Shoulder
Accuracy of magnetic resonance imaging in predicting the intraoperative tear characteristics of pectoralis major ruptures

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Background

Magnetic resonance imaging (MRI) is the preferred study of choice for pectoralis major ruptures. Because this is a rare injury, no large case series have evaluated the efficacy of MRI for diagnosing and characterizing pectoralis major ruptures. We hypothesized that MRI would be accurate for diagnosis of the location and grade of pectoralis major tears.

Methods

The study included 36 operative cases of pectoralis major ruptures with detailed descriptions of tear location and grade and satisfactory preoperative MRIs. Two musculoskeletal fellowship-trained radiologists interpreted the MRIs, which were then compared with the operative findings for location: tendon-bone junction or myotendinous junction, and tear grade (G): G2 (incomplete high grade partial tear) or G3 (complete tear). The sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

Results

The MRI sensitivity was 1.00 for diagnosing complete G3 tears at the sternal head and clavicular head in acute ruptures. The sensitivity of MRI for diagnosing tendon-bone tears at the sternal and clavicular heads was 0.93 and 0.90, respectively. The sensitivity of MRI in diagnosing myotendinous and G2 tears diminishes, but specificity and negative predictive value remain high for sternal and clavicular head ruptures.

Conclusions

Our data support the use of MRI in diagnosing the tear grade and location of pectoralis major tendon ruptures, particularly for acute, tendon-bone, and G3 tears. The diagnostic accuracy of MRI decreases when chronic tears are evaluated. MRI remains a useful adjunct in diagnosing and guiding treatment of pectoralis major ruptures.

Section snippets

Materials and methods

We performed a retrospective review of all patients undergoing surgical repair for pectoralis major tendon ruptures at our institution from 1997 to 2014. The inclusion criteria were an isolated primary pectoralis major injury, a preoperative MRI study, an operative note specifying the tear description according to the Tietjen classification,24 and available clinical records indicating clinical decision making of operative vs nonoperative management. Exclusion criteria included recurrent injury

Results

We identified 53 patients. All but 6 repairs were performed by upper extremity or sports medicine fellowship-trained surgeons with at least 3 years of experience. Thirty-six patients (all male) met the inclusion criteria. An incorrect shoulder protocol was used in 5 of the excluded patients, and the MRIs for 12 patients were deemed poor quality (premature humerus cutoff, motion artifact, or grainy quality).

Patients were an average age of 35.5 years (range, 19-59 years). The most common injury

Discussion

Pectoralis major ruptures are relatively uncommon injuries. Most published reports are case series with small sample sizes.12, 13, 17, 21, 25, 27 The 2 largest case series demonstrated the importance of early surgical treatment of these injuries.1, 8

Aärimaa et al1 retrospectively reviewed 33 patients undergoing operative treatment of complete or nearly complete pectoralis major ruptures, and good/excellent outcomes were achieved in 30 patients (91%). Subgroup analysis of this cohort revealed

Conclusion

Our data support the use of MRI in diagnosing the tear grade and location of pectoralis major tendon ruptures, particularly for acute, bone-tendon junction, and G3 tears. The diagnostic accuracy of MRI decreases when chronic tears are evaluated. MRI remains a useful adjunct in the diagnosis of pectoralis major ruptures and for guiding operative and nonoperative treatment.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (27)

  • W.E. Garrett

    Muscle strain injuries: clinical and basic aspects

    Med Sci Sports Exerc

    (1990)
  • C.M. Hanna et al.

    Pectoralis major tears: comparison of surgical and conservative treatment

    Br J Sports Med

    (2001)
  • J. Kircher et al.

    Surgical and nonsurgical treatment of total rupture of the pectoralis major muscle in athletes: update and critical appraisal

    Open Access J Sports Med

    (2010)
  • Cited by (0)

    The University of Pittsburgh Institutional Review Board approved this study (IRB #PRO13040225).

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