Mr imaging assessment of the pectoralis major myotendinous unit. Pectoralis major tendon rupture is a rare shoulder injury, most commonly seen in weight lifters. In addition, recent literature has redefined the anatomy of the distal pectoralis major. Oblique coronal sequences along the long axis of the pectoralis major tendon are.
Eccentric part where i was about to press up,a pop like23times,pain under armpit. Us and mr imaging of pectoralis major injuries radiographics. This book is distributed under the terms of the creative commons attribution 4. Oblq cor t2 fat grx on axial parallel to pectoralis musclechest wall. Pectoralis major tendon rupture is a relatively rare injury, resulting from violent, eccentric contraction of the muscle. Msk mri protocol overview page 1 of 123 msk mri protocols march 2010 table of contents. Example of the retracted appearance of a chronic sternal head pectoralis major tear. A careful clinic examination is frequently sufficient to identify the extent of the tendon injury in most patients. Pectoralis major repair revised august 2008 postop days 1 14 shoulder immobilizer x 6 weeks even while sleeping place pillow under shoulder arm while sleeping for comfort hand squeezing exercises elbow and wrist active motion arom with shoulder in neutral position at side stationary bike must wear immobilizer goals. The largest of which is the pectoralis major muscle which originates from the sternum breast bone, ribs and. Rupture of the pectoralis major muscle in a collegiate football player.
Radiologists work closely with ohsu mri techs in the art of creating optimal images from current technology. Pectoralis muscle rupture treatment avon pectoralis muscle. Msk mri protocol overview page 3 of 123 msk mri protocols march 2010 1. We present cases of distal rupture of the pectoralis major muscle in athletes. Early diagnosis via mri and surgical repair is important to ensure a sound recovery. Atypical pectoralis major muscle wasting in a recreational. A pectoral strain is a condition characterised by partial or complete tearing of one or more of the pectoral chest muscles figure 1. An axial scan through the same area demonstrates fluid consistent with. Accurate characterization of pectoralis major tears is important to guide management. Until recently, the diagnosis of pectoralis major muscle injury has been based on. Bench pressing is the most common cause of injury, but. The most common cause is weight lifting specifically the bench press but it can occur with other sporting events as well.
Isolated traumatic pectoralis minor tendon tear in a young adult. Pectoralis major tears, also known as pectoralis major ruptures, are an uncommon traumatic injury of the pectoralis major. Jul 18, 2006 pectoralis major tendon rupture is a relatively rare injury, resulting from violent, eccentric contraction of the muscle. Rupture of the pectoralis major tendon is considered an uncommon injury and a significant number of ruptures are missed or diagnosed late, leading to a chronic tear. Intact clavicular head and retracted sternal head of pectoralis major, demonstrated with resisted forward elevation. Deformity and weakness of this muscle in weight lifters is typically due to traumatic tendon. Passive and active range of motion exercises as well as pendulums can. It is best known as the muscle that you develope with the bench press exercise. Isolated tear of the pectoralis minor tendon in a high. At the last followup 12 months, the patient was painfree, with a visual analogic scale at 0 all the time.
Hip pelvis thigh knee lower extremityshin ankle foot special cases soft tissue mass metal protocol. The pectoralis major tendon is most commonly injured during an eccentric contraction when the external force on the muscle is greater than the force that the muscle can generate and when the arm is extended and externally outwardly rotated, such as when performing a bench press. Muscle mr traumatic changes the radiology assistant. I had an mri a few days ago, waiting on insurance prior auth to see surgeon this week, mri says full thickness tear of the distal myotendinous junction of the right pectoralis muscle, with 3.
Rupture of pectoralis major pm occurs most commonly as a result of an indirect mechanism associated with extensive tension on a maximally contracted muscle. Achieving the criteria of each phase should be emphasized more than the approximate duration. Oct 28, 2019 hi dr luks, i injured my pectoralis major on 9242019. Rupture of the pectoralis major muscle is a once rare injury that is becoming more common due to increasing numbers of intense weighttraining and highperformance athletes. How not to tear a pec while bench pressing mark barroso.
Accuracy of magnetic resonance imaging in predicting the. The pectoralis major muscle is one of the most powerful muscles in the body and injuries to the tendon occur in young and middleaged athletes. Pectoralis major muscle an overview sciencedirect topics. The injuries were evaluated for abnormal morphology and signal intensity. Fifteen men underwent mr imaging after injury of the pectoralis major muscle. It travels outward toward the arm and attaches to the humerus with a large tendon. Preoperative pectoralis muscle quantity and attenuation are novel.
Rupture of the pectoralis major tendon is considered an uncommon injury and. As with any other us examination, us evaluation of the. Patient id verified with two identifiers wristband verify correct patient and exam on scanner and ris. Pectoralis major muscle rupture the pectoralis major muscle is the large muscle in front of the upper chest. Us is an inexpensive, readily available examination that can be used to effectively screen for injury and initially survey the extent of the disease process. The fibers converge as a fan into three laminae that twist upon each other 90 before coalescing into a single tendon of insertion 46. Mri is the mainstay for diagnosing pectoralis major tear early surgical. Mr imaging is the optimal imaging technique to study the normal and abnormal conditions of the pectoralis major muscle and tendon unit. Early diagnosis via mri and surgical repair is important to ensure a. All required screening forms completed and singed images sent. We report an open reconstruction technique and its outcomes in a case of chronic and retracted pm tear. Pectoralis major tendon repair post surgical rehabilitation.
Axial t1 and pd fs use coronal loc and plane is straight horizontal if the shoulder is markedly angled, you can angle the axial images perpendicular to the glenohumeral joint. Subjects journals books book series working papers. The pectoralis major is a very powerful muscle that forms the chest prominence and. The purpose of this study was to use mr imaging to. Coronal t2 near complete tear at the musculotendinous junction of pectoralis major with contusionedema of the muscle and surrounding softtissues. Pdf pectoralis major tendon repair post surgical rehabilitation. Sag t2 the fov is bigger, the slices are thicker, and there are more slices to. Imaging evaluation with ultrasound and mr imaging can be difficult given the complex regional anatomy.
Magnetic resonance imaging mri is considered the imaging modality of choice and. Pectoralis tendon repair postop protocol this protocol is intended to be a general outline only. Mr imaging assessment of the pectoralis major myotendinous. Mri performed one year postoperatively confirmed the continuity between. Pectoralis major repair rehabilitation protocol this protocol was developed for patients who have had a pectoralis major repair. Furthermore, this case represents a novel traumatic mechanism of injury. And my mri report read, there is a complete tear of the pectoralis major tendon from the insertion on the humerus. The pec major attaches to the humerus bone upper bone of arm and is divided into two. To improve the morbidity of the disorder, an interprofessional team approach is a recommendation. The physician reserves the right to either advance or delay this protocol as deemed necessary. It moves the shoulder forwards and across your chest.
We hypothesized that these features might be associated with tear severity at surgery. The pectoralis major muscle is often maintained on the chest wall following mastectomy, and an implant can be placed above or beneath it. Pectoralis major rupture rehabilitation protocol shady grove orthopaedic associates, p. The pediatric radiologists will usually protocol specific sequences they need in ris. Beneath the pectoralis major is the pectoralis minor, a thin, triangular muscle. Treatment options vary from conservative to operative. Hi dr luks, i injured my pectoralis major on 9242019. Ankle foot special cases soft tissue mass metal protocol.
An axial scan through the same area demonstrates fluid consistent with haemorrhage in the muscle defect. The pectoralis major muscle is the large muscle in front of the upper chest. If not, follow the adult protocol, but make changes to the slice, gap, and fov as needed. A traditional mri of the shoulder will often miss a pectoralis tendon rupture because. The pectoral muscles are a group of two muscles situated at the front of the chest figure 1. The pectoralis major from latin pectus, meaning breast is a thick, fanshaped muscle, situated at the chest of the human body. Patients with pm tendon ruptures, classically present a history of sudden severe pain in arm and shoulder at the time of injury. Sep 12, 2018 and my mri report read, there is a complete tear of the pectoralis major tendon from the insertion on the humerus. This injury is being seen more regularly due to the increased emphasis on healthy lifestyles. A dedicated study of pectoralis muscle may be required and a typical shoulder mri usually does. The two key imaging modalities used to assess pectoralis major injuries are ultrasonography us and magnetic resonance mr imaging. The pectoralis major pm muscle is a powerful internal rotator, flexor and adductor of the arm. Patients with additional surgery will progress at different rates. She is the author of the book mri of the musculoskeletal system.
Most of the patients nine of 15 were injured while lifting weights, notably benchpressing. Pectoralis major muscle, clavicular head c and sternal head s contrast. A tendon rupture causes a very sharp pain within the pectoralis major muscle or tendon at the time of the injury. Orthopedics pectoralis major injuries are relatively uncommon and can pose a diagnostic challenge.
This protocol provides you with general guidelines for the rehabilitation of patients following a pectoralis major repair or transfer. This chapter focuses on the key imaging features of tendons in both. Pectoralis major transfer for isolated subscapularis tear. There are two parts of the pectoralis muscle, the pectoralis major and the pectoralis minor. There is a complete tear of the tendon or myotendinous junction of the pectoral muscle. May 28, 2014 the pectoralis major is a very large muscle that originates from the clavicle or collar bone at its upper end and the sternum or breast bone and even has some attachments to the upper ribs. Surgical repair of a partial or complete tear of the pectoralis major muscle to.
Partial ruptures are less common and complete rupture occurs when the tendinous attachment of the muscle to the bone tears. Straight ax t2 fat mid humeral head superiorly through soft tissue of axilla inferiorly 5. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. The origin is extensive and ranges from the anterior thorax to the clavicle. The pectoralis major is a very large muscle that originates from the clavicle or collar bone at its upper end and the sternum or breast bone and even has some attachments to the upper ribs. A protocol for evaluating the pectoralis major in its entirety may include the acquisition of t1weighted and stir largefieldofview mr images of the affected side of the anterior chest wall in the axial and. Emergency department physicians and nurse practitioners should order an mri if a pectoralis major tear is suspected. The patient should obtain a referral to a sports physician, orthopedic surgeon, or rehabilitation specialist. An mri can be helpful to determine the location of the injury, meaning whether or not the tear is within the muscle belly of the pectoralis major, at the junction between the muscle and tendon, or the tendon is pulled off of the bone. Primary repair of a chronic pectoralis major tear with retraction duration. Rupture of the pectoralis major muscle is an uncommon clinical entity. It makes up the bulk of the chest muscles and lies under the breast. To demonstrate that magnetic resonance mr imaging allows evaluation of injuries of the pectoralis major muscle. The pectoralis major is the larger of the two, and works to push the arms in front of the body, such as in doing a pushup or bench press exercise.
But the area where anterior axillary fold use to be is gone and when i flex my pec its definitely ball up and theres. Mri reveals localized fluid collection, edema, hemorrhage, and inflammation. Musculotendinous rupture of the sternal head and strain of the clavicular head of the pectoralis major muscle pectoralis tear. Treatment of a complete pectoralis major tendon tear will require surgery to rejoin the tendon back to the muscle or bone where it has become severed. Had two mri scan both on shoulder and chest,result came in as subscapularis 50% tear and coracobrachialis20% tear but no pectoralis major tear. Jun 02, 20 rupture of pectoralis major pm occurs most commonly as a result of an indirect mechanism associated with extensive tension on a maximally contracted muscle.
Despite reports of diagnostic ultrasound imaging being used, mri is the study of choice for most clinicians for assessment of soft tissue injuries, including pectoralis major ruptures. Pectoralis ruptures midwest sports medicine institute. A tear of the pectoralis major is a considerably uncommon injury, often occurring during forceful activity such as bench press. Isolated tear of the pectoralis minor tendon in a high school. Pectoralis major strengthening is begun o single arm pulleys and bands horizontal adduction. Surgical treatment of pectoralis major tendon rupture. If you have any questions regarding the progress of the patient, the physician should be contacted. We prefer to elevate the pectoralis major muscle and place the implant beneath it to provide superior implant coverage and improve the contour transition from the chest wall to the implant along the superior pole of the reconstructed breast.
Pectoralis major tears, also known as pectoralis major ruptures, are an. Sequential mris of the right pectoralis major muscle demonstrates an extensive partial thickness tear arrows commencing from the lower aspect of the muscle, almost involving its entire length. Although the diagnosis is usually suspected clinically, marked edema, pain, and decreased range of motion make clinical assessment of the location and extent of injury difficult. In the acute setting of a pectoralis major tear, swelling and bruising can obscure the visibility of an anterior wall defect. With an understanding of the complicated anatomy of the pectoralis major musculotendinous unit, mri provides the anatomic detail necessary to allow accurate localization and characterization of pectoralis major musculotendinous injuries. Pectoralis major muscle tendon tears are frequently encountered 1, 2, 3, 4. Over 50% of these injuries occur in athletes, classically in weightlifters during the bench press manoeuvre. Specific changes in the program will be made by the physician as appropriate for an individual patient.
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