[Rupture of the pectoralis major tendon and other extra-articular tendons of the shoulder : Recognition and treatment].

Ruptur der Pectoralis-major-Sehne und anderer extraartikulärer Sehnen an der Schulter : Wie erkennen und behandeln?

Publisher: Springer Verlag Country of Publication: Germany NLM ID: 8502736 Publication Model: Print Cited Medium: Internet ISSN: 1433-044X (Electronic) Linking ISSN: 01775537 NLM ISO Abbreviation: Unfallchirurg Subsets: MEDLINE

Publication: Berlin : Springer Verlag
Original Publication: Berlin ; New York : Springer-Verlag, c1985-

Pectoralis Muscles*/diagnostic imaging ; Pectoralis Muscles*/surgery ; Shoulder*; Humans ; Rupture/surgery ; Tendons ; Ultrasonography

Ruptures of the pectoralis major (PM) tendon are rare but have increased in recent years, especially during fitness exercising, such as bench pressing. The pathomechanism is an eccentric load under pretension of the PM (falling onto the outstretched arm, injuries during ground combat, boxing and during downward movement when bench pressing). The rupture sequence starts from superior to inferior at the insertion site with initial rupture of the most inferior muscle parts, followed by the sternal part and the clavicular part. Most classifications are based on rupture location, extent and time of injury. In addition to clinical presentation and sonography, magnetic resonance imaging is now established as the gold standard in diagnosing PM pathologies. Surgical management is indicated for all lateral PM ruptures with relevant strength deficits. Treatment in the acute interval (<3 weeks) is the primary goal; however, even in chronic cases or after failed conservative management a secondary operative approach enables notable clinical improvement. Conservative therapy mostly affects patients who have muscular injuries close to the anatomic origin and smaller partial tears. Surgical management aims for anatomic reconstruction of the PM unit with restoration of the original tension to enable optimal strength transmission. Surgical refixation or reconstruction (with autograft/allograft) of acute and chronic PM ruptures shows excellent clinical results with high patient satisfaction. Latissimus dorsi (LD) and teres major (TM) tendon ruptures are rare injuries but can lead to significant impairments in high-performance athletes. In contrast to PM ruptures, LD and TM injuries are primarily treated conservatively with very satisfactory results.

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Keywords: Acute; Chronic; Latissimus dorsi; Repair; Teres major
Local Abstract: [Publisher, German] Rupturen der M.-pectoralis-major(PM)-Sehne sind seltene Verletzungen, jedoch hat ihre Zahl v. a. bei der Ausübung von Kraftsport in den letzten Jahren zugenommen. Als Pathomechanismus gilt eine exzentrische Belastung unter PM-Anspannung (Sturz auf den ausgestreckten Arm, Verletzung während des Bodenkampfes oder Boxens, aber v. a. während Abwärtsbewegungen beim Bankdrücken). Die Ruptursequenz startet am Ansatz, ausgehend von superior nach inferior, beginnend mit den inferiorsten Muskelsegmenten, gefolgt von Pars sternocostalis (PS) und Pars clavicularis. Die meisten Klassifikationen bauen auf Rupturlokalisation, -ausdehnung und Verletzungszeitpunkt auf. Neben klinischen Zeichen und Sonographie hat sich die MRT als diagnostischer Goldstandard etabliert. Die Indikation zur operativen Versorgung besteht bei fast allen lateralen PM-Sehnen-Rupturen mit relevantem Kraftdefizit. Eine Versorgung <3 Wochen ist primär anzustreben, jedoch ist eine operative Behandlung in chronischen Fällen möglich. Die konservative Therapie betrifft ausschließlich Patienten, die ursprungsnahe, muskuläre Verletzungen aufweisen, sowie kleinere Teilrisse. Ziel der operativen Therapie ist die anatomische Rekonstruktion der PM-Einheit mit Wiederherstellung der ursprünglichen Spannungsverhältnisse, um die optimale Kraftübertragung zu ermöglichen. Die operative Refixation bzw. Rekonstruktion (mit Auto‑/Allograft) von akuten und chronischen PM-Sehnen-Rupturen zeigt gute klinische Ergebnisse mit sehr hoher Patientenzufriedenheit. Latissimus-dorsi(LD)- und Teres-major(TM)-Sehnenrupturen sind selten, können aber bei Hochleistungssportlern zu deutlichen Beeinträchtigungen führen. Entgegen den PM-Sehnen-Rupturen werden LD- und TM-Verletzungen mit sehr zufriedenstellenden Ergebnissen primär konservativ behandelt.

Date Created: 20201214 Date Completed: 20210208 Latest Revision: 20210208

20231215

10.1007/s00113-020-00921-4

33315118