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  • Torn pectoral
  • Pectoral rupture

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

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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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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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Essentials of Diagnosis

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  • Rare condition
  • Diagnosis is made by history and clinical exam with MRI for confirmation of location
  • Occurs from a sudden high force, typically with weightlifting (i.e., bench or chest press)
  • May arise from a repetitive type activity that leads to a gradual degeneration
  • Sudden pain or tearing sensation in the chest may be experienced

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General Considerations

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  • Swelling, ecchymosis, and functional pain
  • Treatment may depend on location of rupture with tendon avulsion from the humerus treated with prompt surgical repair

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Demographics

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  • More common in men between the ages of 20 and 50 that participate in cotact sports and weight lifting

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Signs and Symptoms

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  • Audible snap or pop at the time of injury
  • Sudden pain or tearing sensation in chest
  • Mild swelling and ecchymosis over anterior lateral chest wall or in proximal arm
  • Loss of normal pectoralis contour
  • Weakness with horizontal shoulder adduction

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Functional Implications

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  • Pushing activities
  • Weight training with overload eccentric contractions: such as bench press, push ups, chin ups, dips, and chest flys can cause a rupture
  • Overhead activities may be limited
  • Inability to lift heavy objects

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Possible Contributing Causes

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  • Abnormal biomechanics
  • Muscle weakness or imbalance
  • Muscle tightness
  • Poor posture with change in humeral head position
  • Excessive or inappropriate activity
  • Inadequate warm up
  • Steroid use
  • Forceful eccentric activity (i.e., bench pressing)
  • Often seen in football and rugby injuries

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Differential Diagnosis

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  • Long head of biceps tendon rupture
  • Shoulder dislocation
  • Proximal humerus fracture
  • Rotator cuff tendon tear
  • Medial Pectoral nerve entrapment

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Imaging

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  • Radiographs
  • MRI
  • Diagnostic ultrasound

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  • Radiographs may show avulsion from humerus
  • MRI can be useful in assessing location and severity of tear
  • Acute tears will demonstrate hemorrhage and edema and chronic tears will demonstrate fibrosis and scarring

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Medication

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