Pec Tear

[TPT]

recently a colleague asked me about pec tears because his patient was a bodybuilder with one and he wasnt sure what to do.

well i thought, "this would be a great thread on rxmuscle!" lol.

the following is a link to a case report of a bodybuilder with a pec tear and an editorial on tears. many other papers are out and consistent themes are apparent: 1. all pec tears occur during weight lifting, 2. early surgery is necessary and 2. patients never return to previous "function."

http://www.pectear.com/faq/Rupture%20of%20the%20pectoralis%20major%20muscle%2 0in%20bodybuilders.pdf

http://acldoc.org/Articles2/Complete%20Rupture%20of%20Large%20Tendons.pdf

the following paper by wolfe (1992) found that inferior fibers of the pecs are at mechanical disadvantage at the last 30 degrees of humeral extension (i.e., as you arm extends back or the bar touches your sternum for full range). this disadvantage, eccentric contraction, and high load contributes to the per tear.

Wolfe SW (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Wolfe%20SW%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus), Wickiewicz TL (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Wickiewicz%20TL%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus), Cavanaugh JT (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cavanaugh%20JT%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus).
Hospital for Special Surgery, New York, New York.
We evaluated 12 patients with 14 ruptures of the pectoralis major muscle to compare surgical and conservative management of this injury. Because 9 of the injuries occurred while weight lifting, we performed an anatomic study on human hemithorax specimens during a simulated bench press to determine the mechanism of this rare occurrence. Excursion of individual pectoralis muscle fibers was measured at seven points along the broad muscle origin by the use of fine wires connected to the humeral insertion and to dial gauges on the study apparatus. Excursions in the concentric and eccentric phases of the lift were expressed as a percentage of resting fiber length. The short, inferior fibers of the muscle lengthened disproportionately during the final 30 degrees of humeral extension. We concluded that the inferior fibers have a mechanical disadvantage in the final portion of the eccentric phase of the lift, and application of high loads to these maximally stretched fibers produces rupture. We repaired five acute and two chronic ruptures, and measured peak torque and work production against the contralateral side using Cybex isokinetic testing. Surgically treated patients showed comparable torque and work measurements, while conservatively treated individuals demonstrated and marked deficit in both peak torque and work/repetition. We recommend repair of complete pectoralis muscle ruptures in active patients who require maximum strength in vocational or avocational activities

[TPT]

click on the following link for a good read on pec tears with mr images.
be careful with your benching!

http://radiology.rsnajnls.org/cgi/reprint/210/3/785

Musculoskeletal Imaging


Injuries of the Pectoralis Major Muscle: Evaluation with MR Imaging

David A. Connell, MD1, Hollis G. Potter, MD1, Mark F. Sherman, MD2 and Thomas L. Wickiewicz, MD2

1 Departments of Radiology (D.A.C., H.G.P.)
2 Sports Medicine (M.F.S., T.L.W.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021.
PURPOSE: To demonstrate that magnetic resonance (MR) imaging allows evaluation of injuries of the pectoralis major muscle.
MATERIALS AND METHODS: Fifteen men underwent MR imaging after injury of the pectoralis major muscle. Most of the patients (nine of 15) were injured while lifting weights, notably bench-pressing. The injuries were evaluated for abnormal morphology and signal intensity, specifically the site of injury, degree of tearing, and amount of tendon retraction. RESULTS: Six injuries occurred at the musculotendinous junction, and five were treated conservatively; eight of the nine cases of distal tendon avulsion were treated with primary surgical repair. The MR imaging findings were confirmed in the nine cases treated surgically. Complete tears (three of 15) were less common than partial tears (12 of 15). The sternal and clavicular heads were torn in 10 patients, only the clavicular head was torn in two patients, and only the sternal head was torn in three patients. Acute tears (10 of 15) demonstrated hemorrhage and edema, whereas chronic tears (five of 15) demonstrated fibrosis and scarring. There was a variable amount of tendon retraction.

CONCLUSION: MR imaging allows accurate evaluation of injuries of the pectoralis major muscle and enables identification of patients who would benefit from surgical repair.

Abbreviations: Athletic injuries, 474.499 • Muscles, injuries, 474.499 • Muscles, MR, 474.121416