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[Rupture of the pectoralis major muscle--case study and review of the literature].

Rupture of the pectoralis major muscle is a rare injury. In total 125 cases of complete and uncomplete ruptures are reported. This injury is the result of excessive muscle tension, a direct blow or a combination of both. In a case study the aetiology, diagnostic, treatment and functional outcome of complete muscle ruptures are shown. The reported results of 14 cases who underwent conservative and 51 cases with surgical treatment were classified and analysed. Conservative management is recommended for partial and proximal ruptures. Distal ruptures of the musculo-tendinous or tendinous insertion in active patients should be treated surgically to return previous muscle strength and contour.

Adult↗

Coexistence of a pectoralis quartus muscle and an unusual axillary arch: case report and review.

A pectoralis quartus muscle and an unusual axillary arch were found on the left side of a female cadaver. The axillary arch was a musculoaponeurotic complex continuous with the iliacal fibers of the latissimus dorsi. The muscular part, together with the tendon of pectoralis major, inserted into the lateral lip of the bicipital groove of the humerus, whereas the aponeurotic part was formed by a fibrous band that extended deep to the pectoralis major to insert into the coracoid process between the attachments of the coracobrachialis and pectoralis minor. The pectoralis quartus originated from the rectus sheath, and joined the inferior medial border of the fibrous band of the axillary arch, at the lateral edge of the pectoralis major. The axillary arch muscle crossed anteriorly the axillary vessels and the brachial plexus. The clinical importance of these muscles is reviewed.

Aged↗

[Rupture of the pectoralis major muscle -- causes, diagnosis, treatment].

PURPOSE OF THE STUDY: Between 01/02 and 01/03 four cases of ruptures of the pectoralis major muscle were treated in our hospital by suture. The data were retrospectively analysed, all patients underwent a follow up examination. We compared our results with the literature found by internet search. PATIENTS AND METHODS: Between 01/02 and 01/03 four male patients with a rupture of the pectoralis major muscle (PM) were treated surgically by suture. Three of them had an acute rupture (75%), in one case the injury was older (25%). In three cases patients underwent MRI examination. All patients were examined for a follow up by the Constant score and the score of McEntire. RESULTS: The median age of the patients was 36.5 (min: 27; max: 51) years; in three cases the left side was injured, in one case the right. All cases of the acute injury happened during weight bearing. The older rupture (1.5 years ago) was caused by a motorcycle accident. The follow up examination was performed after 8.5 (min: 7; max: 13) months. According to the score of McEntire the functional and clinical result was in all cases good to very good. The median value of the Constant score on the injured side was 90 (min: 63; max: 96) compared to 99 (min: 95; max: 100) on the other side. CONCLUSION: The rupture of the pectoralis major muscle is a rare entity and appears in young male patients. The most common reason for this injury is weight bearing or physical exercises, often in combination with anabolic steroids. Clinical and functional results after suture are good; patients normally reach the former level of activity and are able to practice their sports in the same way like they did before the trauma. According to our experiences, we recommend the surgical therapy.

Adult↗

Phosphodiesters in muscular dystrophies.

Phosphorus nuclear magnetic resonance studies of various normal and dystrophic muscles have demonstrated differences in phosphodiester contents. Dystrophic chicken pectoralis muscle contains elevated levels of the diester SEP, and Duchenne dystrophic human leg muscle lacks the diester GPC. It is shown that SEP may be characteristic of slow fiber types, indicating imcomplete maturation of the dystrophic pectoralis muscle. The activities of SEP-metabolizing enzymes have been determined in microsomes of pectoralis muscle, kidney, and intestinal mucosa of normal and dystrophic chickens. There was little difference between normal and dystrophic values of SEP phosphodiesterase and SEP synthase in kidney and mucosa. Dystrophic pectoralis muscle microsomes possessed significantly elevated levels of both enzymes. The increase in SEP synthase activity of dystrophic muscle may explain the increase in the SEP level if the phosphodiesterase is regulated in vivo. It is shown that human muscle disease processes may raise, leave unchanged, or lower GPC levels. In certain diseases when GPC is markedly elevated, such as Werdnig-Hoffmann, or depressed, such as Duchenne muscular dystrophy, it may serve as a marker.

Animals↗

Aplasia of pectoralis major muscle and renal anomalies.

We describe two patients with aplasia of the pectoralis major muscle and renal anomalies. We think such an association, which has been reported previously, represents a new congenital malformation, probably not a syndrome but an acro-pectoro-renal field defect. We recommend renal ultrasonography be done on all children with aplasia of the pectoralis major.

Aged↗

An anatomical study of the pectoralis major muscle as related to functioning free muscle transplantation.

The prerequisites for a functioning free muscle transplant are reviewed. A method for studying the anatomy of the pectoralis major muscle is presented, giving special attention to the detail of the neurovascular structures. Fifteen meticulous dissections, documented by sketches and photographs, provide the data base. This work is summarized in Table I and Figure 3. The variability is stressed in Table II. None of the variations observed preclude the use of the inferior four-fifths of the sternocostal muscle as a functioning free muscle transplant. The length and bulk of this muscle are advantages for its use in replacing forearm flexors. The multiple innervations may be an advantage or disadvantage, depending on the availability of the motor nerves in the recipient site. The time-consuming dissection is a disadvantage. With this knowledge, the reconstructive surgeon can assess the advisability of using the pectoralis major muscle as a functioning free muscle transplant.

Female↗

Atraumatic loose shoulder: the treatment by pectoralis major muscle transfer.

From 1975, 40 shoulders of 34 patients with a loose shoulder were operated on by pectoralis major transfer. The insertions of the clavicular and sternal portions were transferred to the inferior angle of the scapula to bring the glenoid cavity upwards. The follow-up period was 5.3 years on average, and complaints of dullness of the shoulder, feeling of subluxation and dullness of the arm had decreased. However, complaints of dullness of the shoulder girdle had increased at follow-up. The inferior instability had improved in all but four shoulders because this method brings the glenoid cavity upwards and the changes of the upward rotating angle of the scapula were confirmed by roentgenographic investigations. The study of the tracking movement pointed out that this method did not affect the motion of the shoulder, and the high activity of the transferred pectoralis major muscle during the movement was thought to play an important role in reducing inferior instability. This method is most recommended for a patient who has multidirectional instability and can subluxate the head antero-inferiorly by the pectoralis major muscle, but it is not recommended for athletes as the power of the shoulder adductor is reduced to some extent after surgery.

Adult↗

Comparison of growth factor receptors and metabolic characteristics of satellite cells derived from the biceps femoris and pectoralis major muscles of the turkey.

Myogenic satellite cells were isolated from the turkey pectoralis major (PM), a muscle composed largely of white fibers, and the biceps femoris (BF), a muscle composed largely of red fibers, and their properties were compared in culture. Satellite cells derived from the PM and BF muscles exhibited differences in metabolic parameters, growth factor receptor characteristics, and mitogenic responses. PM satellite cells exhibited greater responsiveness to platelet-derived growth factor (PDGF), and the PDGF receptor on these cells had a higher affinity toward ligand compared to BF cells (P < 0.05). Protein synthesis, protein degradation, and glucose uptake rates were higher in BF satellite cell cultures (P < 0.05), correlating with previously reported in vivo measurements using red and white muscle fibers.

Animals↗

Carotid artery protection by pectoralis major muscle flap.

A muscle flap made of the upper portion of the pectoralis major is used to protect the carotid artery. This simple technique is applicable either during initial radical neck dissection or repair of orocutaneous fistula.

Carotid Arteries↗

Lymph node metastasis within the pectoralis major muscle in breast cancer--a case report.

We report herein, a case of a 75 year old woman with breast cancer in whom lymph node metastasis within the pectoralis major muscle was found. The breast mass measured 10 X 6 cm, and its overlying skin was red and edematous, suggesting inflammatory carcinoma. An extended radical mastectomy was performed and the lesion was histologically confirmed to be solid-tubular carcinoma with regional lymph node involvement. In the pectoralis major muscle, where lymph nodes do not usually exist, one positive metastatic lymph node and another metastatic lymph node-like nodule were histopathologically confirmed. To our knowledge, no other such case has ever been reported, yet the possibility of lymph nodes existing in the pectoralis major muscle, albeit rare, should nevertheless be considered in the treatment of breast cancer.

Adenocarcinoma↗

Electromyographic validation of basic exercises for physical conditioning programmes. III. Influence of the grip in the capacity of the rowing exercises in determining action potential levels for the deltoid and the pectoralis major muscle.

The electromyographic activity of the shoulder muscles Deltoid--anterior portion (DA) and Pectoralis major--clavicular portion (PMC) was tested on 24 male volunteers using a 2 channel TECA TE4 electromyograph and Hewlett Packard surface electrodes during the execution of three different modalities of rowing exercises comparing middle grip with closed grip. Statistical comparisons showed that in both PMC and DA closed grip determined muscular solicitation higher than middlegrip excepting sitting rowing. The authors present some suggestions to the use of the tested exercises.

Action Potentials↗

Correction of Poland's pectoralis major muscle anomaly with latissimus dorsi musculocutaneous flaps.

This paper describes a new indication for the latissimus dorsi muscle or musculocutaneous flap, which has been applied to the treatment of congenital, unilateral absence of the pectoralis major muscle for formation of the anterior border of the axilla, by simulation of the pectoralis major muscle using the latissimus dorsi muscle. The results of this operation were satisfactory for both the patients and the surgeon.

Adolescent↗

Anatomic basis for the construction of a musculotendinous flap derived from the pectoralis major muscle.

The vascularization, innervation and termination of the clavicular portion of the pectoralis major muscle were studied by dissection of 7 adult subjects and 2 fetuses. The vascular and nervous autonomy of the clavicular portion was confirmed. Blood-supply was effected by 2 arteries and innervation by an independent nerve. The exact distribution of the fibers composing the pectoralis major and their complex insertion are described. It is concluded that the clavicular portion can be employed as an active muscle transplant to the head of the humerus when the short rotator muscles of the shoulder are ineffective.

Acromion↗

Effect of rapid rigor mortis processes on protein functionality in pectoralis major muscle of domestic turkeys.

The pale, soft, exudative (PSE) phenomenon in turkey pectoralis major (breast) muscle was studied using a combination of biochemical, meat quality, microscopic, and gel electrophoresis techniques. Breast muscle samples were collected from turkeys characterized by slow vs fast postmortem glycolysis assessed by muscle pH at 20 min after death. The PSE group was characterized by lower muscle ATP (P < .05) and higher lactate levels (P < .05) compared with the normal group. Excess water-holding capacity and cooking yield were significantly lower (P < .05) in the PSE group than in normal turkeys. Breast muscle of the PSE group was also lighter (P < .05) than that in the normal group as determined by Minolta L* values. The SDS-PAGE, Western blotting, and immunofluorescence microscopy revealed that phosphorylase, a soluble enzyme, became tightly associated with the myofibrils in muscle from the PSE group. Also, less myosin could be solubilized from PSE vs normal myofibril samples. The results indicate that irreversible myosin insolubility due to low pH and high-temperature conditions is decisive in the development of PSE turkey breast muscle.

Adenosine Triphosphate↗

Use of pectoralis minor muscle in immediate reconstruction of the breast.

A technique is described in which the pectoralis minor muscle is rotated as a muscle pedicle flap to be used in immediate reconstruction of the breast. The advantages of this procedure are that it provides additional muscle coverage over the prosthesis as well as preventing lateral displacement. Seven patients have undergone this technique with excellent results.

Breast Neoplasms↗

Rupture of the pectoralis major muscle in a collegiate football player. Use of magnetic resonance imaging in early diagnosis.

We have reported an unusual case of pectoralis major muscle rupture and repair. There were three interesting aspects of this case. First, the injury occurred in a football player with an unusual mechanism of injury. Second, MRI using special techniques was valuable in confirming the diagnosis acutely and in planning treatment. Finally, we reported on the use of suture anchors to secure the avulsed tendon. We recommend the early use of MRI for diagnosis and in planning treatment of suspected pectoralis major muscle ruptures.

Adult↗