Summary

This diagnosis is rare but with the growing number of adolescents that participate in weight lifting and gym activity, its potential as a diagnosis should be highlighted.

Abstract

Introduction

Rupture of the pectoralis major is a rare injury that was first described in 1822. Bony avulsion is particularly uncommon, with only four few published cases since 1822. Following a literature search we failed to identify any cases of this injury in a patient under the age of 16. We are presenting the symptoms, diagnosis and the treatment of a 15 years old child with pm avulsion injury.

Case description:
A 15 year old boy was lifting heavy weights as a fly exercise at the gym and he fell a pop at his left shoulder area. He was seen in Emergency Department on the day of injury. His diagnosis was given as a muscle strain around the left shoulder and he was discharged to physiotherapy and verbal advice to return if any problems. He re-attended 13 days later with pain, ecchymosis, swelling to an area close to his left axilla. He was referred to fracture clinic where he was seen 28 days after the initial injury by a non-shoulder Orthopaedic Surgeon who questioned the diagnosis and arranged for an MRI Scan. He was reviewed 56 days following the injury for discussion of the MRI Scan results which demonstrated a pectoralis major rupture at its distal insertion and he was referred on to a sports injuries surgeon.

He was then seen 63 days following the injury and clinical examination demonstrated abnormal appearance of the Pectoralis Major Muscle, worse on contraction (hip press test). He had weakness when testing the muscle. There was a palpably hard finding in the axilla which was thought to be a periosteal avulsion that had matured to bone over the time period.

Eight days later he subsequently underwent Open Reduction and Internal Fixation of his Pectoralis Major using 3x Tapes passed through 3x Unicortical Buttons. At surgery the periosteal avulsion was confirmed and the mature bone excised.

He underwent successful rehabilitation and returned to sport 6 months following surgery.

Discussion

While Pectoralis Major rupture is well recognised among the sporting population in adults we believe this case highlights the possibility in an adolescent. With the growing incidence of teenagers attending gyms and weight training we suspect that such a diagnosis will become more common and therefore should be considered by all Orthopaedic Surgeons in a generalist Fracture Clinic. Such a delay in diagnosis and ultimately treatment would normally result in retraction of the tendon and a likely poorer outcome from injury. In this case that was fortunately avoided due to the periosteal avulsion and a good outcome was achieved.