Nathan P Shepard1, Richard B Westrick2, Brett D Owens3, Michael R Johnson4. 1. Resident, US Military-Baylor University Sports Physical Therapy Doctoral Residency, Keller Army Community Hospital, West Point, NY, 10996. 2. Faculty, US Military-Baylor University Sports Physical Therapy Doctoral Residency, Keller Army Community Hospital, West Point, NY, 10996. 3. Associate Professor John A. Feagin, Jr. Sports Medicine Fellowship, Orthopedic Surgery, Keller Army Community Hospital, West Point, NY, 10996. 4. Director, US Military-Baylor University Sports Physical Therapy Doctoral Residency, Keller Army Community Hospital, West Point, NY, 10996.
Abstract
BACKGROUND AND PURPOSE: Bony avulsion of the pectoralis major muscle is a rare but potentially devastating injury for athletes. Pectoralis major rupture typically occurs in 20 to 39 year-old males. The shoulder region is one of the most frequently injured areas in Judo athletes. The purpose of this case report is to describe diagnosis and treatment following a pectoralis major bony avulsion due to an atypical mechanism of injury in a young Judo athlete. CASE DESCRIPTION: A 19-year-old military cadet and competitive judo athlete reported to a direct-access sports physical therapy clinic 7 weeks after incurring a shoulder injury during a judo match. He complained of shoulder pain and weakness with the inability to perform pushups. He presented with horizontal adduction weakness and visible discontinuity of the pectoralis muscle with resisted adduction. OUTCOMES: Radiographs demonstrated a bony avulsion of the pectoralis major from its humeral attachment. The patient underwent surgical repair of the lesion the next week and was able to resume most military cadet activities within 5 months post-operation. DISCUSSION: Bony avulsions are exceptionally rare injuries, and are even more uncommon in athletes under the age of 20. It is important for clinicians to perform a thorough history and physical examination in order to avoid missing this diagnosis. Surgery is likely the best option for a young athletic population; while conservative management may be optimal for the older, inactive population. LEVEL OF EVIDENCE: 4.
BACKGROUND AND PURPOSE:Bony avulsion of the pectoralis major muscle is a rare but potentially devastating injury for athletes. Pectoralis major rupture typically occurs in 20 to 39 year-old males. The shoulder region is one of the most frequently injured areas in Judo athletes. The purpose of this case report is to describe diagnosis and treatment following a pectoralis major bony avulsion due to an atypical mechanism of injury in a young Judo athlete. CASE DESCRIPTION: A 19-year-old military cadet and competitive judo athlete reported to a direct-access sports physical therapy clinic 7 weeks after incurring a shoulder injury during a judo match. He complained of shoulder pain and weakness with the inability to perform pushups. He presented with horizontal adduction weakness and visible discontinuity of the pectoralis muscle with resisted adduction. OUTCOMES: Radiographs demonstrated a bony avulsion of the pectoralis major from its humeral attachment. The patient underwent surgical repair of the lesion the next week and was able to resume most military cadet activities within 5 months post-operation. DISCUSSION: Bony avulsions are exceptionally rare injuries, and are even more uncommon in athletes under the age of 20. It is important for clinicians to perform a thorough history and physical examination in order to avoid missing this diagnosis. Surgery is likely the best option for a young athletic population; while conservative management may be optimal for the older, inactive population. LEVEL OF EVIDENCE: 4.
Authors: Lucas Gomes da Silva; Rafael Marques Ferrer; José Roberto de Souza; Mauro E C Gracitelli; Leonardo Luiz Barretti Secchi Journal: Int J Sports Phys Ther Date: 2022-06-01