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Pectoralis major

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Pectoralis major lesion

Causes

  • Overuse
  • Indirect injury
  • Weightlifting 1
    • Typically bench press
    • In full stretch position where full force is applied to the muscle (typically eccentric)

Localization

  • In muscle belly, either:
    • In the lateral lower portion
    • Just below the outer portion of the clavicula

Indications

  • Pain may in some rare cases be felt at the shoulder and radiates down the inner aspect of the arm (if the lesion is at the crest of the greater tubercle of humerus)

Examination

In severe cases

  • Full passive elevation – painful
  • Resisted adduction – painful
  • Resisted medial rotation – painful

Minor cases

  • Full passive elevation – painful
  • Resisted adduction – painful
  • Resisted medial rotation – may be painless and negative

Pectoralis major rupture

Causes

  • Extreme muscle tension
    • Usually occurs on the lateral fibers when excessive force is applied to full stretch position
  • Direct trauma
  • A combination of both previously mentioned causes
    • Examples strength training/powerlifting, gymnastics, fall

Localization

  • Myotendenious junction tears

As a result of direct trauma

  • At tendon insertion at the crest of greater tubercle with avulsion2
    • There is disagreement in the literature and studies as to which of these are more common

Indications

  • Sharpy, burning pain
  • Swelling
  • Bruising
  • The patient will usually report a tearing sensation or a ‘pop’ that can also be heard followed by painful limitation of movement, as well as swelling, asymmetry and bruising 3

Examination

  • Passive elevation – very painful and somewhat limited
  • Resisted adduction – painful and weak
  • Resisted medial rotation – painful and weak
  • Palpate for tenderness and gaps on the iliac crest
    • Patient position should be in abduction and medial rotation, such as when hand is resting at the back of their pelvis

References

  1. https://www.ncbi.nlm.nih.gov/books/NBK549875/
  2. https://pubmed.ncbi.nlm.nih.gov/25280620/
  3. https://pubmed.ncbi.nlm.nih.gov/15712983/