Management of pectoralis major muscle injuries

OVERVIEW

Chapter synopsis

The incidence of pectoralis major muscle tears continues to increase. Understanding the mechanism of injury and a thorough physical examination are essential for the proper diagnosis of such injury. For active, high-demand individuals, surgical repair is recommended to return to pre-injury levels.

Important points

History and physical examination are often sufficient to make the diagnosis of a pectoralis major muscle injury.
While technically more difficult, chronic or delayed reconstructions have satisfactory and improved outcomes as opposed to those treated nonoperatively in young, high-demand individuals.

Clinical and surgical pearls

Advanced imaging should include the distal extent of the tendinous insertion on the proximal humerus.
A full-length deltopectoral incision is recommended for chronic cases in which allograft augmentation is anticipated.
Often the sternal head ruptures while the clavicular head remains intact and can obstruct visualization of the torn sternal head upon initial dissection.
A thorough understanding of the pectoralis major tendinous insertion is required to successfully perform an anatomic repair.
Running, a locked, heavy non-absorbable suture is recommended to affix the tendon to the repair construct.

Clinical and surgical pitfalls

Ensure careful surgical dissection so as to avoid iatrogenic injury to the cephalic vein.
Thorough irrigation and meticulous closure are necessary to limit postoperative infection.
Strict adherence to postoperative restrictions is essential to prevent early postoperative failure.

Introduction

In 1822, Patissier first described injury to the pectoralis major muscle after it was sustained by a Parisian butcher boy attempting to lift a large piece of meat. Throughout the subsequent 150 years, pectoralis major muscle injuries rarely occurred, but when sustained, were often related to occupational injury. However, over the last three decades, there has been a dramatic increase in the incidence of pectoralis major muscle injuries, which have coincided with a rise in the number of individuals engaged in rigorous physical activity ranging from weightlifting ^, to elite tactical athletics. Surgical repair is required to allow these patients to predictably and reliably return to their pre-injury functional levels. Pectoralis major muscle injuries present a relatively unique pathology in orthopedics because a thorough understanding of anatomy not only allows the surgeon to direct a focused history and diagnostic physical exam, but also allows for surgical precision with operative repair techniques.

Preoperative considerations

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