Pectoralis Minor Syndrome Miscible With Subacromial Impingement Syndrome

Abstract

Objective: Pectoralis minor syndrome (PMS) is a neurovascular disorder affecting the upper extremity. In the present study, the demographic and clinical features of patients diagnosed as PMS were examined, as well as cases of concomitant subacromial impingement syndrome (SIS). Methods:A retrospective trial was conducted with 12 patients with the diagnosis of PMS according to a pectoralis minor muscle (PMM) block test. The PMM block was performed under the guidance of ultrasonography. Results:Of the 12 PMS patients evaluated, 83% had a complaint of pain, 58.3% had paresthesia, and 16.6% had swelling of the hand. A physical examination revealed that 58.3% of the patients had tenderness at the biceps tendon, 16.6% had subacromial tenderness, and 16.6% had tenderness at the acromioclavicular joint. In 66.6% patients, subacromial impingement tests were positive, and 33.3% of them had a positive subacromial injection test (SIT).

Pectoralis minor syndrome

“…The duration of the symptoms is reported to be protracted due to slow diagnosis. [1,2,16,17] To avoid overlooking PMS, it is necessary to recognize the symptoms and signs of this syndrome well. There is a broad spectrum of clinical presentation with pain in the arm, shoulder, neck, chest, and scapular region, and weakness, paresthesia, swelling and coldness in the upper extremity.…”

“…Pain all over the arm including muscles of shoulder girdle, trapezius and rhomboid muscles may be observed. [16] Numbness, tingling, and paresthesia are also widespread symptoms. Although paresthesia is common in the fourth and fifth fingers, complaints can be observed in the whole hand.…”

“…Subacromial impingement maneuvers, such as Neer and Hawkins tests, can yield positive results. [16] Together with these physical examination findings and pain in the shoulder region, the patient may be misdiagnosed with subacromial impingement syndrome (SIS). Although shoulder impingement tests are insufficient for a definitive diagnosis of SIS, they are important in clinical evaluation.…”

“…A study in patients with PMS indicated that subacromial impingement tests were positive in 66.6% of the patients, and 33.3% responded positively to a subacromial injection test. [16] Subacromial impingement syndrome may be seen in relation to the damage to shoulder muscles and excessive overhead activity that leads to PMS and shoulder impingement. [24] Another reason is the deterioration of shoulder biomechanics due to the shortened or contracted PM muscle.…”

“…In such painful pathologies, a subacromial injection test can be performed for a the differential diagnosis of SIS. [16,22,23] The cervical region should be also evaluated carefully. Supraclavicular entrapments and cervical radiculopathy should be excluded.…”