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Treatment Options

The past treatment of pectoralis major ruptures has been controversial. There have been studies advocating conservative treatment, some operative repair , and several have included both in their descriptions . More recently, most authors advocate early repair of these injuries . The pectoralis major functions to adduct, forward flex, and internally rotate the shoulder.

Several […]

Imaging

Imaging of the soft tissue injury in pectoralis major ruptures can be difficult. Plain x-rays can reveal bone avulsions, or loss of the pectoralis shadow. Ultrasound exam can demonstrate intra-muscular injury or loss of continuity of the tendon . CT scan can outline the muscle, but has difficulty visualizing the distal soft tissue of the […]

Clinical Evaluation

The most common mechanism for sustaining a pectoralis muscle injury is from weight-lifting or athletics. Wolfe et al.It described the transition period from eccentric loading to concentric loading (bench press position) as the most stressful to the inferior muscle fibers of the pectoralis muscle. The patient typically presents after sudden onset of pain in the […]

Anatomy

The anatomy of the pectoralis major muscle demonstrates two distinctively different parts—the clavicular head and the sternal head . We feel that when evaluating injuries to the pectoralis it is important to understand the anatomy of the pectoralis major muscle complex.

Unfortunately, many of the published reports never comment on this difference, or describe it […]

Biceps Tendon Rupture

Although acute ruptures of the LHB do occur, they are more commonly the end result of chronic biceps tendinitis. Acute ruptures can occur with a violent force placed on the LHB such as with a fall on an outstretched hand. Another traumatic event, which can cause significant damage to the LHB, is rapid deceleration of […]

Pathoanatomy

Before describing the mechanics of rotator cuff pathology, post-mortem studies provide an interesting backdrop to the issue of etiology. There is little doubt that rotator cuff tearing is a function of age among other factors. Post-mortem studies have indicated an incidence of full or partial thickness tears ranging from 5% to nearly 40% . Fukuda […]

Principles of Instability Surgery

The goal of treatment in both open and arthroscopic instability surgery is twofold: to restore the labrum to its anatomic attachment site and to re-establish the appropriate tension to the inferior capsuloligamentous complex of the joint. Cadaveric studies have shown that both the labrum and the capsule must be injured for a dislocation to occur.

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Posterior drawer test

Positioning.

The subject lies in the supine position with the knee flexed to a right angle, and the heel resting on the couch. The examiner sits on the foot of the subject. The heel of one hand is placed on the tibial tuberosity and the other hand is placed at the back of the upper […]

Anterior drawer test in external rotation

Positioning.

The subject is positioned as for the previous test. The lower leg and foot are externally rotated as far as is comfortably possible.The examiner places both hands around the upper part of the tibia with the index fingers on the hamstring tendons and the thumbs at the anterior border of the joint .

Procedure. […]

Knee extension mechanism injuries

The knee extension mechanism includes the quadriceps muscle-tendon, the patellar bone, the patellar tendon, and its insertion into the tibia. Injuries can occur in all these structures.

Quadriceps tendon injuries The distal quadriceps tendon attaches to the patella and its adjacent soft tissue structures (the retinaculum). It is important for the extensor mechanism. This tendon […]