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

Abstract

This is a rare case of an isolated pectoralis minor partial-thickness tendon tear in a 24-year-old man who was involved in a major trauma. The purpose of this paper is to report the clinical signs, symptoms, cross-sectional imaging findings, and management of an isolated pectoralis minor tendon tear. Furthermore, this case represents a novel traumatic mechanism of injury, as opposed to the classic sports-related pectoralis minor tendon tear injury. The current limited body of literature on isolated pectoralis minor tendon tears is reviewed.

Isolated Pectoralis Minor Tendon Rupture with Subclavian Vein Thrombosis

“…We present the first case of a patient with an isolated atraumatic pectoralis minor tendon rupture in combination with a subclavian vein thrombosis. In agreement with the previously reported cases [ 1 – 7 ], the tendon lesion was treated conservatively with an excellent functional result. However, the patient continues suffering from a postthrombotic syndrome caused by the subclavian vein thrombosis.…”

“…The work sequence consisted of repetitive adduction and abduction movements under an increased load in an anteverted shoulder, requiring constant repositioning of the scapula. The latter matches the key function of the pectoralis-minor muscle-tendon unit [ 1 ] and, in case of exertion, presumably represents the pathomechanism leading to tendon injury, similar to the case reported by Vance et al [ 7 ] and the “bench-presser's shoulder” described by Bhatia et al [ 12 ]. In addition, tensile forces of 340–500 Newton were measured using the cutting wire according to a report conducted by an authorized technical expert, which were rated as too high in an ergonomics workplace assessment and surpass the ultimate tensile strength of the pectoralis minor tendon of 177.15 Newton measured by Moinfar and Murthi [ 10 ].…”

“…The pectoralis minor tendon is approximately eighteen millimeters wide and four centimeters long at its coracoid insertion [ 10 ]. The principal function of the pectoralis minor muscle consists of depressing the coracoid process and drawing the scapula anteriorly and inferiorly towards the thorax, thus moving the inferior scapular angle posteriorly [ 1 ]. With the shoulder in a fixed position, the pectoralis minor acts as a respiratory muscle due to its origin on the outer surface of the third through the fifth rib.…”

“…The first six published cases describe injuries in athletes after direct trauma. Common among these cases is a direct impact on the shoulder [ 1 , 3 , 4 ] or the arm in different positions, with either a contracted pectoralis minor tendon (anteversion of the shoulder with extended elbow, e.g., blocking drills [ 6 ]) or a pectoralis minor tendon under tension (arm in slight abduction, external rotation, and extension [ 2 ]). The most recent case published by Vance et al [ 7 ] describes a second injury mechanism: the isolated pectoralis minor tendon rupture was triggered by a static eccentric load in a fatigued muscle during lateral plank exercise with body weight.…”

“…Isolated tears of the pectoralis minor tendon are very rare. To our knowledge, only 8 cases have been reported to date [ 1 – 7 ], resulting from two different injury mechanisms: acute traumatic injuries with sudden impact, commonly in contact sport athletes, and atraumatic fatigue ruptures under eccentric loading. The diagnosis is often delayed, and the treatment of choice is traditionally conservative, with excellent outcomes in the literature and no long-term sequelae reported so far.…”