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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 pectoralis.

MRI has been demonstrated to reliably identify injury to the muscle and distal tendon . Acute injury and edema of the pectoralis muscle, however, and insertion can make identification of a complete rupture difficult. The hematoma is easily identified in acute injuries, but is not present in more chronic tears. It can also be difficult to differentiate a sternal head rupture versus complete injury.

Incomplete tendon injuries and medial muscle ruptures are not usually amenable to repair. In our practice, we have not found MRI results to significantly affect our pre-operative planning. In general, most of the information required for surgical decision-making can be obtained from the physical exam.

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