Injuries of the Pectoralis Major Muscle: Evaluation with MR Imaging

Connell, David; Potter, Hollis G.; Sherman, Mark F.; Wickiewicz, Thomas L.

doi:10.1148/radiology.210.3.r99fe43785

Cited by 138 publications

(119 citation statements)

References 12 publications

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“…The pectoralis major tendon inserts at the lateral lip of the bicipital groove of the humerus, directly adjacent to the location of the small focus of signal abnormality presented here 7 . Injuries to the pectoralis major tendon are rare and occur most often at the site of insertion 7,8 . Tears as well as calcific tendinitis are the most common pathological findings of the pectoralis tendon [9][10][11] whereas chronic avulsion injuries more frequently involve the deltoid tendon inserting at the humerus or the gluteus maximus tendon at the femur 12,13 .…”

Section: Discussionmentioning

confidence: 76%

Enthesopathy of the pectoralis major tendon mimicking osteoid osteoma. A case report with an unfortunate series of events

Baumhoer

Jundt

Lenze

et al. 2015

MLTJ

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IntroductionTendons, aponeuroses and fasciae transfer the forces developed by muscle activity to bone and are firmly attached at both the periosteum and the cortical bone by extrinsic collagen fibers 1 . Summarized under the term entheses, these bone-soft tissue interfaces are especially prone to mechanical injuries that are well documented in a number of sports. As a consequence of repetitive biomechanical stress affecting the periosteal anchorage, extensive reactive new bone formation can occur and clinically as well as radiologically mimic neoplastic disease. We present a case of an enthesopathy of the pectoralis major tendon that was initially regarded suspicious for a metastasis, then, during radiological workup, proved difficult to distinguish from an osteoid osteoma and eventually was resected. The report illustrates the difficulties in assessing enthesopathies with unusual presentations and the potential complications of avoidable partial resections of cortical bone. Case reportA 50-year-old woman with a history of localized breast cancer (TNM classification: pT1c, pN0, cM0, G2) that was resected and treated with additional adjuvant radiotherapy three years ago, underwent a 99 m Technetium DPD bone scintigraphy due to chronic back pain to assess bone metastasis. While the spine was unremarkable, the left proximal humerus showed a focal uptake of the radioisotope on the whole body scan and the spot view of the left upper arm (Fig. 1). Specifically asked for symptoms she complained about minor pain in this region. Due to clinically suspected metastatic breast cancer, radiographs and a magnetic resonance (MR) imaging were acquired. The externally rotated anteroposterior radiograph of the left proximal humerus showed a focal juxtacortical osteolysis of 8 x 5 mm with a central calcification of the lateral cortex and a concomitant uniform smooth, non-aggressive periosteal reaction (Fig. 2). Corresponding to the radiographs, the MR images revealed a 5 x 4 mm lesion adjacent to the anterolateral humeral cortex with increased signal intensity on the T2-weighted fat saturated images, intermediate signal intensity on the T1-weighted images and enhancement after contrast administration (Fig. 3 A-D). The cortex underneath the lesion was slightly thinned, neither bone nor soft tis- SummaryBackground: we present the case of an enthesopathy at the proximal humerus which was initially -due to the clinical history and a positive bone scintigraphy -regarded suspicious for metastatic breast cancer in a 50-year-old woman. Case report: after complementing radiographs and a magnetic resonance (MR) examination exhibiting a focally contrast enhancing juxtacortical osteolysis of the humerus, a metastasis seemed radiologically unlikely, but besides a traction-related periosteal reaction of the pectoralis major tendon an unusual osteoid osteoma could not unequivocally be ruled out. Although radiological follow-up was recommended the patient insisted on a surgical resection that was performed subsequently and confirmed an enthesopa...

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Section: Discussionmentioning

confidence: 76%

Enthesopathy of the pectoralis major tendon mimicking osteoid osteoma. A case report with an unfortunate series of events

Baumhoer

Jundt

Lenze

et al. 2015

MLTJ

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“…Additional investigations like roentgenography and ultrasonography can be helpful, but are usually inconclusive in determining the extent and site of injury. Recent data have shown that MRI can accurately differentiate between partial and complete ruptures of the major pectoral muscle [12,[14][15][16][17]. In two studies where MRI images were compared to intraoperative findings, no false positives were found in the case of complete ruptures [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…Recent data have shown that MRI can accurately differentiate between partial and complete ruptures of the major pectoral muscle [12,[14][15][16][17]. In two studies where MRI images were compared to intraoperative findings, no false positives were found in the case of complete ruptures [15,16]. Even though these two series only report the results of 25 patients, due to the rareness of the injury it does represent more than ten percent of all reported cases in the literature.…”

Section: Discussionmentioning

confidence: 99%

Complete Avulsion of the Pectoralis Major Tendon: a Case Report

Jonge

Goslings

et al. 2007

Eur J Trauma Emerg Surg

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“…The primary action of the entire PM muscle is adduction, internal rotation, and flexion of the shoulder. 20,23,40 But the 3 PM portions may also have distinct actions. 25,52 For instance, contraction of the clavicular portion brings the extended arm forward into flexion, in contrast to the contraction of the sternal portion, which brings the arm into extension against resistance from a flexed position.…”

Section: Supplemental Video Onlinementioning

confidence: 99%

Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery

Stegink-Jansen

Buford²,

Patterson³

et al. 2011

J Orthop Sports Phys Ther

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Early detection and successful cancer treatments have increased the number of long-term breast cancer survivors, 3,5 making optimal recovery and quality of life a primary goal. 8 Up to 50% of survivors have a loss of shoulder motion after completion of their treatments, 28,46 which often extends into a long-term impairment. 33,48 This loss of motion has been found to be predictive of reduced capability to perform functional activities 28 and has been shown to be related to depressive symptoms in a group of 183 older women. 13T T STUDY DESIGN: Descriptive study. T T OBJECTIVES:To quantify and rank the order of strain (length change in proportion to the resting length) of 3 portions of the pectoralis major (PM) muscle during various exercises. T T BACKGROUND:A biomechanical foundation on which to base exercise prescriptions for patients after breast cancer surgery is lacking. T T METHODS: An interactive, 3-D, computergraphic simulation system, developed to study biomechanical properties of the musculoskeletal system, was used to simulate movements of the glenohumeral, scapulothoracic, and scapuloclavicular joints of the shoulder, and to estimate strain in 3 portions of the pectoralis major (PM) muscle throughout the motions. The computed tomography scans of 2 male cadavers and literature review formed the basis for the estimations used in the model. Strains in the clavicular, midsternum, and abdominal regions of the PM were expressed as percent strain: [(change in muscle length/resting length) × 100]. Exercise motions were based on PM muscle anatomy and published breast cancer rehabilitation protocols. T T RESULTS:Strains of the PM regions ranged from -21% shortening of the clavicular region during flexion to 55% lengthening of the abdominal region during the overhead stretch. Strain between adjacent regions was most uniform for the movement of abduction with external rotation, and least uniform with flexion. T T CONCLUSION: PM muscle lengtheningestimates were not linearly proportioned to shoulder joint motions, and varied for 3 portions of the PM. This information may help clinicians and researchers to estimate lengthening of PM portions throughout measurable shoulder motions.

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Injuries of the Pectoralis Major Muscle: Evaluation with MR Imaging

Abstract: MR imaging allows accurate evaluation of injuries of the pectoralis major muscle and enables identification of patients who would benefit from surgical repair.

Cited by 138 publications

References 12 publications

Enthesopathy of the pectoralis major tendon mimicking osteoid osteoma. A case report with an unfortunate series of events

Enthesopathy of the pectoralis major tendon mimicking osteoid osteoma. A case report with an unfortunate series of events

Complete Avulsion of the Pectoralis Major Tendon: a Case Report

Computer Simulation of Pectoralis Major Muscle Strain to Guide Exercise Protocols for Patients After Breast Cancer Surgery

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