Surgical Treatment of a Tear of the Pectoralis Major Muscle at Its Sternal Origin

Shindle, Michael K.; Khosravi, Abtin H.; Cascio, Brett M.; Deune, E. Gene; McFarland, Edward G.

doi:10.2106/jbjs.f.00934

Cited by 8 publications

(11 citation statements)

References 31 publications

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“…1 Rupture of the pectoralis major muscle is generally caused by excessive, eccentric loads, particularly while bench pressing, [2][3][4][5][6] although it has also been reported to occur during parallel bar dips, 7,8 throwing, 9 and car accidents. [10][11][12] Weight lifters who are involved with anabolic steroid use are particularly prone to pectoralis major muscle rupture. 5,13,14 Operative treatment leads to improved function compared with nonoperative management and is generally recommended for the athletic, weight-lifting population that generally sustains this injury.…”

Section: A B E1184mentioning

confidence: 99%

“…1, 5,9,12,15 Nonoperative treatment is occasionally used for partial or muscle belly ruptures 16,17 or in lower-demand patients. 18 Surgical options include fixing the tendon to the humerus with bone tunnels or suture anchors, 5,15,19,20 suturing the ruptured sternal head tendon to an intact clavicular head tendon, 11 wedge excision of the medial bulge and suturing the free edges of the tear laterally, 13 screws with tissue grasping washers, 5 and direct repair of musculotendinous junction tears. 3,19 Allograft may be necessary for reconstructions performed more than a few weeks following the initial injury or if the injury is at the musculotendinous junction and repair requires reinforcement.…”

Section: A B E1184mentioning

confidence: 99%

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Repair of Pectoralis Major Ruptures: Single-surgeon Case Series

Garrigues¹,

Kraeutler²,

Gillespie³

et al. 2012

Orthopedics

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Rupture of the pectoralis major is an uncommon injury that can lead to pain, loss of strength, and cosmetic deformity. The purpose of this study was to analyze the outcome of pectoralis major repairs by a single surgeon. Twenty-four patients who underwent pectoralis major repair by the senior author (M.D.L.) between May 2005 and March 2011 were retrospectively identified. Patients were assessed at least 6 months postoperatively with the use of various questionnaires, including the Penn Shoulder Score, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, and Single Assessment Numeric Evaluation (SANE). All patients were men with an injury to the sternal head of the pectoralis. Most (16/24; 67%) patients sustained the injury while bench or incline bench pressing. Nineteen (79%) patients were successfully contacted for follow-up. Of these, an average preinjury bench press of 318 lb (range, 145-525 lb) was restored to an average of 264 lb (range, 100-500 lb) at follow-up. Average preoperative Penn Shoulder Score was 60 points (range, 33-77 points), improving to 94 points (range, 64-100 points) at last follow-up (P=.011). Average postoperative ASES and SANE scores were 96 points (range, 60-100 points) and 93 points (range, 50-100 points), respectively. All but 1 patient were rated excellent (14/19; 74%) or good (4/19; 21%) by the Bak criteria. Operative treatment of pectoralis major rupture yields high patient satisfaction and allows predictable return of comfort, range of motion, cosmesis, and overall limb strength, with a slightly less predictable return of maximum bench press strength.

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Section: A B E1184mentioning

confidence: 99%

Section: A B E1184mentioning

confidence: 99%

Repair of Pectoralis Major Ruptures: Single-surgeon Case Series

Garrigues¹,

Kraeutler²,

Gillespie³

et al. 2012

Orthopedics

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“…ectoralis major tendon ruptures are associated with injuries involving sports, motor vehicle accidents (MVAs), and the workplace. Typically, these ruptures occur at the tendon attachment to the humerus or at the musculotendinous junction just proximal to the humeral insertion, although midsubstance ruptures have also been reported [1][2][3][4][5][6][7][8][9] . Tears of the pectoralis major muscle at its sternal origin, however, are exceedingly rare, but have been associated with seat belt injuries in MVAs [5][6][7] .…”

mentioning

confidence: 99%

Surgical Management of Pectoralis Major Tears of the Sternal Origin Because of Seat Belt Trauma

Orvets

Bhale

Budge

2021

JBJS Case Connector

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Cases: Two patients presented with medial chest pain and deformity after high-speed motor vehicle accidents (MVAs) in which they were restrained drivers. Physical examination revealed retraction of the pectoralis major from the sternum on resisted adduction and internal rotation of the arm. MRI confirmed tears of the pectoralis major from the sternal origin. Both patients underwent delayed surgical repair with excellent results. Conclusion: Tears of the pectoralis major at the sternal origin are rare injuries that can result in significant deformity and pain. Surgical repair, even in a delayed fashion, can result in excellent patient outcomes.

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“…∥References 2, 3, 5, 7, 8, 10, 12, 16 -19, 23, 28, 31, 35, 37, 40, 42, 48, 50, 52, 54, 58, 59, 61, 62, 64 -67, 69, 70, 72, 77, 79 -84, 86, 87.…”

mentioning

confidence: 99%

Surgical Treatment of Pectoralis Major Muscle Ruptures: A Systematic Review and Meta-analysis

Gupton

Johnson

2019

Orthopaedic Journal of Sports Medicine

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Background:Pectoralis major muscle (PMM) tendon ruptures are becoming more common. Multiple techniques for fixation of the avulsed tendon to its humeral insertion have been described. None of these techniques has been reviewed to compare outcomes in efforts to establish a first-line surgical technique.Purpose:To systematically review and analyze the data available in the literature to establish a clinically superior surgical technique and time frame in which surgery should occur.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature review was conducted. Only studies reporting the surgical techniques and outcomes of PMM repair were included. Data including patient age, injury mechanism, type and extent of the rupture, time from injury to surgery, surgical technique, outcome including complications, steroid use, location and year of publication, and activity level were extracted from the included studies. Statistical and descriptive analyses were conducted on the available literature.Results:Of 259 cases from studies that provided the timing of repair, 72.6% (n = 188) were repaired acutely, while the remaining were repaired more than 8 weeks after the injury. There was no statistical difference found in the outcomes of these repairs. There were 265 cases included in the statistical analysis comparing the outcomes of surgical techniques. The odds of an excellent/good outcome were significantly better for the transosseous suture (TOS) compared with the unicortical button (UCB) technique (odds ratio [OR], 6.28 [95% CI, 1.37-28.75]; P = .018) and also for the suture anchor (SA) compared with the UCB technique (OR, 3.40 [95% CI, 1.06-10.85]; P = .039). The odds of an excellent/good outcome were not significantly different when comparing the TOS, SA, and TOS with trough techniques to one another. The probability of complications was highest with the TOS with trough technique (12.0%), although the odds of having a complication were not statistically significant for any single technique compared with the others.Conclusion:The low quality of evidence available limited this review. There were no significant differences observed in the outcomes of PMM repair based on the timing of repair. The TOS and SA techniques had statistically significantly greater odds of resulting in an excellent/good outcome compared with the UCB technique, but 1 study that contributed to this analysis may have statistically skewed the results for the UCB technique. Therefore, all 3 surgical techniques are accepted options, and the best technique is that with which the surgeon is most proficient and comfortable. Comparative research with a greater level of evidence is needed to determine a definitive first-line surgical technique.

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Surgical Treatment of a Tear of the Pectoralis Major Muscle at Its Sternal Origin

Cited by 8 publications

References 31 publications

Repair of Pectoralis Major Ruptures: Single-surgeon Case Series

Repair of Pectoralis Major Ruptures: Single-surgeon Case Series

Surgical Management of Pectoralis Major Tears of the Sternal Origin Because of Seat Belt Trauma

Surgical Treatment of Pectoralis Major Muscle Ruptures: A Systematic Review and Meta-analysis

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