Immediate surgical repair of pectoralis major tendon rupture caused by weightlifting. Case Report
DOI:
https://doi.org/10.1016/j.rccot.2020.06.005Keywords:
pectoralis muscles, rupture, tendon injuries, weight liftingAbstract
The rupture of the pectoralis major muscle tendon in young and athletic patients is a rare event for which surgical repair is indicated. The repair can be acute or chronic, up to or after 8 weeks, respectively. Acute repair has shown excellent results, and so far there are no reports of surgical repairs within the first 24 hours of the injury. A case is presented of the immediate surgical repair of a ruptured pectoralis major muscle tendon occurring in a 45-year-old man with no history of steroid use, while lifting weights. The immediate diagnosis was confirmed with an emergency MRI plus clinical evaluation. The surgical intervention was performed in less than 24 hours. A protocol of gradual rehabilitation with passive exercises was established. Six months after surgery, there was recovery of range of motion and shoulder strength, as well as complete anatomical restoration. It is concluded that early surgical repair of a rupture of the pectoralis major muscle tendon on the first day of the injury, or in less than 24 hours, accompanied by a good surgical technique and a gradual rehabilitation protocol, yielded excellent results six months after the trauma, similar to that reported in the literature for acute repairs.
Evidence level: Level IV
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References
Balazs GC, Brelin AM, Donohue MA, Dworak TC, Rue J-PH, Giuliani JR, et al. Incidence Rate and Results of the Surgical Treatment of Pectoralis Major Tendon Ruptures in Active-Duty Military Personnel. Am J Sports Med. 2016;44:1837-43. Available from: https://doi.org/10.1177/0363546516637177
Pochini ADC, Andreoli CV, Ejnisman B, Maffulli N. Surgical repair of a rupture of the pectoralis major muscle. Case Reports. 2015;(feb25 1), bcr2013202292-bcr2013202292. Available from: http://casereports.bmj.com/cgi/doi/10.1136/bcr2013-202292. https://doi.org/10.1136/bcr-2013-202292
Pochini A, de C, Ferretti M, Kawakami EFKI, Fernandes A, da RC, Yamada AF, Oliveira GCde, et al. Analisys of pectoralis major tendon in weightlifting athletes using ultrasonography and elastography. Einstein (São Paulo). 2015;13:541-6. Available from: http://www.scielo.br/scielo.php?script=sciarttext&pid=S1679-45082015000400541&lng=en&tlng=en. https://doi.org/10.1590/S1679-45082015AO3335
Butt U, Mehta S, Funk L, Monga P. Pectoralis major ruptures: A review of current management. J Shoulder Elb Surg. 2015;24:655-62. https://doi.org/10.1016/j.jse.2014.10.024
Edgar CM, Singh H, Obopilwe E, Voss A, Divenere J, Tassavor M, et al. Pectoralis Major Repair: A Biomechanical Analysis of Modern Repair Configurations Versus Traditional Repair Configuration. Am J Sports Med. 2017;45:2858-63 [cited 2018 Dec 20]Available from: http://www.ncbi.nlm.nih.gov/pubmed/28749741. https://doi.org/10.1177/0363546517716175
ElMaraghy AW, Devereaux MW. A systematic review and comprehensive classification of pectoralis major tears. J Shoulder Elb Surg. 2012;21:412-22. https://doi.org/10.1016/j.jse.2011.04.035
Chang ES, Zou J, Costello JM, Lin A. Accuracy of magnetic resonance imaging in predicting the intraoperative tear characteristics of pectoralis major ruptures. J Shoulder Elb Surg. 2016;25:463-8. https://doi.org/10.1016/j.jse.2015.08.037
de Castro Pochini A, Andreoli CV, Belangero PS, Figueiredo EA, Terra BB, Cohen C, et al. Clinical Considerations for the Surgical Treatment of Pectoralis Major Muscle Ruptures Based on 60 Cases: A Prospective Study and Literature Review. Am J Sports Med. 2014;42:95-102. https://doi.org/10.1177/0363546513506556
Provencher CMT, Handfield K, Boniquit NT, Reiff SN, Sekiya JK, Romeo AA. Injuries to the Pectoralis Major Muscle. Am J Sports Med. 2010;38:1693-705. https://doi.org/10.1177/0363546509348051
Äärimaa V, Rantanen J, Heikkilä J, Helttula I, Orava S. Rupture of the Pectoralis Major Muscle. Am J Sports Med. 2004;32:1256-62. Available from: http://journals.sagepub.com/doi/10.1177/0363546503261137. https://doi.org/10.1177/0363546503261137
Pedrazzini A, Banchi M, Bertoni N, Pedrabissi B, Simo HCY, Medina V, et al. Pectoralis major tendon rupture in a weight lifter: a rare case. Acta Biomed. 2017;88:86-90 [cited 2018 Dec 20]Available from: http://www.ncbi.nlm.nih.gov/pubmed/28467340.
Hasegawa K, Schofer JM. Rupture of the Pectoralis Major: A Case Report and Review. J Emerg Med. 2010;38:196-200. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0736467908003168. https://doi.org/10.1016/j.jemermed.2008.01.025
de Castro Pochini A, Ejnisman B, Andreoli CV, Monteiro GC, Silva AC, Cohen M, et al. Pectoralis Major Muscle Rupture in Athletes. Am J Sports Med. 2010;38:92-8. Available from: http://journals.sagepub.com/doi/10.1177/0363546509347995. https://doi.org/10.1177/0363546509347995
Ordas Bayon A, Sandoval E, Valencia Mora M. Acute Pectoralis Major Rupture Captured on Video. Case Rep Orthop [Internet]. 2016;2016:1-4. Available from: http://www.hindawi.com/journals/crior/2016/2482189/. https://doi.org/10.1155/2016/2482189
Merolla G, Paladini P, Artiaco S, Tos P, Lollino N, Porcellini G. Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years. Eur J Orthop Surg Traumatol. 2015;25:91-8. Available from: http://link.springer.com/10.1007/s00590-014-1451-y. https://doi.org/10.1007/s00590-014-1451-y
Carney B, Porrino J, Marx R. Complete Rupture of the Pectoralis Major Tendon: Comparison of Magnetic Resonance Imaging and Intraoperative Images. PM R. 2015;7:671-3. https://doi.org/10.1016/j.pmrj.2015.01.021
Chiavaras MM, Jacobson JA, Smith J, Dahm DL. Pectoralis major tears: Anatomy, classification, and diagnosis with ultrasound and MR imaging. Skeletal Radiol. 2014;44:157-64. https://doi.org/10.1007/s00256-014-1990-7
Cordasco FA, Mahony GT, Tsouris N, Degen RM. Pectoralis major tendon tears: functional outcomes and return to sport in a consecutive series of 40 athletes. J Shoulder Elb Surg. 2017;26:458-63. https://doi.org/10.1016/j.jse.2016.07.018
Godoy IRB, Martinez-Salazar EL, Simeone FJ, Bredella MA, Palmer WE, Torriani M. MRI of pectoralis major tears: association between ancillary findings and tear severity. Skeletal Radiol. 2018:1-9. https://doi.org/10.1007/s00256-018-2893-9
Zvijac JE, Schurhoff MR, Hechtman KS, Uribe JW. Pectoralis Major Tears. Am J Sports Med. 2006;34:289-94. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16219945%0Ahttp://journals.sagepub.com/doi/10.1177/0363546505279573. https://doi.org/10.1177/0363546505279573
Lee SJ, Jacobson JA, Kim S-M, Fessell D, Jiang Y, Girish G, et al. Distal Pectoralis Major Tears. J Ultrasound Med. 2013;32:2075-81. Available from: https://doi.org/10.7863/ultra.32.12.2075
Carrino JA, Chandnanni VP, Mitchell DB, Choi-Chinn K, DeBerardino TM, Miller MD. Pectoralis major muscle and tendon tears: diagnosis and grading using magnetic resonance imaging. Skeletal Radiol. 2000;29:305-13 [cited 2018 Jul 30]Available from: http://www.ncbi.nlm.nih.gov/pubmed/10929411. https://doi.org/10.1007/s002560000199
Haley CA, Zacchilli MA. Pectoralis Major Injuries: Evaluation and Treatment. Clin Sports Med. 2014;33:739-56. https://doi.org/10.1016/j.csm.2014.06.005
Flint JH, Wade AM, Giuliani J, Rue JP. Defining the terms acute and chronic in orthopaedic sports injuries: A systematic review. Am J Sports Med. 2014;42:235-41. https://doi.org/10.1177/0363546513490656
Schepsis AA, Grafe MW, Jones HP, Lemos MJ. Rupture of the pectoralis major muscle: Outcome after repair of acute and chronic injuries. Am J Sports Med. 2000;28:9-15. https://doi.org/10.1177/03635465000280012701
Bak K, Cameron EA, Henderson IJP. Rupture of the pectoralis major: A meta-analysis of 112 cases. Knee Surgery, Sport Traumatol Arthrosc. 2000;8:113-9. https://doi.org/10.1007/s001670050197
