This document discusses pectoralis major injuries, including anatomy, diagnosis, treatment options, and outcomes. It provides an overview of the author's experience treating tears in athletes from various sports. Diagnosis involves clinical exam and imaging like ultrasound or MRI. Treatment can be non-operative with strength loss, or operative with surgical repair which often provides best results, especially for distal tears. Post-operative rehabilitation is outlined in phases focusing first on range of motion and later on strengthening. Reported outcomes include patients regaining 90% of strength on average and returning to sports within 6 months.

1. Lennard Funk
Pectoralis Major Injuries

2. Experience

3. My experience - Diagnosis Pec Major Tears
Pec Major Tears

4. Pec Major Tears Pec Major Repairs
My experience - Surgery Pec Major Tears

5. My experience - Athletes
Rugby
Boxer / Martial Arts
Competitive Bodybuilder
Olympic Powerlifting
Sailor / Paddler
Military
Football
Rock Climbers

6. Anatomy

7. Pec Major Anatomy

9. Pec Major Footprint

10. Diagnosis

11. Clinical Exam
• What is important?
• Why?

12. 1
2
3
4

13. 1
2
3
4

14. Fascial Cord

15. Fascial Cord

16. Ultrasound

17. MRI Protocol
• Surface coil - to increase signal to noise ratio & spacial resolution
• Oblique coronal along the plane of the muscle-tendon
unit
• Axial T1 & PDFS
• Coronal STIR & T1
• Sagittal PDFS
• Fat suppression for periosteal stripping

18. Tendon Avulsion

19. Musculo-tendinous

20. Muscle Belly

21. Surgery?

22. Non-operative treatment
• 40-50% loss of adduction and flexion strength
• Cramping
• Fatigue
• Deformity

23. UN KNOWN
SUPPORTIVE
SURGERY
0
1044 J. E. MCENTIRE, W. E. HESS. AND S. S. COLEMAN
RESULTS OF THERAPY FOR PECTORALIS MUSCLE RUPTURE
:..:.1 L
. EXCELLENT
0 GOOD
0 FAIR
0 POOR
0 UNKNOWN
‘:ii
10 15 20
NO TREATMEN1
NUMBER OF PATIENTS
FIG. 5
Results of treatment suggest that surgical repair most often gives the best results, especially
with distal ruptures.
muscle, and postoperative support and therapy. Many patients who requested a late
McEntire,Hess,Coleman, JBJSA, 1972

24. Isokinetic evaluation
he skateboarding
a result of direct
er athlete’s skate-
hlete occurred due
pper extremity in
ad a PMM rupture
milar to the trau-
zed in Table 5. In
urned to their pre-
me), and 2 (20%)
ith reduced perfor-
t (10%) had a poor
return to competi-
d discomfort at the
. The outcome of
ment (nonoperated
he Bak et al3
scale
0%), and bad for 3
greater than that measured for the operated group (P
.05; Mann-Whitney test).
TABLE 6
Isokinetic Evaluation Results
Deficit of Peak Torque, %
Cases Nonoperated Operated
1 62 0
2 45 14
3 15 34
4 14 40
5 58 –13
6 12 –12
7 30 5
8 72 –11
9 65 7
10 39 73
Total 41.2% 13.7%a
a
P .05 vs nonoperated group, Mann-Whitney test.
De Castro & Pochini, AJSM, 2010

25. NOT Cosmetic!!

26. Surgical
Technique

27. Footprint Repair

28. Footprint Repair

29. Surgical Procedure
Shah & Funk, TSES, 2010

30. Can’t repair it?

31. Tendo-Achilles Allograft

34. Rehab
&
Outcomes

35. Post-Op Rehabilitation
• Phase 1:
• (Level 1-2 Exercises) (0-3wks)
• Active Assisted ROM
in ‘safe zone’
• Closed chain
• Phase 2:
• (Level 2-3 Exercises) (3-6 wks)
• Open Chain
• Phase 3:
• (Level 3+) (> 6wks)
• Active resisted exercise

36. Post-Op Ultrasound

37. Allograft Post-op 1yr

38. Outcomes
• Follow-up: 20.3months (12-39)
• Pain: None: 9 and Mild: 1
• Post-op strength: 90% recovery
• (Cosmesis: 80% Completely Satisfied)
• All Returned to Sport at mean of 6 months
• Complic: 1 deep infection

39. <5%
<5%

40. thank you