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CONDITION/DISORDER SYNONYMS

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  • Torn pectoral

  • Pectoral rupture

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ICD-9-CM CODE

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  • 840.8 Sprains and strains of other specified sites of shoulder and upper arm

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ICD-10-CM CODES

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  • S43.499A Other sprain of unspecified shoulder joint, initial encounter

  • S46.819A Strain of other muscles, fascia and tendons at shoulder and upper arm level, unspecified arm, initial encounter

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PREFERRED PRACTICE PATTERNS

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  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

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PATIENT PRESENTATION

A 23-year-old male college gymnast presents with right shoulder pain and significant ecchymosis that spreads down to the elbow. He reports that he over-rotated during a flip on the parallel bars and he caught himself with his right arm. He felt a sudden sharp pain in his right shoulder and then a cramp-like contraction in his right arm and chest. He later noticed discoloration in his chest and right arm and a depression in the right anterior portion of his chest. He states that he feels a constant pain in his right shoulder along with noticeable weakness.

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KEY FEATURES

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Description
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  • Partial or complete rupture of the pectoral muscles

  • Grades of tear1,2

    • Grade 1: Contusion or strain

    • Grade 2: Partial tear

    • Grade 3: Complete rupture

    • Grade 3A: Tear muscle origin

    • Grade 3B: Tear muscle belly

    • Grade 3C: Musculotendinous junction

    • Grade 3D: Muscle tendon itself

  • Four common locations

    • Rupture at the humeral insertion

    • Rupture at the musculotendinous junction

    • Rupture at the muscle belly

    • Muscle torn off the sternum

  • Commonly affects the pectoralis major muscle

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FIGURE 155-1

Pectoralis major, lower portion (C5–8; T1; lateral and medial pectoral nerves). The arm is adducted from a forward position below the horizontal level against resistance. (From Waxman SG: Clinical Neuroanatomy. 26th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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FIGURE 155-2

Pectoralis major, upper portion (C5–8; T1; lateral and medial pectoral nerves). The arm is adducted from an elevated or horizontal and forward position against resistance. (From Waxman SG. Clinical Neuroanatomy. 26th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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FIGURE 155-3

Pectoralis major muscle. (Reproduced with permission from Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. McGraw-Hill, 2011.)

Graphic Jump Location
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Essentials of Diagnosis
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  • Rare condition

  • Diagnosis is made by history and clinical examination with MRI for confirmation of location

  • Occurs from a sudden high force, typically with weightlifting ...

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