Pectoralis Major Rupture Injury during Bench Press Exercise CLINICAL: a rare injury patterns with typical sudden "tear/pop" sensation as the pectoralis major ruptures. Primarily men: 20-40yo (weightlifting) HOW? excessive tension on a maximally eccentrically contracted muscle -> tendon fails in a predictable sequence--> inferior fibers of sternocostal head fail first, then superior fibers of the sternocostal head, and finally the clavicular head. EXAM: severe ecchymosis, swelling, "dropped nipple sign ". Severe weakness in adduction of upper extremity. IMAGING: radiographs of low utility. Likely need MRI. APPROACH: NON-OPERATIVE-->initial sling immobilization, rest, ice, NSAIDs, physical therapy: Indicationsl W/ Low-demand, sedentary, and elderly patients . Muscle belly tears, low-grade partial ruptures OUTCOMES: Inferior to operative management for young, active individuals. cosmetic disfigurement, significant deficit in strength (most pronounced with isokinetic adduction) and peak torque, delayed recovery, poor patient satisfaction, lower return to competitive sports. OPEN OPERATIVE: majority of these cases in active young patients go right to the OR for repair by orthopedic specialists. Followed by PT/OT rehab. the_resuscitationist @the_resuscitationist #Pectoralis #Major #Rupture #Injury #clinical #video #msk #orthopedics
