Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures

Abstract

INTRODUCTION:Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established.OBJECTIVES:To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture.METHODS:We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically). Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured.RESULTS:Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20%) for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60% and 57.80% and non-surgical, 62.06% and 54.06%, for the dominant and non-dominant sides, respectively). The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27%; non-surgical, 98.61%). CONCLUSIONS:This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance.

Pectoral nerves I block is associated with a significant motor blockade with no dermatomal sensory changes: a prospective volunteer randomized-controlled double-blind study

“…13 The dynamometer has been used to diagnose and evaluate pectoralis major muscle tears 14 as well as to evaluate muscle recovery after rupture or tear of this muscle. 15,16 Nevertheless, this method of evaluation is not practical in the clinical anesthesia setting.…”

Clinical Considerations for the Surgical Treatment of Pectoralis Major Muscle Ruptures Based on 60 Cases

“…Isokinetic assessments have been widely used in the literature 13,[28][29][30][32][33][34] to quantify the loss of force after the lesion or even after surgery, based on criteria described by Motzkin et al 24 and Dvir. 10 We performed isokinetic tests on almost all chronic cases preoperatively and 5 months after surgery but not in acute cases because of pain within 30 days after the lesion.…”

Pectoralis major tendon repair: a biomechanical study of suture button versus transosseous suture techniques

“…The loads used and cycles tested are calculated from clinical data derived from post operative patients [7] and rehabilitation regimes.  The cyclical study was unable to show a difference of 10,000 cycles, which is considered the difference between rehabilitation philosophies and our data does not support accelerated rehabilitation.…”