(Radiology. 1999;210:785-791.)
© RSNA, 1999
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.
 |
Abstract
|
|---|
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.
Index terms: Athletic injuries, 474.499 • Muscles, injuries, 474.499 • Muscles, MR, 474.121416
|
Introduction
|
|---|
Rupture of the pectoralis major muscle is an uncommon sports injury that is becoming more prevalent as the numbers of both professional and recreational athletes increase. Complete rupture typically occurs when the muscle is under full tension and subject to additional stress (1). Common activities associated with this type of injury include weight lifting (particularly bench-pressing), waterskiing, wrestling, and football.
Until recently, the diagnosis of pectoralis major muscle injury has been based on clinical assessment, the results of which may be misleading and are often affected by hemorrhage, tenderness, or spasm in the acute setting. Preoperative diagnosis of the location of the tear is important because tendon avulsion from the humerus is treated with prompt surgical repair, whereas muscle-tendon injuries are generally treated in a conservative manner (2,3). Early surgical repair allows avoidance of adhesions, muscle scarring, fibrosis, and atrophy and hastens the return of the athlete to competition. Chronic injury presents a greater surgical challenge due to retraction and scarring after complete avulsion of the tendon from the humerus (4) and hence is important to identify.
There have been several reports regarding the findings of magnetic resonance (MR) imaging in pectoralis major muscle injury (5,6), including the MR imaging findings in three patients (7); these reports suggest that MR imaging is superior to computed tomography and should be the modality of choice for assessment of pectoralis major muscle injury. We performed a study to demonstrate the usefulness of MR imaging in the evaluation of pectoralis major muscle injury. Specifically, the purpose was to characterize the location and degree of the injury, identify which portion of the muscle was affected, and demonstrate the amount of tendon retraction. To our knowledge, this is the first study of the MR imaging findings in a relatively large series of patients.
|
NORMAL ANATOMY
|
|---|
The pectoralis major muscle is a fan-shaped muscle with two major origins separated by a distinct interval (Fig 1). The smaller clavicular head arises from the anterior surface of the medial two-thirds of the clavicle. The larger sternal head arises from the anterior surface of the manubrium and sternal body and has tendinous fibers that decussate medially with those from the opposite side. The deeper fibers of the sternal head arise from the cartilage of the first six ribs. There is a small abdominal head arising from the aponeurosis of the external oblique muscle. The muscle fibers converge as they approach the proximal humerus and are inseparably blended just proximal to their insertion onto the lateral lip of the bicipital groove of the humerus.
View larger version (47K):
[in this window]
[in a new window]
|
Figure 1. Normal anatomy of the pectoralis major muscle. Frontal diagram of the chest wall shows the distinct orientation of the clavicular head (C) at the superior margin of the chest, as well as the sternal head (S) more inferiorly. The insertional fibers from the sternal head pass deep to those arising from the clavicular head.
|
|
At the insertion onto the humerus, the arrangement of muscle fibers is unusual. The insertional fibers from the clavicle lie anterior to the sternal fibers and blend inferiorly with the tendinous insertion of the deltoid muscle. The upper insertional fibers of the sternal head lie beneath the clavicular fibers near the humerus and blend with the deep surface of the pectoralis tendon. The lower insertional fibers of the sternal head curve upward with the abdominal head to lie behind the upper sternal fibers. The abdominal fibers have the most superior attachment to the shaft of the humerus and contribute to the fascial sheath covering the biceps tendon (8). Hence, the insertional fibers from the clavicular head have the most inferior attachment onto the humeral shaft, whereas the abdominal fibers attach most superiorly.
A bilaminar tendon is thus produced: The superficial lamina is formed by the upper sternal fibers blended with fibers from the clavicular head, and the deep lamina is formed by the intertwined lower sternal and abdominal fibers. Deep to the pectoralis major muscle are the ribs and intercostal muscles; clavipectoral fascia; pectoralis minor, biceps, and coracobrachialis muscles; axillary vessels; and nerves of the brachial plexus. The nerve supply of the pectoralis major muscle is from the lateral and medial anterior thoracic nerves (C5, C6, C7, and T1). Branches of these nerves penetrate the midportion of the sternal head.
When the thorax is held in a fixed position, the pectoralis major muscle adducts, flexes, and internally rotates the arm. The clavicular fibers help flex the arm forward to the horizontal; the sternal fibers extend the arm when acting against resistance (9). The pectoralis is a climbing muscle, drawing the body upward when the arms are fixed. It also acts as an accessory muscle of respiration when the shoulders are elevated and fixed.
|
MATERIALS AND METHODS
|
|---|
From November 1993 through January 1998, 13 patients were referred by several orthopedic surgeons for MR imaging of the pectoralis major muscle at our institution. Two additional studies were submitted from other institutions and were thought to be of sufficient quality to include in our study group. Hence, there were 15 patients in the study group. All patients were male and were aged 23–38 years (mean, 28.1 years). There were nine injuries of the right muscle and six of the left muscle. Ten injuries were acute, and five were chronic.
Nine patients were injured while weight training: eight while performing a bench press, the other while performing a dead lift (lifting weights from the floor in a squat position). Two patients were professional football players. One player was injured when his arm was out in abduction while tackling another player; the other was a quarterback who was attempting to throw when tackled. One patient was injured while wrestling, another by falling from a ladder, and another while lifting a jackhammer off the back of a truck. The remaining patient was injured while waterskiing. The initial diagnosis was made on the basis of the history and clinical findings and was confirmed with MR imaging. The interval from injury to MR imaging was 1 day to 36 months (mean, 5 months).
Patients were examined with a 1.5-T superconducting unit (Signa Horizon; GE Medical Systems, Milwaukee, Wis). They were placed in the supine position and encouraged to breathe with diaphragmatic (rather than chest wall) excursions. A phased-array surface coil (Shoulder Array; Medrad, Indianola, Pa) was strapped to the patient anteriorly and centered over the axilla and pectoralis major muscle. A direct coronal localizing image was obtained, after which the following sequences were performed: (a) axial fast spin-echo imaging through the bulk of the pectoralis major muscle (repetition time msec/echo time msec = 4,000/30–45 [effective], 512 x 256 matrix, two signals acquired, 18–22-cm field of view, 4-mm section thickness with no intersection gap, echo train length of eight to 12) and (b) oblique coronal fast spin-echo imaging prescribed relative to the long axis of the pectoralis major tendon (4,000/30–45, 512 x 256 or 512 x 384 matrix, two signals acquired, 18–22-cm field of view, 3-mm section thickness with no intersection gap).
On MR images, the normal pectoralis major muscle appears as a fan-shaped structure of striated intermediate signal intensity. Muscle fibers can be followed from the point of origin down to the musculotendinous junction, where they twist to form a low-signal-intensity tendon that inserts onto the humerus (Fig 2).
View larger version (140K):
[in this window]
[in a new window]
|
Figure 2a. Normal anatomy of the pectoralis major muscle in a 32-year-old male volunteer. (a) Axial fast spin-echo MR image (4,000/30) of the right side shows the normal pectoralis major tendon (solid arrow) inserting onto the humerus (black *). The pectoralis minor muscle (open arrow) and coracobrachialis muscle (white *) are also shown. (b) Oblique coronal fast spin-echo MR images are plotted from the axial images to approximate the course of the pectoralis major tendon. (c) Oblique coronal fast spin-echo MR image (4,000/30) shows the sternal (curved arrow) and clavicular (straight arrow) heads, which unite to form the bilaminar tendon.
|
|
View larger version (150K):
[in this window]
[in a new window]
|
Figure 2b. Normal anatomy of the pectoralis major muscle in a 32-year-old male volunteer. (a) Axial fast spin-echo MR image (4,000/30) of the right side shows the normal pectoralis major tendon (solid arrow) inserting onto the humerus (black *). The pectoralis minor muscle (open arrow) and coracobrachialis muscle (white *) are also shown. (b) Oblique coronal fast spin-echo MR images are plotted from the axial images to approximate the course of the pectoralis major tendon. (c) Oblique coronal fast spin-echo MR image (4,000/30) shows the sternal (curved arrow) and clavicular (straight arrow) heads, which unite to form the bilaminar tendon.
|
|
View larger version (167K):
[in this window]
[in a new window]
|
Figure 2c. Normal anatomy of the pectoralis major muscle in a 32-year-old male volunteer. (a) Axial fast spin-echo MR image (4,000/30) of the right side shows the normal pectoralis major tendon (solid arrow) inserting onto the humerus (black *). The pectoralis minor muscle (open arrow) and coracobrachialis muscle (white *) are also shown. (b) Oblique coronal fast spin-echo MR images are plotted from the axial images to approximate the course of the pectoralis major tendon. (c) Oblique coronal fast spin-echo MR image (4,000/30) shows the sternal (curved arrow) and clavicular (straight arrow) heads, which unite to form the bilaminar tendon.
|
|
The pectoralis major muscle and tendons were evaluated with respect to morphology and abnormal signal intensity. Specifically, the site of injury (ie, tendon-bone interface, tendon, musculotendinous junction, or muscle) and the degree of tearing (partial vs complete) were noted. A confidence level was not assigned for partial versus complete tears because the distinction between these entities was unequivocal in all cases. A complete tear was defined as a distinct complete interval involving all of the fibers at the site of injury. A partial tear was defined as some continuity of the fibers at the site of injury. Partial injuries were considered high grade if more than 70% of the fibers were torn, moderate if 30%–70% of the fibers were torn, and low grade if less than 30% of the fibers were torn. The percentage of injury was quantified by assessing the integrity of fibers arising from the muscle belly and following them to their osseous insertion. Coronal images were the most useful for determining the grade of partial tearing.
Acute injuries manifested as high signal intensity at the musculotendinous junction with retraction of muscle fibers or tendon-bone discontinuity corresponding to the site of injury. When present, hematoma or periosteal stripping from a primary tendon avulsion was noted. Periosteal stripping was considered present when intermediate to increased signal intensity was seen superficial to the humeral cortex at the insertion site in the presence of tendon avulsion. Chronic injuries manifested as low signal intensity and muscle retraction, findings indicative of scarring and fibrosis.
The MR images were prospectively interpreted by a musculoskeletal radiologist (H.G.P.) and a musculoskeletal radiology fellow (D.A.C.) by means of consensus. This interpretation represented the original MR imaging report. The two studies from other institutions were also prospectively read before surgery; the radiologists did not have access to these original MR imaging reports. Nine patients subsequently underwent surgical evaluation in the course of primary tendon repair. The original MR imaging results were known to the surgeon at the time of surgery. Six patients were treated conservatively with clinical follow-up. Two of these patients underwent repeat MR imaging to demonstrate resolution of hematoma and evaluate interval muscle healing.
The study was approved by our institutional review board. Institutional review board approval and informed consent were obtained for the 15 patients. In addition, institutional review board approval and informed consent were obtained for three volunteers, who were imaged to identify and illustrate normal anatomy.
|
RESULTS
|
|---|
The results are summarized in Tables 1 and 2. Of the 15 injuries, six occurred at the musculotendinous junction (Fig 3) and nine at the tendon-bone interface (Fig 4). Injuries at the tendon-bone interface tended to be more severe, with both heads involved in all cases and complete detachment of both heads in three of nine cases. Tendon avulsion was always associated with periosteal stripping and hematoma adjacent to the humeral cortex. Injuries of the musculotendinous junction tended to be less severe, with only one head affected in four of six cases. These injuries tended to be partial and of lower grade.
View larger version (119K):
[in this window]
[in a new window]
|
Figure 3a. Musculotendinous junction injury in a 27-year-old professional quarterback who was tackled while attempting to throw. (a) Axial fast spin-echo MR image (4,000/45) of the right pectoralis major muscle shows a tear at the musculotendinous junction (straight arrow). Note the intact tendon insertion (curved arrow). (b) Oblique coronal fast spin-echo MR image (4,000/45) shows a high-grade tear of the clavicular head (straight arrow) with relative preservation of the sternal head (curved arrow). (c) Far anterior oblique coronal fast spin-echo MR image (4,000/45) shows some intact muscle fibers arising from the clavicular head (arrow). This finding confirms that the injury is a high-grade partial tear, not a complete tear.
|
|
View larger version (138K):
[in this window]
[in a new window]
|
Figure 3b. Musculotendinous junction injury in a 27-year-old professional quarterback who was tackled while attempting to throw. (a) Axial fast spin-echo MR image (4,000/45) of the right pectoralis major muscle shows a tear at the musculotendinous junction (straight arrow). Note the intact tendon insertion (curved arrow). (b) Oblique coronal fast spin-echo MR image (4,000/45) shows a high-grade tear of the clavicular head (straight arrow) with relative preservation of the sternal head (curved arrow). (c) Far anterior oblique coronal fast spin-echo MR image (4,000/45) shows some intact muscle fibers arising from the clavicular head (arrow). This finding confirms that the injury is a high-grade partial tear, not a complete tear.
|
|
View larger version (156K):
[in this window]
[in a new window]
|
Figure 3c. Musculotendinous junction injury in a 27-year-old professional quarterback who was tackled while attempting to throw. (a) Axial fast spin-echo MR image (4,000/45) of the right pectoralis major muscle shows a tear at the musculotendinous junction (straight arrow). Note the intact tendon insertion (curved arrow). (b) Oblique coronal fast spin-echo MR image (4,000/45) shows a high-grade tear of the clavicular head (straight arrow) with relative preservation of the sternal head (curved arrow). (c) Far anterior oblique coronal fast spin-echo MR image (4,000/45) shows some intact muscle fibers arising from the clavicular head (arrow). This finding confirms that the injury is a high-grade partial tear, not a complete tear.
|
|
View larger version (156K):
[in this window]
[in a new window]
|
Figure 4a. Tendon-bone interface injury in a 25-year-old man due to bench-pressing. (a) Axial fast spin-echo MR image (4,000/45) of the left side shows a retracted pectoralis major tendon (straight solid arrow) and hemorrhage within the muscle (open arrow). Note the periosteum (curved arrow) pulled off the humeral cortex adjacent to the biceps tendon; contrast this appearance with the normal tendon attachment in Figure 2a. (b) Oblique coronal fast spin-echo MR image (4,000/45) shows acute complete avulsion of the insertional fibers of the sternal head (long arrow) from the humerus. There is a high-grade partial injury of the clavicular head (short arrow). Anterior images (not shown) showed only a few fibers inserting onto the humerus. These findings were confirmed at surgery.
|
|
View larger version (169K):
[in this window]
[in a new window]
|
Figure 4b. Tendon-bone interface injury in a 25-year-old man due to bench-pressing. (a) Axial fast spin-echo MR image (4,000/45) of the left side shows a retracted pectoralis major tendon (straight solid arrow) and hemorrhage within the muscle (open arrow). Note the periosteum (curved arrow) pulled off the humeral cortex adjacent to the biceps tendon; contrast this appearance with the normal tendon attachment in Figure 2a. (b) Oblique coronal fast spin-echo MR image (4,000/45) shows acute complete avulsion of the insertional fibers of the sternal head (long arrow) from the humerus. There is a high-grade partial injury of the clavicular head (short arrow). Anterior images (not shown) showed only a few fibers inserting onto the humerus. These findings were confirmed at surgery.
|
|
Complete tears involving both heads (three of 15 cases) (Fig 5) were less common than partial tears (12 of 15 cases). The degree of injury and the muscle fibers affected were representative of the amount of stress inflicted on specific muscle groups. 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 demonstrated edema and hemorrhage, whereas chronic tears demonstrated fibrosis and scarring (Fig 6). In cases of tendon avulsion, the amount of tendon retraction was 0–13 cm, often with a variable degree of tendon retraction in a single muscle head.
View larger version (165K):
[in this window]
[in a new window]
|
Figure 5a. Complete tears of both muscle heads in a 28-year-old professional football player injured while tackling with his arm in an abducted position. (a) Axial fast spin-echo MR image (4,000/40) of the left side shows periosteal stripping (long arrow) from the humerus with tendon (short arrow) retraction. (b) Oblique coronal fast spin-echo MR image (4,000/40) shows complete detachment of the insertional fibers of both heads (arrow) from the humerus. These findings were confirmed at surgery.
|
|
View larger version (152K):
[in this window]
[in a new window]
|
Figure 5b. Complete tears of both muscle heads in a 28-year-old professional football player injured while tackling with his arm in an abducted position. (a) Axial fast spin-echo MR image (4,000/40) of the left side shows periosteal stripping (long arrow) from the humerus with tendon (short arrow) retraction. (b) Oblique coronal fast spin-echo MR image (4,000/40) shows complete detachment of the insertional fibers of both heads (arrow) from the humerus. These findings were confirmed at surgery.
|
|
View larger version (135K):
[in this window]
[in a new window]
|
Figure 6. Chronic tear in a professional bodybuilder who was injured while lifting weights 2 years earlier. Axial fast spin-echo MR image (4,000/45) of the right side shows muscle retraction and dense scarring (arrows) at the lateral border of the pectoralis major muscle.
|
|
Nine of the 15 patients underwent primary surgical repair, and MR imaging findings were confirmed in all cases. In particular, periosteal stripping was identified at the normal insertion site in all patients with complete tendon avulsion. The amount of tendon retraction correlated with the MR imaging findings. In one patient with complete tendon avulsion, there was a mild partial injury at the musculotendinous junction; this injury was not identified on the preoperative MR image. In the remaining six patients, the MR imaging findings were consistent with the clinical findings.
|
DISCUSSION
|
|---|
Avulsion of the pectoralis major muscle results in sudden pain in the arm and shoulder at the time of injury (with or without an audible pop), with subsequent swelling, ecchymosis, and functional pain. At clinical examination, patients may have a palpable defect along the course of the pectoralis major muscle and there is asymmetry of the muscle in comparison with the muscle on the uninjured side. There is also a decrease in adduction strength; although subtle, this decrease may be important in professional weight lifters and may become a cosmetic issue in bodybuilders.
Tears of the pectoralis major muscle tend to occur during powerful eccentric contraction, at which time the muscle is subject to concomitant forceful stretching. Although injury may occur in the muscle belly due to a direct blow (10), rupture generally occurs at the musculotendinous junction or the insertion onto the humerus (1,11). Because of the wide origin and varied fiber direction of the muscle, it does not retract far (10). Partial tears are more common than complete tears (12). Partial tears usually occur at the musculotendinous junction, whereas complete tears tend to occur at the tendon-bone interface (2). Rupture of the sternal head occurs more frequently than rupture of the clavicular head (3), although in older individuals the frequency of avulsion of the two major heads is probably the same (13). Our results are in concordance with those reported in the literature.
Although MR imaging allows accurate evaluation of injuries of the pectoralis major muscle, certain technical aspects should be considered. Use of a surface coil increases the signal-to-noise ratio, enhances spatial resolution, and increases the conspicuity of the injury. Oblique coronal images obtained along the plane of the muscle-tendon unit allow easy distinction of normal from abnormal anatomy, obviating acquisition of comparison views of the uninjured side. Recognition of abnormal signal intensity surrounding the cortex of the humerus is important because this finding is typically due to stripping of the periosteum as the tendon is avulsed from the osseous insertion. Owing to the proximity of the biceps tendon to the insertion of the pectoralis major muscle, one should be careful not to misinterpret abnormal signal intensity and hematoma at this location as an injury of the biceps muscle. Fast spin-echo techniques decrease imaging time without loss of resolution or contrast. When patients are treated conservatively, MR imaging may be used to monitor interval healing, including resolution of hematoma, and to evaluate muscle quality before a return to competitive sport.
Limitations of this study include the fact that the surgeons had access to the MR imaging reports at the time of surgery and the lack of surgical correlation of injuries at the musculotendinous junction. These injuries tend to be partial, of lower grade, and not amenable to surgical repair. Such injuries are usually managed conservatively. Several studies have shown that full strength is not attained after conservative management of complete pectoralis muscle tears (4,10,12,14), and dynamometric testing has shown a 70%–90% return of strength (15,16). However, conservative management may not result in a substantial functional loss and is advocated for inactive or older patients, small partial tears, or the rare intramuscular crush injury. Early surgical repair produces the best cosmetic results and functional return of full strength in young, athletic individuals (3,13,14).
In conclusion, MR imaging allows accurate evaluation of injuries of the pectoralis major muscle and enables identification of patients who would benefit from primary surgical repair.
|
Footnotes
|
|---|
Address reprint requests to H.G.P.
Author contributions: Guarantors of integrity of entire study, D.A.C., H.G.P.; study concepts and design, D.A.C., H.G.P.; definition of intellectual content, D.A.C., H.G.P.; literature research, D.A.C.; clinical studies, M.F.S., T.L.W.; data acquisition, D.A.C.; data analysis, D.A.C., H.G.P.; statistical analysis, D.A.C.; manuscript preparation, D.A.C., H.G.P.; manuscript editing, H.G.P.; manuscript review, H.G.P., M.F.S., T.L.W.
Received March 4, 1998;
revision requested May 6, 1998; revision received June 26, 1998;
accepted August 24, 1998.
|
References
|
|---|
-
Garrett WE. Muscle strain injuries: clinical and basic aspects. Med Sci Sports Exerc 1990; 22:436-443.[Medline]
-
McEntire JE, Hess WE, Coleman SS. Rupture of the pectoralis major muscle: a report of eleven injuries and review of fifty-six. J Bone Joint Surg [Am] 1972; 54:1040-1046.[Abstract/Free Full Text]
-
Wolfe SW, Wickiewicz TL, Cavanaugh JT. Ruptures of the pectoralis major muscle: an anatomic and clinical analysis. Am J Sports Med 1992; 20:587-593.[Abstract/Free Full Text]
-
Letenneur M. Rupture sous-entrance du muscle grand pectoral: guerison complete en quinze jours. Gaz de Hops 1862; 1:54.
-
Miller MD, Johnson DL, Fu FH, Thaete FL, Blanc RO. Rupture of the pectoralis major muscle in a collegiate football player. Am J Sports Med 1993; 21:475-477.[Free Full Text]
-
Shellock FG, Mink J, Deutsch AL. MR imaging of muscle injuries. Appl Radiol 1994; 1:11-16.
-
Ohashi K, El-Khoury GY, Albright JP, Tearse DS. MRI of complete rupture of the pectoralis major muscle. Skeletal Radiol 1996; 25:625-628.[Medline]
-
Thorek P. Anatomy in surgery. In: Thorek P, eds. The superior extremity. Philadelphia, Pa: Lippincott, 1951; 669-773.
-
Brash JC, ed. Cunningham's text book of anatomy London, England: Oxford University Press, 1953; 478-484.
-
Kretzler HH, Richardson AB. Rupture of the pectoralis major muscle. Am J Sports Med 1989; 17:453-458.[Abstract/Free Full Text]
-
Garrett WE. Histochemical correlates of hamstring injuries. Am J Sports Med 1984; 12:98-103.[Abstract/Free Full Text]
-
Park JY, Espiniella JL. Rupture of pectoralis major muscle: a case report and review of the literature. J Bone Joint Surg [Am] 1970; 52:577-581.[Abstract/Free Full Text]
-
Berson BL. Surgical repair of pectoralis major rupture in an athlete. Am J Sports Med 1979; 7:348-351.[Free Full Text]
-
Zeman SC, Rosenfeld RT, Lipscomb PR. Tears of the pectoralis major muscle. Am J Sports Med 1979; 7:343-347.[Abstract/Free Full Text]
-
Scott BW, Wallace WA, Barton MAJ. Diagnosis and assessment of pectoralis major rupture by dynamometry. J Bone Joint Surg [Br] 1992; 74:111-113.
-
Liu J, Wu JJ, Cheng-Yen C, Chou YH, Lo WH. Avulsion of the pectoralis major tendon. Am J Sports Med 1992; 20:366-368.[Free Full Text]
This article has been cited by other articles:
|
|
|
|
 
J. E. Zvijac, M. R. Schurhoff, K. S. Hechtman, and J. W. Uribe
Pectoralis Major Tears: Correlation of Magnetic Resonance Imaging and Treatment Strategies
Am. J. Sports Med.,
February 1, 2006;
34(2):
289 - 294.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. E. Anderson, R. Hertel, J. O. Johnston, E. Stauffer, E. Leinweber, and L. S. Steinbach
Latissimus Dorsi Tendinosis and Tear: Imaging Features of a Pseudotumor of the Upper Limb in Five Patients
Am. J. Roentgenol.,
November 1, 2005;
185(5):
1145 - 1151.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Rehman and P. Robinson
Sonographic Evaluation of Injuries to the Pectoralis Muscles
Am. J. Roentgenol.,
April 1, 2005;
184(4):
1205 - 1211.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Petilon, D. R. Carr, J. K. Sekiya, and D. V. Unger
Pectoralis Major Muscle Injuries: Evaluation and Management
J. Am. Acad. Ortho. Surg.,
January 1, 2005;
13(1):
59 - 68.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Weaver, J. A. Jacobson, D. A. Jamadar, S. E. Theisen, F. Ebrahim, and M. Kalume-Brigido
Sonographic Findings of Pectoralis Major Tears With Surgical, Clinical, and Magnetic Resonance Imaging Correlation in 6 Patients
J. Ultrasound Med.,
January 1, 2005;
24(1):
25 - 31.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. K. Potter, R. A. Lehman Jr., and W. C. Doukas
Simultaneous Bilateral Rupture of the Pectoralis Major Tendon. A Case Report
J. Bone Joint Surg. Am.,
July 1, 2004;
86(7):
1519 - 1521.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J F Quinlan, M Molloy, and B J Hurson
Pectoralis major tendon ruptures: when to operate
Br. J. Sports Med.,
June 1, 2002;
36(3):
226 - 228.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. T. Bencardino, Z. S. Rosenberg, R. R. Brown, A. Hassankhani, E. S. Lustrin, and J. Beltran
Traumatic Musculotendinous Injuries of the Knee: Diagnosis with MR Imaging
RadioGraphics,
October 1, 2000;
20(90001):
103S - 120.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J. Lee, K. R. Brookenthal, M. L. Ramsey, J. B. Kneeland, and R. Herzog
MR Imaging Assessment of the Pectoralis Major Myotendinous Unit: An MR Imaging--Anatomic Correlative Study with Surgical Correlation
Am. J. Roentgenol.,
May 1, 2000;
174(5):
1371 - 1375.
[Abstract]
[Full Text]
[PDF]
|
|
|
TOP
Abstract
Introduction
