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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 shoulder.

Acutely injured patients have limited shoulder range of motion; however, the more chronic injuries typically have a full range of motion. A large ecchymoses may be present on the lateral chest, but commonly extends onto the upper arm. Without a careful exam, the rupture can be misdiagnosed as a biceps tendon injury .

Acutely, it may be difficult to see a deformity in the lateral chest secondary to swelling. The classic loss of the anterior axillary fold and lateral chest border is seen in chronic injuries with either sternal head ruptures, or complete pectoralis ruptures. Often the avulsed tendon end is palpable on the chest wall.

In more chronic injuries the deformity is usually obvious, with noticeable skin retraction and loss of the anterior axillary fold. Sternal head ruptures can be differentiated from complete ruptures by careful clinical exam. With forward elevation, the clavicular head of the muscle can be both palpated and visualized. Resisted adduction or internal rotation will reveal the deficient sternal head.

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