She is the author of the book mri of the musculoskeletal system. The pectoralis major is a very powerful muscle that forms the chest prominence and. If not, follow the adult protocol, but make changes to the slice, gap, and fov as needed. Lastly, mri has been noted to be less accurate in differentiating between a pectoralis major muscle tear versus a rupture 11. This is a rare case of an isolated pectoralis minor partialthickness tendon tear in a 24yearold man who was involved in a major trauma. In addition, recent literature has redefined the anatomy of the distal pectoralis major.
Near complete tear at the musculotendinous junction of pectoralis major with contusionedema of the muscle and surrounding softtissues. Surgery is often needed to repair complete pec tears. The pectoralis major pm is the main chest muscle, often called the pecs for short. Oblique coronal sequences along the long axis of the pectoralis major tendon. Traumatic injuries in sports can also result in a pec tendon tear. Diagnostic testing may include plain radiographs which are usually not diagnostic, although reports of bony abnormalities have been noted. At the last followup 12 months, the patient was painfree, with a visual analogic scale at 0 all the time. The pectoralis major tendon is most commonly injured during an eccentric contraction when the external force on the muscle is greater than the force that the muscle can generate and when the arm is extended and externally outwardly rotated, such as when performing a bench press. The pectoral muscles are a group of two muscles situated at the front of the chest figure 1. In the planning section you will find full explanations and illustrations of how to plan mri scans of different parts of the body, together with suitable protocols and parameters. A grade 2 strain occurs when a tendon or muscle is partially torn but still intact, leaving the pec area noticeably weaker. It moves the shoulder forwards and across your chest. I was wondering if a shoulder mri will show a pectoral tear. The largest of which is the pectoralis major muscle which originates from the sternum breast bone, ribs and.
Bench pressing is the most common cause of injury, but. Msk mri protocol overview page 4 of 123 msk mri protocols march 2010 cover from anterior portion of coracoid process to 1 slice posterior to the humeral head. Mr imaging is the optimal imaging technique to study the normal and abnormal conditions of the pectoralis major muscle and tendon unit. A dedicated study of pectoralis muscle may be required and a typical shoulder mri usually does. Sep 12, 2018 the pectoralis major pm is the main chest muscle, often called the pecs for short. Muscle mr traumatic changes the radiology assistant. Typically xrays will not reveal any type of bone injury and mri is required to further define the injury. The purpose of this study was to use mr imaging to provide an anatomic survey of the normal pectoralis major tendon and its insertion and to compare these findings with surgically proven cases of rupture. The two key imaging modalities used to assess pectoralis major injuries are ultrasonography us and magnetic resonance mr imaging. Straight ax t2 fat mid humeral head superiorly through soft tissue of axilla inferiorly 5. Us and mr imaging of pectoralis major injuries radiographics. The purpose of this paper is to report the clinical signs, symptoms, crosssectional imaging findings, and management of an isolated pectoralis minor tendon tear.
The athlete or active person has a lot of pain when the injury occurs, and the chest and arm often turn black and blue. Historically, nonoperative treatment has been advocated for older or sedentary individuals or for those with incomplete tears. Us is an inexpensive, readily available examination that can be used to effectively screen for injury and initially survey the extent of the disease process. Pectoralis major tendon repair shoulderdoc by prof. Injury of the pectoralis major can occur at the muscle origin, muscle belly. It outlines all sequences and protocols currently applied in our mri section. The physician reserves the right to either advance or delay this protocol as. Preoperative pectoralis muscle quantity and attenuation are novel. A three plane localiser must be taken initially to localise and plan the sequences. Geier video, i explain what the role of mri is for some pectoral.
Pectoralis major repair revised august 2008 postop days 1 14 shoulder immobilizer x 6 weeks even while sleeping place pillow under shoulder arm while sleeping for comfort hand squeezing exercises elbow and wrist active motion arom with shoulder in neutral position at side stationary bike must wear immobilizer goals. Shady grove orthopaedic associates, pa 301 3409200 9715 medical center drive, suite 415 rockville, md 20850 craig miller, m. In the initial evaluation of such injuries, mr imaging of the shoulder is sometimes performed because of a lack of suspicion of pectoralis injury or unfamiliarity with the optimal pectoralis mr imaging protocol. Pectoralis major tendon rupture is a rare shoulder injury, most commonly seen in weight lifters.
Pectoralis major tears, also known as pectoralis major ruptures, are an. Guidelines for basic mri of suspected bone and soft tissue tumours the scandinavian sarcoma group 2012 it is recommended that imaging of suspected tumours should be done on a highfield system minimum 1. If the muscle tear is an avulsion where the muscle tendon completely tears and no longer works as in the case with a pec tendon tear, or more commonly a bicep tendon tear, and the muscle rolls up and moves away from the insertion of the tendon, then. Book a consult to see dr gupta online by using our special. Magnetic resonance imaging mri can be especially helpful where a partial tear is suspected. Additional sequences should be done according to local preferences. Specific changes in the program will be made by the physician as appropriate for an individual patient. Pectoralis major muscle rupture the pectoralis major muscle is the large muscle in front of the.
Aug 30, 2019 perform stretching exercises for a pectoral tear to help scar tissue align properly and increase the flexibility of your injured muscle. Sure i was familiar with the rice protocol, but that first r, or rest, didnt seem to sink in. The pectoral tendon attaches the pec major muscle to your humerus or arm bone. This chapter focuses on the key imaging features of tendons in both. A pectoral tear is an extremely painful injury to the chest wall and upper arm of athletes. It provides control of the clavicular head and crossinnervates the sternocostal head of the muscle. Shoulderpost gadolinium indirect mr arthrogram inject standard dose of iv contrast and wait 20 minutes before scanning 3. The following sequences are recommended as a minimum. Feb 19, 2016 pectoral injuries are some of those injuries. Sag t2 fs perpendicular to coronal sequence angle approximately parallel to gh joint on the cor t2 sequence use. A pectoral strain is a condition characterised by partial or complete tearing of one or more of the pectoral chest muscles figure 1. How to rehab muscle strains and tears the art of manliness. I thought i would share my experiences of the tearing of my left pectoral and rehab, has this information may help others, and also as a thank you for the brilliant work done by my surgeon and his team.
Injuries to the pectoralis major muscle diagnosis and. Oct 28, 2019 eccentric part where i was about to press up,a pop like23times,pain under armpit. C, a complete pectoralis major tendon rupture with retraction. In june 2018, i tore my pm tendon off the humerus, got it surgically reattached, and am. The lateral pectoral nerve arises from the lateral cord of the brachial plexus and is composed of branches of c5, c6, and c7. However, the injury appears to be increasing in prevalence as the number of highperformance athletes in both the professional and recreational sector increases 3. Accurate characterization of pectoralis major tears is important to guide management. Ankle foot special cases soft tissue mass metal protocol. The medial pectoral nerve arises from the medial cord of the brachial plexus and is composed of branches of c8 and t1. I injured my chest and arm, but the shoulder mri is showing nothing wrong. Incomplete ruptures of the pectoralis major are most common and typically occur at the musculotendinous junction or muscle belly of the sternal head.
The pediatric radiologists will usually protocol specific sequences they need in ris. There is a complete tear of the tendon or myotendinous junction of the pectoral muscle. Imaging evaluation with ultrasound and mr imaging can be difficult given the complex regional anatomy. The pectoralis major attaches to the anterior humerus via its tendon which inserts to the lateral lip of the bicipital groove. Dr manish gupta is a qualified shoulder expert and available to help you with your pec tear condition. Mri is the best imaging modality that can determine the location and extent of the injury, as can ultrasound in experienced hands 1. A tear of the pectoralis major is a considerably uncommon injury, often occurring during forceful activity such as bench press. In passive stretches, you relax as the weight of your body, an ankle weight or the weight of someone pushing on you stretches your pectorals. This can lead to a missed or incompletely characterized diagnosis. Guidelines for basic mri of suspected bone and soft tissue. The pec major attaches to the humerus bone upper bone of. Had two mri scan both on shoulder and chest,result came in as subscapularis 50% tear and coracobrachialis20% tear but no pectoralis major tear. Pectoral tendons are usually ruptured or torn in weight lifters during bench pressing.
A grade ii injury is an actual tear in the muscle or tendon. Rupture of the pectoralis major muscle is a once rare injury that is becoming more common due to increasing numbers of intense weighttraining and highperformance athletes. These are fast single shot localisers with under 25s aqusition time which are excellent for localising chest structures. Pectoralis major tendon repair post surgical rehabilitation. The multiplanar capabilities of mri allow optimal depiction of the portions of the pectoralis major muscle and tendon involved. Subjects journals books book series working papers. Fluid sensitive sequences are valuable for detecting the site of injury, demonstrating edema and hemorrhage in the muscle, tendon and in the surrounding soft tissues. It is typically seen in bodybuilders and weightlifters who notice severe pain and a tearing sensation during a bench press or other weightlifting motion. Msk mri protocol overview page 3 of 123 msk mri protocols march 2010 1. Rehabilitation pec reattachment surgery kabuki strength.
Radiologists work closely with ohsu mri techs in the art of creating optimal images from current technology. The main function of the pm muscle is to adduct and internally rotate the shoulder. For complete or partial tears of the pectoralis major, mri has been shown to have. The technical section will tell you how to manipulate parameters to produce good. Mr imaging assessment of the pectoralis major myotendinous unit. Injuries to the pectoralis major muscle diagnosis and management. It is best known as the muscle that you develope with the bench press exercise. Pectoralis ruptures midwest sports medicine institute. It also gives you a view into the mindset that it takes to never give up and not only overcome a major setup back. Mri is important to distinguish a ruptured tendon from an injury further over into the muscle itself as the treatment for these will vary.
Mri is the mainstay for diagnosing pectoralis major tear early surgical. As with any other us examination, us evaluation of the. Mri identified 1 fullthickness pm tear at the humeral tendonbone junction including both pectoral heads figure 1, 2 tendon retracted medial to the anterior chest wall figure 2, 3 absence of any muscle fatty infiltration, and 4 a calcification inside the conjoint tendon immediately under its coracoid insertion figure 3. Partial ruptures are less common and complete rupture occurs when the tendinous attachment of the muscle to the bone tears. Lateral pectoral nerve an overview sciencedirect topics. B, an acute, complete tendon tear arrows, which can be distinguished from the previous acute, partial musculotendinous tear on mri. Early diagnosis via mri and surgical repair is important to ensure a sound recovery. Pectoralis muscle rupture treatment avon pectoralis muscle. Musculotendinous rupture of the sternal head and strain of the clavicular head of the pectoralis major muscle pectoralis tear. This injury is being seen more regularly due to the increased emphasis on healthy lifestyles. The pec major attaches to the humerus bone upper bone of arm and is divided into two parts. Mri offers multiplanar imaging and fluid sensitive sequences that are ideal for evaluating acute pectoralis major muscle and tendon injuries. May 28, 2014 typically xrays will not reveal any type of bone injury and mri is required to further define the injury. The most common form of the injury is tearing away of the tendon directly off the bone.
Rupture of the pectoralis major muscle and tendon is a rare entity, with fewer than 100 reported cases in the literature 1,2,3,4,5,6,7,8,9,10,11,12. Pectoralis major tears, also known as pectoralis major ruptures, are an uncommon traumatic injury of the pectoralis major. But the area where anterior axillary fold use to be is gone and when i flex my pec its definitely ball up and theres. Mr imaging assessment of the pectoralis major myotendinous. Perform stretching exercises for a pectoral tear to help scar tissue align properly and increase the flexibility of your injured muscle. This protocol provides you with general guidelines for the rehabilitation of patients following a pectoralis major repair or transfer. It would feel like a sharp pain within the pectoral muscle or tendon, perhaps even accompanied by a tearing sound. Injury of the pectoralis major can occur at the muscle origin, muscle belly, musculotendinous junction. Mri protocols, mri planning, mri techniques and anatomy.
The physician reserves the right to either advance or delay this protocol as deemed necessary. We report an open reconstruction technique and its outcomes in a case of chronic and retracted pm tear. Rehabilitation pec reattachment surgery january 12, 2015. Rupture of the pectoralis major tendon is considered an uncommon injury and a significant number of ruptures are missed or diagnosed late, leading to a chronic tear. Pdf pectoralis major tendon repair post surgical rehabilitation. How not to tear a pec while bench pressing mark barroso. An mri can be helpful to determine the location of the injury, meaning whether or not the tear is within the muscle belly of the pectoralis major, at the junction between the muscle and tendon, or the tendon is pulled off of the bone. Our radiologists work closely with ohsu mri technologists in the art of creating. Mri of these injuries can be necessary, though, for some patients. Axial t1 and pd fs use coronal loc and plane is straight horizontal if the shoulder is markedly angled, you can angle the axial images. In the operation room it seemed that this was a complete tear at the humeral insertion. It was the second rep of a heavy set, not my working weight, but a heavy set on the bench press nonetheless. Us and mr imaging of pectoralis major injuries1 during the past 2 decades, the frequency of pectoralis major muscle injuries has increased in association with the increased popularity of bench press exercises.
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