Isolated Tear of the Pectoralis Minor Tendon in a High School Football Player

Abstract

Multiple pectoralis major tendon tears have been reported in the literature; however, isolated rupture of the pectoralis minor tendon is rare and has been reported 3 times (4 patients).This article describes a case of an isolated pectoralis minor tendon tear in a male high school football player after a traumatic injury. The patient was injured while making a tackle and leading with his arm and chest. He presented with left anterior shoulder and chest wall pain with direct tenderness on palpation over the coracoid. Magnetic resonance imaging of the chest revealed an isolated tear of the pectoralis minor tendon with slight retraction and significant edema in the muscle belly. The patient returned to full activities after conservative management.Although rare, the diagnosis of pectoralis minor tendon rupture should be considered in patients who sustain a contact injury to the shoulder with tenderness on palpation over the coracoid. The mechanism of injury can be related to a direct anterior force to the shoulder, forced external rotation of the arm in slight abduction, or with the arm in extension and shoulder in flexion (eg, blocking in football). The diagnosis can be confirmed with magnetic resonance imaging when edema exists on the medial aspect of the coracoid and extends into the muscle belly. Physical therapy with scapular stabilization exercises and avoidance of abduction and active adduction can be successful in returning these patients to their previous activity levels.

Isolated traumatic pectoralis minor tendon tear in a young adult diagnosed with MRI

“…Identical to our case, all five previously reported cases describe force that was applied along the anterior shoulder. Interestingly, in this case, like one other case in the literature [5] , the patient had his arms at the side when the injury happened whereas in the four other reported cases, extension of the affected arm at the time of injury was observed [6] , [7] , [8] . Thus, a pectoralis minor tendon injury can be caused by a direct anterior force to the shoulder [5] , forced external rotation of the arm in slight abduction [6] , or with the arm in extension and shoulder in flexion [7] .…”

“…Similar to our case, all five previously reported cases also described coracoid process tenderness upon palpation. In the reported cases, significant pain was elicited with forced shoulder abduction, extension, and external rotation of the afflicted arm [ [5] , [6] , [7] , [8] , Table 1 ]. Our patient's physical examination was limitedly given the patient's significant pain.…”

“…The medically accepted mechanism for a pectoralis major tear is forced abduction and external rotation. Pectoralis minor tear mechanisms of injury are relatively unknown since very few cases have been described [5] , [6] , [7] , [8] . In these cases, conservative management is indicated [9] , [10] .…”

Isolated spontaneous pectoralis minor tendon rupture in a patient with chronic renal failure

“…It's been thought that the overlying pectoralis major muscle protects the pectoralis minor muscle from direct anterior traumas to shoulder (6). Therefore, isolated rupture of the pectoralis minor muscle tendon is extremely rare with only 4 cases that were reported in the literature (5)(6)(7)(8). All cases involved healthy sports players and had an antecedent direct trauma.…”

Common Shoulder Injuries in American Football Athletes

“…This muscle stabilizes the scapula to the chest wall. Pectoralis minor ruptures are rare, but four football players with isolated pectoralis minor ruptures have been described in the literature (24,29,50). Each of these four athletes presented after trauma was sustained to the arm during a game or practice.…”