What's the Diagnosis - Case 28

History 40 year old man with lifting injury.

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History 35 year old man with lifting injury.

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History 37 year old man with lifting injury.

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Findings In the first case there is a discontinuity of a tendon as it approaches the lateral aspect of the intertubercular groove. This has yielded edema within the adjacent musculature as well as about the humerus.

In the two related cases, there is abnormal architecture at the myotendinous junction of a tendon eliciting edema into the adjacent muscle belly. Particularly, a pertinent negative is the absence of edema at the humerus.

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Diagnosis: Pectoralis Major Tears Injuries of the pectoralis major tendon occur as a result of typical eccentric contraction and are seen particularly with lifting as in weight lifting. The muscle has three heads with a clavicular, sternal, and a small abdominal head. The tendon has a complex, bilaminar attachment to the lateral aspect of the intertubercular groove with a superior clavicular and inferior sternal head. Partial tears typically occur at the myotendinous junction and more frequently involve the sternal head. Complete tears occur more frequently at the tendon attachment on the proximal humerus. As the injury occurs at the tendon bone interface, these complete tears frequently produce edema directly about the proximal humerus.

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Resources

• Injuries of the pectoralis major muscle: evaluation with MR imaging.

Connell DA, Potter HG, Sherman MF, Wickiewicz TL. Radiology.

1999 Mar;210(3):785-91.

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