577421 PMCID: PMC7288815 DOI: 10.1177/2325967120925019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- John Synovec
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - K Aaron Shaw
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Joshua Hattaway
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Aimee M Wilson
- Department of Radiology, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Mickey Chabak
- Department of Radiology, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
| | - Stephen A Parada
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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21
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Bois AJ, Lo IKY. Surgical anatomy of the pectoralis major tendon insertion revisited: relationship to nearby structures and the pectoral eminence for defining the anatomic footprint. JSES Int 2020; 4:324-332. [PMID: 32490421 PMCID: PMC7256899 DOI: 10.1016/j.jseint.2020.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Intraoperative identification of the normal pectoralis major (PM) footprint can be challenging to identify in the acute and chronic settings. The purpose of this study was to revisit the anatomic footprint of the PM tendon and to determine which nearby landmarks can be used to re-create the normal insertion site during anatomic repair or reconstruction. Methods Twenty-one fresh-frozen human cadaveric shoulder specimens were used to define the PM tendon width (ie, superior-to-inferior) and to determine the relationship between the superior aspect of the PM insertion and that of the latissimus dorsi (LD) and anterior deltoid (AD) tendons. An attempt was made to identify potential useful bony landmarks that can be used during anatomic repair or reconstruction of the PM tendon. Results The mean PM tendon width was 68.8 ± 4.4 mm. The superior margin of the LD insertion was 9.4 ± 5.9 mm above and the AD was 48.4 ± 7.1 mm below the superior margin of the PM tendon insertion, respectively. In 17 of 21 specimens (81%), the superior insertion of the PM tendon attached onto a bony prominence, named the pectoral eminence. Conclusions The LD and AD tendon insertions represent reliable soft tissue landmarks for identifying the superior extent of the PM tendon along its bony footprint. The pectoral eminence can also be used as an additional reference point in the majority of cases to facilitate anatomic restoration of the pectoralis tendon during repair and reconstruction. Surgeons should be familiar with the proximity of nearby neurovascular structures when performing PM repairs.
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Affiliation(s)
- Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Investigation Performed at the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Ian K Y Lo
- Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Investigation Performed at the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
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22
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Sephien A, Orr J, Remaley DT. Pectoralis major tear in a 23-year-old woman while performing high-intensity interval training: a rare presentation. BMJ Case Rep 2020; 13:13/3/e232649. [PMID: 32193177 DOI: 10.1136/bcr-2019-232649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pectoralis major (PM) tears are a rare injury, that commonly occurs at the sternocostal head and has a greater incidence in men, with only two previously reported cases in young and middle-aged women. The authors report a complete PM tear that occurred in a 23-year-old woman, that presented after performing a 'muscle-up'. MRI revealed PM rupture at the humeral insertion. Surgical management was performed, and patient returned to high-intensity interval training at 11 months postoperatively and reported great satisfaction. This is the first case in literature that reports a complete tear of the PM in a young woman through an atraumatic mechanism of injury with no previous alteration to the PM. With a cultural increase in wellness, atraumatic PM tear in young women should be expected and remain on the differential for any athlete that participates in high-intensity interval training.
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Affiliation(s)
- Andrew Sephien
- Orthopaedics and Sports Medicine, University of South Florida, Tampa, Fl, USA.,USF Health Morsani College of Medicine, University of South Florida, Tampa, Fl, USA
| | - Jeffrey Orr
- Orthopaedics and Sports Medicine, University of South Florida, Tampa, Fl, USA
| | - D Trey Remaley
- Orthopaedics and Sports Medicine, University of South Florida, Tampa, Fl, USA
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23
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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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Abstract
Background: Pectoralis major ruptures are increasing in incidence primarily due to an increase in awareness, activity level among young males between 20 and 40 years of age, and use of anabolic steroids. Although the majority of pectoralis major ruptures are acute injuries, many chronic ruptures are unrecognized and it is imperative to understand the proper evaluation of these injuries, as well as the appropriate treatment for acute and chronic ruptures.Purpose: Pectoralis major ruptures can lead to deformity and physical disability if left untreated. This review paper discusses both acute and chronic ruptures as well as indications for nonoperative treatment and operative treatment to give the reader the best understanding of this diagnosis and proper management.Methods: A systematic review of the literature was performed using a search of electronic databases. Search terms such as pectoralis major rupture, pectoralis major repair, pectoralis major tendon transfer, and pectoralis major nonoperative treatment were used. Case reports, systematic reviews, prospective and retrospective studies were included to provide a comprehensive review. The only exclusion criteria consisted of studies not published in English. This review article includes the anatomy and biomechanics of the pectoralis major muscle, proper evaluation of the patient, operative and nonoperative treatment of acute and chronic pectoralis major ruptures, and outcomes of the recommended treatment.Conclusion: Nonoperative treatment is indicated for patients with medical comorbidities, older age, incomplete tears, or irreparable damage. Patients treated non-operatively have been shown to lose strength, but regain full range of motion. Patients with surgery before 6 weeks reported better outcomes than patients with surgery between 6 and 8 weeks. The chronicity of the rupture (>8 weeks) increases the likelihood of reconstruction, involving the use of autografts or allografts. Patients treated with delayed repair had significantly better strength, satisfaction, and outcomes than patients with nonoperative treatment. The pectoralis tendon can also be transferred in patients with rotators cuff tears, atrophy, or significant functional limitation. Tendon transfers have been shown to have unpredictable outcomes, but overall satisfactory results.
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Affiliation(s)
- Kamali Thompson
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Young Kwon
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Evan Flatow
- Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Laith Jazrawi
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Eric Strauss
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Michael Alaia
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
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25
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Nute DW, Kusnezov N, Waterman BR. Functional Outcomes and Complications Following Pectoralis Major Tendon Allograft Reconstruction in a Military Population. Orthop J Sports Med 2019; 7:2325967119878709. [PMID: 31692733 PMCID: PMC6811763 DOI: 10.1177/2325967119878709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There are limited data available regarding outcomes following pectoralis major tendon (PMT) reconstruction with allograft. PURPOSE To evaluate the functional outcomes and complication profile following PMT reconstruction with allograft in a military population. STUDY DESIGN Case series; Level of evidence, 4. METHODS All active duty military personnel who underwent PMT allograft reconstruction between 2008 and 2013 were identified. Demographics, injury characteristics, and surgical technique were recorded from the electronic medical record. Self-reported pain scores and manual strength were evaluated pre- and postoperatively, as recorded in physician electronic medical record notes, in addition to the ability and degree to which each patient was able to return to function. Standardized outcome measures included the Bak criteria; visual analog scale for pain; Disabilities of the Arm, Shoulder and Hand (DASH) score; American Shoulder and Elbow Surgeons (ASES) score; and 36-Item Short Form Health Survey (SF-36). Complications, including rerupture and reoperation, were additionally recorded. RESULTS Nine male patients (mean ± SD age, 35.7 ± 5.8 years) underwent allograft PMT reconstruction. Mean improvement in self-reported pain score at a mean 53.5 months (range, 31.1-110.9 months) was 2.1 ± 1.3 points (P = .08). Improvements in manual strength during forward flexion (0.5 ± 0.7; P = .03), adduction (0.6 ± 0.6; P = .01), and internal rotation (0.5 ± 0.7; P = .03) were significant. Seven patients (78%) returned to full preinjury level of occupational function, and 88% returned to performing the bench press, although maximum weight decreased by a self-reported mean of 141.3 lb. According to the Bak criteria, 5 (56%) patients had excellent outcomes, 2 (22%) had fair outcomes, and 2 (22%) had poor outcomes. Mean visual analog scale for pain (1.9 ± 2.8), DASH (10.8 ± 17.4), ASES (88.1 ± 20.3), and SF-36 scores (96.3% ± 6.9%) were obtained for the 8 patients available at final follow-up. Complications included 2 cases (22%) of persistent shoulder pain leading to military separation, 1 rerupture (11%), and 1 (11%) surgical scar revision. CONCLUSION While allograft reconstruction is a reliable option to decrease pain and improve function in patients with tears not amenable to primary repair, patients should be educated about the risk profile and fitness limitations after surgery.
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Affiliation(s)
- Drew W. Nute
- Department of Orthopaedic Surgery and Rehabilitation, William
Beaumont Army Medical Center, El Paso, Texas, USA
| | - Nicholas Kusnezov
- Department of Orthopaedic Surgery, Blanchfield Army Community
Hospital, Fort Campbell, Kentucky, USA
| | - Brian R. Waterman
- Department of Orthopaedic Surgery, School of Medicine, Wake Forest
University, Winston-Salem, North Carolina, USA
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Liu JN, Gowd AK, Garcia GH, Manderle BJ, Beletsky A, Nicholson GP, Forsythe B, Romeo AA, Verma NN. Analysis of Return to Sport and Weight Training After Repair of the Pectoralis Major Tendon. Am J Sports Med 2019; 47:2151-2157. [PMID: 31303006 DOI: 10.1177/0363546519851506] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of routine patient-reported outcomes after repair of the pectoralis major tendon (PMT) is often prone to the ceiling effect owing to the high functional demand of those who sustain this injury. HYPOTHESIS A significant number of patients are expected to fail to achieve return to preoperative activity after PMT repair despite achieving significant improvements in functional score. STUDY DESIGN Case series; Level of evidence, 4. METHODS A prospectively maintained institutional database was reviewed for all patients undergoing PMT repair from 2010 to 2016. Patients were surveyed with regard to pre- and postoperative participation in sports, level of intensity, maximum weight repetitions in exercises utilizing the PMT, and American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. RESULTS Forty-four patients (73.3%) were available for final follow-up. All patients were male. Mean ± SD follow-up was 51.1 ± 24.1 months. Mean age was 39.6 ± 8.8 years (range, 24-61 years), and mean body mass index was 28.6 ± 3.5 kg/m2. The dominant side was affected in 20 of 44 cases. Acute repairs were performed in 30 cases and chronic in 14. There were statistically significant improvements in both ASES and SANE scores (P < .001). Return to sport at any level was achieved by 43 of 44 (97.7%) patients, while 22 of 44 patients (50.0%) reported returning to sport at the same or better intensity as preinjury status. On average, there was a 23.3% ± 45.6% decrease in 1-repetition maximum (1RM) barbell bench press, 14.7% ± 62.3% decrease in 5-repetition maximum barbell bench press, 24.3% ± 21.8% decrease in 1RM dumbbell bench press, 35.7% ± 32.1% decrease in 1RM dumbbell fly, and 15.6% ± 39.8% decrease in consecutive push-ups able to be performed. Seventeen patients (38.6%) reported a degree of apprehension that affected their ability to lift weights. When all preoperative variables were accounted for, history of surgery to the contralateral shoulder (odds ratio, 0.600; 95% CI, 0.389-0.925) was associated with a decreased likelihood of returning to sport at the same or better level of intensity, while injury sustained during sport had a greater likelihood (odds ratio, 2.231; 95% CI, 1.234-4.031). CONCLUSION Patients undergoing PMT repair should expect significant functional improvements and a low complication rate. Yet, only 50% are able to return to preoperative intensity of sport, and they will also have significant reductions in their ability to weight lift.
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Affiliation(s)
- Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, California, USA
| | - Anirudh K Gowd
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
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Jagiasi JD, Valavi AS, Ubale TV, Sahu D. Insertion anatomy of the pectoralis major tendon. J Clin Orthop Trauma 2019; 10:541-543. [PMID: 31061586 PMCID: PMC6492044 DOI: 10.1016/j.jcot.2019.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 01/02/2019] [Accepted: 01/10/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pectoralis major tendon tears are encountered in young active patients. METHODS In 10 fresh cadaveric shoulders we measured-1. Proximal to distal insertion width of the pectoralis major tendon.2. The distance of the superior border of the tendon from the supero-medial tip of the greater tuberosity (GT). RESULTS The average insertion width was 46 mm. The average distance between the superior border of the tendon and the tip of the GT was 48.5 mm. CONCLUSION The superior border of the tendon should be repaired with two anchors at a distance of 48.5 mm from the tip of the GT so as to cover a width of 46 mm.
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Affiliation(s)
| | | | | | - Dipit Sahu
- Department of Orthopaedics, Dr RN Cooper Hospital & HBT Medical College, Juhu, Ville Parle, Mumbai, Maharashtra, India
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Haładaj R, Wysiadecki G, Clarke E, Polguj M, Topol M. Anatomical Variations of the Pectoralis Major Muscle: Notes on Their Impact on Pectoral Nerve Innervation Patterns and Discussion on Their Clinical Relevance. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6212039. [PMID: 31061824 PMCID: PMC6466946 DOI: 10.1155/2019/6212039] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The presented study attempts to classify individual anatomical variants of the pectoralis major muscle (PM), including rare and unusual findings. Rare cases of muscular anomalies involving the PM or its tendon have been presented. An attempt has also been made to determine whether anatomical variations of the PM may affect the innervation pattern of the lateral and medial pectoral nerves. MATERIAL AND METHODS The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. RESULTS Typical PM structure was observed in 63.75% of specimens. The most frequently observed variation was a separate clavicular portion of the PM. In one female cadaver (2.5% of specimens) the hypotrophy of the clavicular portion of the PM was noticed. In two male cadavers (5% of specimens) the fusion between the clavicular portion of the PM and the deltoid muscle was observed. In one of those cadavers, small sub-branches of the lateral pectoral nerve bilaterally joined the clavicular portion of the deltoid muscle. The detailed intramuscular distribution of certain nerve sub-branches was visualized by Sihler's stain. PM is mainly innervated by the lateral pectoral nerve. In all specimens stained by Sihler's technique, the contribution of the intercostal nerves in PM innervation was confirmed. CONCLUSIONS Surgeons should be aware of anatomic variations of the PM both in planning and in conducting surgeries of the pectoral region.
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Affiliation(s)
- Robert Haładaj
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Edward Clarke
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
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Gupton M, Johnson JE. Surgical Treatment of Pectoralis Major Muscle Ruptures: A Systematic Review and Meta-analysis. Orthop J Sports Med 2019; 7:2325967118824551. [PMID: 30800687 PMCID: PMC6378447 DOI: 10.1177/2325967118824551] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Pectoralis major muscle (PMM) tendon ruptures are becoming more common. Multiple techniques for fixation of the avulsed tendon to its humeral insertion have been described. None of these techniques has been reviewed to compare outcomes in efforts to establish a first-line surgical technique. Purpose: To systematically review and analyze the data available in the literature to establish a clinically superior surgical technique and time frame in which surgery should occur. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was conducted. Only studies reporting the surgical techniques and outcomes of PMM repair were included. Data including patient age, injury mechanism, type and extent of the rupture, time from injury to surgery, surgical technique, outcome including complications, steroid use, location and year of publication, and activity level were extracted from the included studies. Statistical and descriptive analyses were conducted on the available literature. Results: Of 259 cases from studies that provided the timing of repair, 72.6% (n = 188) were repaired acutely, while the remaining were repaired more than 8 weeks after the injury. There was no statistical difference found in the outcomes of these repairs. There were 265 cases included in the statistical analysis comparing the outcomes of surgical techniques. The odds of an excellent/good outcome were significantly better for the transosseous suture (TOS) compared with the unicortical button (UCB) technique (odds ratio [OR], 6.28 [95% CI, 1.37-28.75]; P = .018) and also for the suture anchor (SA) compared with the UCB technique (OR, 3.40 [95% CI, 1.06-10.85]; P = .039). The odds of an excellent/good outcome were not significantly different when comparing the TOS, SA, and TOS with trough techniques to one another. The probability of complications was highest with the TOS with trough technique (12.0%), although the odds of having a complication were not statistically significant for any single technique compared with the others. Conclusion: The low quality of evidence available limited this review. There were no significant differences observed in the outcomes of PMM repair based on the timing of repair. The TOS and SA techniques had statistically significantly greater odds of resulting in an excellent/good outcome compared with the UCB technique, but 1 study that contributed to this analysis may have statistically skewed the results for the UCB technique. Therefore, all 3 surgical techniques are accepted options, and the best technique is that with which the surgeon is most proficient and comfortable. Comparative research with a greater level of evidence is needed to determine a definitive first-line surgical technique.
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Affiliation(s)
- Marco Gupton
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, North Carolina, USA
| | - Jordan E Johnson
- MountainView Regional Medical Center, Las Cruces, New Mexico, USA
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Yu J, Zhang C, Horner N, Ayeni OR, Leroux T, Alolabi B, Khan M. Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review. Sports Health 2018; 11:134-141. [PMID: 30543493 PMCID: PMC6391551 DOI: 10.1177/1941738118818060] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT: Pectoralis major tendon ruptures are becoming increasingly common due to the growing prevalence of active lifestyles. Studies investigating the efficacy of pectoralis major tendon repair have limited sample sizes and offer mixed results, while existing reviews do not explore postoperative activity outcomes for patients. OBJECTIVE: To summarize and synthesize the clinical outcomes and rate of return to activity after isolated pectoralis major tendon repair. DATA SOURCES: Four databases (MEDLINE, EMBASE, PubMed, and CINAHL) were searched from database inception through March 7, 2018. STUDY SELECTION: Studies reporting outcomes of isolated pectoralis major tendon repair for pectoralis major tendon rupture were included. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data including patient demographics, intervention details, and clinical outcomes were extracted. The methodological quality of included studies was evaluated. RESULTS: Of 2332 retrieved articles, 18 studies were included, with a total of 536 patients. A majority (90%; 134/149) of patients undergoing pectoralis major tendon repair successfully returned to sport at a mean 6.1 ± 1.7 months postsurgery, of which 74% (95/128) successfully returned to their preinjury level of sport. The majority (95%; 269/284) of patients returned to work at a mean 6.9 ± 1 months. Postsurgically, 81% (83/102) of patients experienced complete pain relief after the surgery, and 19% (21/109) had cosmetic complaints after pectoralis major repair. Of the 10 studies that reported complications, 18% (75/423) of patients had postoperative complications, including reruptures and wound infections; 7% (30/423) of patients required reoperation for their complications. CONCLUSION: Pectoralis major tendon repair is an effective treatment that results in a high rate of return to sport and work, pain relief, and improved cosmetic appearance, albeit with a significant rate of complication. The evidence supporting all outcomes was limited by the rarity of the injury, the variable surgical techniques, and outcome assessment criteria.
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Affiliation(s)
- James Yu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Cindy Zhang
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nolan Horner
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Timothy Leroux
- Division of Orthopedics, University of Toronto, Toronto, Ontario, Canada
| | - Bashar Alolabi
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Godoy IRB, Martinez-Salazar EL, Simeone FJ, Bredella MA, Palmer WE, Torriani M. MRI of pectoralis major tears: association between ancillary findings and tear severity. Skeletal Radiol 2018; 47:1127-1135. [PMID: 29426957 DOI: 10.1007/s00256-018-2893-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the significance of biceps tendon (BT) displacement and peri-bicipital hematoma on MRI in subjects with pectoralis major (PM) tears. We hypothesized that these features might be associated with tear severity at surgery. MATERIALS AND METHODS We retrospectively identified MRI cases with PM injury and reviewed clinical, imaging, and surgical records. MR images were reviewed independently by two musculoskeletal radiologists to determine anterior displacement of BT (BT-disp, in mm) and the presence of triangular-shaped peri-bicipital hematoma. Data were compared with an age- and sex-matched control group and correlated with surgical reports grouped by tear severity. RESULTS We identified 46 subjects with PM injury (43 men, 3 women; mean age 34 ± 9 years), 26 of whom underwent surgical reconstruction, and 20 matched controls (P > 0.2). BT-disp was significantly higher in PM injury vs controls (P = 0.003), and in tendon vs myotendinous (MT) junction PM tears (P < 0.0001); however, MT junction tears vs controls were similar (P = 0.98). Higher BT-disp and presence of peri-bicipital hematoma correlated significantly with surgical reports describing full-thickness complete tears. BT-disp > 4.5 mm had 86% sensitivity and 75% specificity to detect the most severe tears on surgical reports, whereas the presence of peri-bicipital hematoma was the strongest predictor among both parameters. CONCLUSION Anterior BT displacement and peri-bicipital hematoma are helpful indicators of full-thickness complete tears at the humeral insertion.
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Affiliation(s)
- Ivan R B Godoy
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street-YAW 6048, Boston, MA, 02114, USA
| | - Edgar L Martinez-Salazar
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street-YAW 6048, Boston, MA, 02114, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street-YAW 6048, Boston, MA, 02114, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street-YAW 6048, Boston, MA, 02114, USA
| | - William E Palmer
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street-YAW 6048, Boston, MA, 02114, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street-YAW 6048, Boston, MA, 02114, USA.
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Surgical repair of acute pectoralis major muscle ruptures. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:390-397. [PMID: 29980801 DOI: 10.1007/s00064-018-0557-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/29/2017] [Accepted: 01/03/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Surgical repair of a partial or complete tear of the pectoralis major muscle to restore internal rotation, adduction, and anteversion. INDICATIONS Acute avulsion, acute tear of the tendinous insertion, acute tear of the musculotendinous region (<6 weeks after trauma). Relative indication: chronic retracted tear (>6 weeks). CONTRAINDICATIONS Muscular tears, local infection, other general contraindications. SURGICAL TECHNIQUE Open repair using suture anchors or flip buttons. POSTOPERATIVE MANAGEMENT Week 1-3: early passive-assisted functional physical therapy. Week 3-6: early active-assisted functional physical therapy. Week 7-9: active assisted free range of motion (ROM). From week 9: free ROM. From week 12: exercise with resistance, careful strengthening. RESULTS Between 2005 and 2017, 20 men with an acute or subacute tear of the pectoralis major muscle underwent surgery. Mean age 36 years (range 28-55 years). No previous antibiotic treatment or steroid abuse/treatment reported. Reasons for rupture were weight lifting (bench-press, n = 10), skiing and snowboard accidents (n = 3), fitness training (n = 3), soccer (n = 1), martial arts (n = 1), a canyoning accident (n = 1), and a simple fall (n = 1). Follow-up examinations were performed 6 weeks and 3 months postoperative. No infections or wound healing disorders; no revisions necessary. Normal muscle function via open refixation of the tendon stump. No re-rupture observed. Free ROM observed 3 months after surgery.
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Schnaubelt S, Neophytou G, Richter B, Domanovits H, Niessner A, Sulzgruber P. The "Pectoral-Gap Phenomenon": A Hypothesis on Origin and Mechanism. Sports Med 2018; 48:1987-1988. [PMID: 29508372 DOI: 10.1007/s40279-018-0886-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Division of Cardiology, Department of Internal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georgios Neophytou
- Department of Orthopedics, Sozialmedizinisches Zentrum Ost, Langobardenstraße 122, 1220, Vienna, Austria
| | - Bernhard Richter
- Division of Cardiology, Department of Internal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Ludwig-Boltzmann-Cluster for Cardiovascular Research, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Moatshe G, Marchetti DC, Chahla J, Ferrari MB, Sanchez G, Lebus GF, Brady AW, Frank RM, LaPrade RF, Provencher MT. Qualitative and Quantitative Anatomy of the Proximal Humerus Muscle Attachments and the Axillary Nerve: A Cadaveric Study. Arthroscopy 2018; 34:795-803. [PMID: 29225017 DOI: 10.1016/j.arthro.2017.08.301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide a quantitative and qualitative anatomic analysis of the pectoralis major, teres major, and latissimus dorsi on the humerus, as well as the deltoid tendinous attachments on the proximal humerus and acromion, and to quantitatively characterize the humeral course of the axillary nerve. METHODS Ten nonpaired, fresh-frozen human cadaveric shoulders were analyzed. A portable coordinate-measuring device quantified the location of bony landmarks and tendon attachment areas. The tendon footprints were recorded by tracing their outlines and center points. The footprint areas of the tendons, the distances between the footprint areas and pertinent osseous and soft-tissue landmarks, and the distance between where the axillary nerve courses across the humerus relative to the acromion and greater tuberosity were measured. RESULTS Of the 10 specimens, 9 (90%) had 5 distinct tendinous bands attaching the deltoid to the acromion; 1 specimen had 4 bands. The distances between the center of the deltoid footprint on the humerus and the centers of the pectoralis major, latissimus dorsi, and teres major tendon footprints on the humerus were 43.5 mm, 58.5 mm, and 49.4 mm, respectively. The shortest distances from the perimeter of the pectoralis major to the latissimus dorsi and teres major tendon footprints were 3.9 mm and 9.5 mm, respectively. The distance from the superior aspect of the greater tuberosity to the axillary nerve on the humeral shaft was 50.3 mm (95% confidence interval, 47.0-53.5 mm). The distance from the lateral acromion to the axillary nerve was 69.3 mm (95% confidence interval, 64.1-74.5 mm). CONCLUSIONS The deltoid muscle had 4 to 5 tendinous insertions on the acromion, and the axillary nerve was 50.3 mm from the tip of the greater tuberosity. The distance between the lower border of the pectoralis major and the axillary nerve was 9.4 mm. CLINICAL RELEVANCE Knowledge of the quantitative anatomy of the tendons of the proximal humerus and axillary nerve can aid in identifying structures of interest during open shoulder surgery and in avoiding iatrogenic axillary nerve injury. Furthermore, this study provides direction to avoid injury to the deltoid tendons during open surgery.
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Affiliation(s)
- Gilbert Moatshe
- The Steadman Clinic, Vail, Colorado, U.S.A.; Oslo University Hospital and University of Oslo, Oslo, Norway; Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
| | | | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - George Sanchez
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, U.S.A
| | - George F Lebus
- The Steadman Clinic, Vail, Colorado, U.S.A.; Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Alex W Brady
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Robert F LaPrade
- The Steadman Clinic, Vail, Colorado, U.S.A.; Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Matthew T Provencher
- The Steadman Clinic, Vail, Colorado, U.S.A.; Steadman Philippon Research Institute, Vail, Colorado, U.S.A..
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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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