Pec major ruptures - acute and chronic - experience, diagnosis, treatment and outcomes

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