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Hoffman RA, Kutschke MJ, Portnoff B, Paxton ES, Green A. Staged Repair of Bilateral Isolated Teres Major Tears: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00037. [PMID: 39208145 DOI: 10.2106/jbjs.cc.24.00013] [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: 09/04/2024]
Abstract
CASE A 58-year-old, very active man sustained bilateral isolated teres major (TM) tendon tears when his arms were forcefully elevated overhead while wakeboarding. Staged surgical repair was performed. A progressive rehabilitation protocol was followed, and he returned to high-level activities 7 months postoperatively. At 1-year follow-up, outcome measures for bilateral shoulders were DASH 0, SST 12, ASES 100, and EQ-5D 1.0. CONCLUSION Despite literature supporting conservative treatment, this case demonstrates that operative treatment of acute, isolated TM tears can result in highly successful outcomes for motivated active patients.
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Affiliation(s)
- Ryan A Hoffman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
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[Rupture of the pectoralis major tendon and other extra-articular tendons of the shoulder : Recognition and treatment]. Unfallchirurg 2021; 124:125-131. [PMID: 33315118 DOI: 10.1007/s00113-020-00921-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ruptures of the pectoralis major (PM) tendon are rare but have increased in recent years, especially during fitness exercising, such as bench pressing. The pathomechanism is an eccentric load under pretension of the PM (falling onto the outstretched arm, injuries during ground combat, boxing and during downward movement when bench pressing). The rupture sequence starts from superior to inferior at the insertion site with initial rupture of the most inferior muscle parts, followed by the sternal part and the clavicular part. Most classifications are based on rupture location, extent and time of injury. In addition to clinical presentation and sonography, magnetic resonance imaging is now established as the gold standard in diagnosing PM pathologies. Surgical management is indicated for all lateral PM ruptures with relevant strength deficits. Treatment in the acute interval (<3 weeks) is the primary goal; however, even in chronic cases or after failed conservative management a secondary operative approach enables notable clinical improvement. Conservative therapy mostly affects patients who have muscular injuries close to the anatomic origin and smaller partial tears. Surgical management aims for anatomic reconstruction of the PM unit with restoration of the original tension to enable optimal strength transmission. Surgical refixation or reconstruction (with autograft/allograft) of acute and chronic PM ruptures shows excellent clinical results with high patient satisfaction. Latissimus dorsi (LD) and teres major (TM) tendon ruptures are rare injuries but can lead to significant impairments in high-performance athletes. In contrast to PM ruptures, LD and TM injuries are primarily treated conservatively with very satisfactory results.
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Pardiwala DN, Subbiah K, Rao N, Modi R. Latissimus Dorsi Tear in an Olympics-Level Tennis Player: Case Report and Review of Literature. Indian J Orthop 2020; 54:332-338. [PMID: 32399153 PMCID: PMC7205911 DOI: 10.1007/s43465-020-00055-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/17/2020] [Indexed: 02/04/2023]
Abstract
Latissimus dorsi tears are extremely rare and are encountered primarily in high-level athletes. Noted initially in baseball pitchers, cases have been described in other sports too, with one report of a latissimus dorsi tear at the muscle-tendon junction in a tennis player. Anecdotal outcomes have been comparative after both non-operative and operative treatments. Although no clear indications for operative intervention exist, there is a general consensus that partial non-retracted tears can be managed with non-operative treatment, whereas complete tears warrant surgical repair. This case report describes a complete rupture with retraction of the latissimus dorsi tendon that occurred during a competitive match in an international level tennis player. Due to compelling sports participation reasons, this tear was managed with non-operative treatment. The player returned to competitive tennis within 6 weeks and won the Asian Games men's doubles tennis gold medal 53 days following his injury. He has had no subsequent shoulder-related symptoms despite his continuous participation in international level tennis for the past 18 months. We analyse the role of the latissimus dorsi in tennis and also review the available literature on this uncommon sports injury.
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Affiliation(s)
- Dinshaw N. Pardiwala
- Arthroscopy Service, Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital, Four Bungalows, Andheri (W), Mumbai, 400053 India
| | - Kushalappa Subbiah
- Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Nandan Rao
- Arthroscopy and Sports Orthopaedic Service, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, India
| | - Rahul Modi
- Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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Takase K. Isolated Tear of the Teres Major Muscle. Orthopedics 2019; 42:e276-e278. [PMID: 30540879 DOI: 10.3928/01477447-20181206-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/08/2018] [Indexed: 02/03/2023]
Abstract
Rotator cuff tears are frequently treated in daily clinical practice. However, there have been few reports of tears around the shoulder involving the latissimus dorsi and teres major muscles. The author reports the rare case of an isolated tear of the teres major muscle with symptom onset during ordinary sports activities without a clear traumatic mechanism. The patient received conservative treatment, and satisfactory results were obtained. [Orthopedics. 2019; 42(2):e276-e278.].
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Isolated Rupture of the Teres Major Muscle When Water Skiing: A Case Report and Literature Review. Case Rep Orthop 2018; 2018:3806534. [PMID: 29808143 PMCID: PMC5902125 DOI: 10.1155/2018/3806534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/07/2018] [Indexed: 11/17/2022] Open
Abstract
Isolated lesions to the teres major muscle are rare. They generally occur in patients participating in sports such as baseball, tennis, or boxing. We report the case of a sports patient who suffered an isolated injury to the teres major while water skiing. The clinical presentation was confirmed by MRI. Conservative treatment was chosen and consisted of brief analgesic immobilization, followed by rehabilitative treatment. The rapid recovery of this patient with normal isokinetic strength evaluation at 6 months was interesting for objectifying full muscle recovery. Our results and the data from the literature suggest that functional rather than surgical treatment is preferable in isolated lesions to the teres major muscle.
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Abstract
Injuries to the latissimus dorsi and teres major muscles, while rare, are debilitating. They are seen in a variety of sports, although disproportionately in the throwing shoulder of baseball pitchers. There have been 25 case reports and 2 case series published on the nonoperative and operative management of these injuries. Latissimus dorsi and teres major muscle anatomy, function, and common injury patterns are well described in these case reports. Also well detailed are the typical patient presentation, physical examination, and imaging findings. Latissimus dorsi tendon injuries are sometimes treated operatively, whereas latissimus dorsi muscle belly or isolated teres major injuries are treated nonoperatively. Nonoperative treatment includes oral anti-inflammatories and shoulder physical therapy. A number of surgical patient positions, approaches, and fixation constructs have been described, although 2 techniques of positioning and surgical approach are used most commonly. Fixation is most often performed with suture anchors. Return-to-play timing, shoulder strength, and healing on magnetic resonance imaging are variable. No standard of care currently exists for the treatment of latissimus dorsi or teres major injuries. If treating a patient with an injury to either muscle, the clinician should be familiar with accumulated experience as reported in the published literature.
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Affiliation(s)
| | - Marc G Lubitz
- Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
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Fitzpatrick D, Cagle P, Flatow E. Isolated Teres Major Rupture: A case report with a suggested dedicated imaging protocol and review of the literature. J Radiol Case Rep 2016; 10:31-6. [PMID: 27200170 DOI: 10.3941/jrcr.v10i4.2674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Isolated injuries to the teres major muscle occur in competitive sporting activities such as baseball pitching, hockey and tennis. We report a similar event of a physically fit man sustaining an isolated teres major rupture while waterskiing. Non-operative management was chosen, with pain resolution and no appreciable functional limitations at follow up. Because teres major muscle injury was suspected at the time of imaging, we present a dedicated imaging protocol to optimize assessment for teres major injury.
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Affiliation(s)
- Darren Fitzpatrick
- Department of Radiology, Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Paul Cagle
- Department of Orthopedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Evan Flatow
- Professor of Orthopedic Surgery, Mount Sinai Roosevelt, New York, NY, USA
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Maciel RA, Zogaib RK, Pochini ADC, Ejnisman B. Isolated rupture of teres major in a goalkeeper. BMJ Case Rep 2015; 2015:bcr-2015-210524. [PMID: 26701915 DOI: 10.1136/bcr-2015-210524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A complete rupture of the teres major is an extremely rare injury and rarely described in the literature. We report the first case of an isolated rupture of the teres major in a professional football goalkeeper. The diagnosis requires a high degree of suspicion and complementation by image examinations. Conservative treatment has a high success rate with early return to sport.
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Affiliation(s)
- Rafael Almeida Maciel
- Centro de Traumatologia Esportiva (CETE), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rodrigo Kallas Zogaib
- Department of Orthopedics and Traumatology, Universidade de Campinas, Hospital das Clinicas, São Paulo, Brazil
| | | | - Benno Ejnisman
- Centro de Traumatologia Esportiva (CETE), Universidade Federal de São Paulo, São Paulo, Brazil
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Boutin RD, Fritz RC. MRI of Musculotendinous Injuries—What’s New? Part II: Strain Injuries. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0109-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Martin E, Lotito G, Le Corroler T, Coudreuse JM, Bensoussan L, Delarque A, Viton JM. Teres major tendon tears in a professional boxer. Ann Phys Rehabil Med 2014; 57:727-33. [PMID: 25304997 DOI: 10.1016/j.rehab.2014.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
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Garrigues GE, Lazarus MD. Operative treatment of isolated teres major ruptures. J Shoulder Elbow Surg 2012; 21:e6-11. [PMID: 22217640 DOI: 10.1016/j.jse.2011.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 10/10/2011] [Indexed: 02/01/2023]
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Grosclaude M, Najihi N, Lädermann A, Menetrey J, Ziltener JL. Teres major muscle tear in two professional ice hockey players: cases study and literature review. Orthop Traumatol Surg Res 2012; 98:122-5. [PMID: 22197182 DOI: 10.1016/j.otsr.2011.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 08/28/2011] [Accepted: 09/13/2011] [Indexed: 02/02/2023]
Abstract
Ice hockey is a sport renowned for its numerous injuries; different studies report between 13.8 and 20 lesions per 1000 athlete exposures. Exactly 65.5% of these injuries occur during games, compared to 34.5% during training sessions. And 35.1% of all injuries involve the lower extremity and 29.7% the upper extremity (results drawn from games and training combined). Determining whether muscle injuries are extrinsic (contusions) or intrinsic (tears) is of utmost importance since the former generally require simple follow-up, whereas the latter necessitates further investigations, appropriate treatment and often prolonged absence from sports for the injured athlete. To our knowledge, no publication to date has reported isolated damage of the teres major muscle in Ice Hockey players. Seven cases were reported amongst baseball pitchers. Two cases presented after a waterskiing traction accident and a further case has been described in a tennis player. In the present study, we report two cases of isolated teres major tear in ice hockey players. These two athletes were both professional players competing at the highest level in the Swiss Ice Hockey League.
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Affiliation(s)
- M Grosclaude
- Departement of Surgery, University Hospital of Geneva, Geneva, Switzerland.
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