Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Pectoralis Muscle Rupture

SYMPTOMS

Sudden onset of localised pain in the anterior part of the shoulder and upper arm after excessive abduction and external rotation such as in a rugby tackle. There is weakness on internal rotation and forward flexion.

AETIOLOGY

The pectoralis muscle insertion at the upper humerus or muscle bulk can rupture partially or completely.

CLINICAL FINDINGS

Clinical tests of resisting an internal rotation manoeuvre will identify the weakness and pain typical of a rupture.

INVESTIGATIONS

This is a clinical diagnosis. MRI or ultrasound are helpful to delineate the extent of the injury.

TREATMENT

A complete tear will require surgery while a partial tear can be treated with progressive rehabilitation over 12 weeks

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon In all cases a thorough rehabilitation programme, including specific treatment, thoraco-scapular control training, strength, flexibility and posture training is required

EXERCISE PRESCRIPTION

Most general activities are possible but secondary symptoms due to compensation and avoidance of pain are common and must be addressed. Running should initially be avoided since the shoulder will be sensitive to this type of impact and holding the arm still while running will cause secondary upper back and neck pain. Swimming should also wait for around three months. The specific rehabilitation should aim at a full range of controlled motion, good posture and thoraco-scapular control by three months followed by functional training for up to six months before resuming sports like rugby.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. Functional strength, control and flexibility should be comparable with the other shoulder.

DIFFERENTIAL DIAGNOSES

Fracture of proximal humerus or rib fractures in the area.

PROGNOSIS

Good-Fair, depending on severity of the injury. Usually athletes in overhead sports can return to play within six to 12 months.

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