Mr imaging assessment of the pectoralis major myotendinous unit. Mr imaging assessment of the pectoralis major myotendinous. This book is distributed under the terms of the creative commons attribution 4. How not to tear a pec while bench pressing mark barroso. Pectoralis major tears, also known as pectoralis major ruptures, are an. Isolated traumatic pectoralis minor tendon tear in a young adult. The purpose of this study was to use mr imaging to.
Eccentric part where i was about to press up,a pop like23times,pain under armpit. If not, follow the adult protocol, but make changes to the slice, gap, and fov as needed. Muscle mr traumatic changes the radiology assistant. 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. Straight ax t2 fat mid humeral head superiorly through soft tissue of axilla inferiorly 5. Accuracy of magnetic resonance imaging in predicting the. 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. Rupture of pectoralis major pm occurs most commonly as a result of an indirect mechanism associated with extensive tension on a maximally contracted muscle. All required screening forms completed and singed images sent.
Radiologists work closely with ohsu mri techs in the art of creating optimal images from current technology. Pectoralis major muscle an overview sciencedirect topics. The pectoralis major is a very powerful muscle that forms the chest prominence and. Beneath the pectoralis major is the pectoralis minor, a thin, triangular muscle. To evaluate the significance of biceps tendon bt displacement and peribicipital hematoma on mri in subjects with pectoralis major pm tears. Rupture of the pectoralis major tendon is considered an uncommon injury and. Pectoralis major muscle rupture the pectoralis major muscle is the large muscle in front of the upper chest. 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. Until recently, the diagnosis of pectoralis major muscle injury has been based on.
Hip pelvis thigh knee lower extremityshin ankle foot special cases soft tissue mass metal protocol. Jul 18, 2006 pectoralis major tendon rupture is a relatively rare injury, resulting from violent, eccentric contraction of the muscle. Pectoralis major transfer for isolated subscapularis tear. 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. This chapter focuses on the key imaging features of tendons in both. 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. The pediatric radiologists will usually protocol specific sequences they need in ris.
Magnetic resonance imaging mri is considered the imaging modality of choice and. Patient id verified with two identifiers wristband verify correct patient and exam on scanner and ris. A tear of the pectoralis major is a considerably uncommon injury, often occurring during forceful activity such as bench press. Rupture of the pectoralis major muscle in a collegiate football player. Mri reveals localized fluid collection, edema, hemorrhage, and inflammation. We hypothesized that these features might be associated with tear severity at surgery. A traditional mri of the shoulder will often miss a pectoralis tendon rupture because. There are two parts of the pectoralis muscle, the pectoralis major and the pectoralis minor. The largest of which is the pectoralis major muscle which originates from the sternum breast bone, ribs and. The pectoralis major from latin pectus, meaning breast is a thick, fanshaped muscle, situated at the chest of the human body. There is a complete tear of the tendon or myotendinous junction of the pectoral muscle. Sag t2 the fov is bigger, the slices are thicker, and there are more slices to.
An axial scan through the same area demonstrates fluid consistent with haemorrhage in the muscle defect. In addition, recent literature has redefined the anatomy of the distal pectoralis major. 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. Bench pressing is the most common cause of injury, but. Pectoralis ruptures midwest sports medicine institute. This protocol is based on maintaining range of movement in the first phase and then gradually building strength in the middle to the last phase.
To demonstrate that magnetic resonance mr imaging allows evaluation of injuries of the pectoralis major muscle. Msk mri protocol overview page 3 of 123 msk mri protocols march 2010 1. Deformity and weakness of this muscle in weight lifters is typically due to traumatic tendon. Early diagnosis via mri and surgical repair is important to ensure a sound recovery. Pectoralis major muscle, clavicular head c and sternal head s contrast. Most of the patients nine of 15 were injured while lifting weights, notably benchpressing. Patients with additional surgery will progress at different rates. Oblique coronal sequences along the long axis of the pectoralis major tendon are. The physician reserves the right to either advance or delay this protocol as deemed necessary. Sep 12, 2018 and my mri report read, there is a complete tear of the pectoralis major tendon from the insertion on the humerus. Hi dr luks, i injured my pectoralis major on 9242019. The pectoral muscles are a group of two muscles situated at the front of the chest figure 1.
This protocol provides you with general guidelines for the rehabilitation of patients following a pectoralis major repair or transfer. Oct 28, 2019 hi dr luks, i injured my pectoralis major on 9242019. Msk mri protocol overview page 1 of 123 msk mri protocols march 2010 table of contents. It moves the shoulder forwards and across your chest. 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.
Orthopedics pectoralis major injuries are relatively uncommon and can pose a diagnostic challenge. A tendon rupture causes a very sharp pain within the pectoralis major muscle or tendon at the time of the injury. A careful clinic examination is frequently sufficient to identify the extent of the tendon injury in most patients. We report an open reconstruction technique and its outcomes in a case of chronic and retracted pm tear. But the area where anterior axillary fold use to be is gone and when i flex my pec its definitely ball up and theres. 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. In the acute setting of a pectoralis major tear, swelling and bruising can obscure the visibility of an anterior wall defect. We present cases of distal rupture of the pectoralis major muscle in athletes. A dedicated study of pectoralis muscle may be required and a typical shoulder mri usually does. The patient should obtain a referral to a sports physician, orthopedic surgeon, or rehabilitation specialist. And my mri report read, there is a complete tear of the pectoralis major tendon from the insertion on the humerus. Mri is the mainstay for diagnosing pectoralis major tear early surgical. 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. 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.
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 major rupture rehabilitation protocol shady grove orthopaedic associates, p. An axial scan through the same area demonstrates fluid consistent with. Pectoralis major strengthening is begun o single arm pulleys and bands horizontal adduction. Magnetic resonance imaging revealed an isolated tear of the pectoralis minor tendon from the coracoid process with slight retraction and edema in the muscle. Partial ruptures are less common and complete rupture occurs when the tendinous attachment of the muscle to the bone tears. For complete or partial tears of the pectoralis major, mri has been. Oblq cor t2 fat grx on axial parallel to pectoralis musclechest wall. At the last followup 12 months, the patient was painfree, with a visual analogic scale at 0 all the time.
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. Atypical pectoralis major muscle wasting in a recreational. It travels outward toward the arm and attaches to the humerus with a large tendon. The two key imaging modalities used to assess pectoralis major injuries are ultrasonography us and magnetic resonance mr imaging. 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. Pectoralis muscle rupture treatment avon pectoralis muscle. 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. The injuries were evaluated for abnormal morphology and signal intensity. 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. 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. Passive and active range of motion exercises as well as pendulums can. Pectoralis major repair rehabilitation protocol this protocol was developed for patients who have had a pectoralis major repair. It is best known as the muscle that you develope with the bench press exercise.
Pectoralis major tendon rupture is a rare shoulder injury, most commonly seen in weight lifters. Pdf pectoralis major tendon repair post surgical rehabilitation. Furthermore, this case represents a novel traumatic mechanism of injury. Rupture of the pectoralis major muscle is an uncommon clinical entity. The pectoralis major muscle is the large muscle in front of the upper chest. 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. If you have any questions regarding the progress of the patient, the physician should be contacted.
Us and mr imaging of pectoralis major injuries radiographics. The fibers converge as a fan into three laminae that twist upon each other 90 before coalescing into a single tendon of insertion 46. Imaging evaluation with ultrasound and mr imaging can be difficult given the complex regional anatomy. Over 50% of these injuries occur in athletes, classically in weightlifters during the bench press manoeuvre. This injury is being seen more regularly due to the increased emphasis on healthy lifestyles. Mri performed one year postoperatively confirmed the continuity between. Had two mri scan both on shoulder and chest,result came in as subscapularis 50% tear and coracobrachialis20% tear but no pectoralis major tear. The origin is extensive and ranges from the anterior thorax to the clavicle. Primary repair of a chronic pectoralis major tear with retraction duration. Accurate characterization of pectoralis major tears is important to guide management. A pectoral strain is a condition characterised by partial or complete tearing of one or more of the pectoral chest muscles figure 1.
Pectoralis major tears, also known as pectoralis major ruptures, are an uncommon traumatic injury of the pectoralis major. Mr imaging is the optimal imaging technique to study the normal and abnormal conditions of the pectoralis major muscle and tendon unit. Treatment options vary from conservative to operative. It makes up the bulk of the chest muscles and lies under the breast. Pectoralis tendon repair postop protocol this protocol is intended to be a general outline only. Isolated tear of the pectoralis minor tendon in a high school. Surgical repair of a partial or complete tear of the pectoralis major muscle to. Achieving the criteria of each phase should be emphasized more than the approximate duration. Near complete tear at the musculotendinous junction of pectoralis major with contusionedema of the muscle and surrounding softtissues. Isolated tear of the pectoralis minor tendon in a high. Example of the retracted appearance of a chronic sternal head pectoralis major tear. Intact clavicular head and retracted sternal head of pectoralis major, demonstrated with resisted forward elevation. The pec major attaches to the humerus bone upper bone of arm and is divided into two.
The pectoralis major muscle is often maintained on the chest wall following mastectomy, and an implant can be placed above or beneath it. 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. 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. The pectoralis major pm muscle is a powerful internal rotator, flexor and adductor of the arm. Subjects journals books book series working papers. She is the author of the book mri of the musculoskeletal system. Patients with pm tendon ruptures, classically present a history of sudden severe pain in arm and shoulder at the time of injury. Emergency department physicians and nurse practitioners should order an mri if a pectoralis major tear is suspected.
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. Ankle foot special cases soft tissue mass metal protocol. Surgical treatment of pectoralis major tendon rupture. The most common cause is weight lifting specifically the bench press but it can occur with other sporting events as well. To improve the morbidity of the disorder, an interprofessional team approach is a recommendation. Coronal t2 near complete tear at the musculotendinous junction of pectoralis major with contusionedema of the muscle and surrounding softtissues. Preoperative pectoralis muscle quantity and attenuation are novel. As with any other us examination, us evaluation of the. Musculotendinous rupture of the sternal head and strain of the clavicular head of the pectoralis major muscle pectoralis tear. Early diagnosis via mri and surgical repair is important to ensure a. Pectoralis major tendon rupture is a relatively rare injury, resulting from violent, eccentric contraction of the muscle. Fifteen men underwent mr imaging after injury of the pectoralis major muscle.
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