The "bench-presser's shoulder": an overuse insertional tendinopathy of the pectoralis minor muscle.
BACKGROUND
Tendinopathies of the rotator cuff muscles, biceps tendon and pectoralis major muscle are common causes of shoulder pain in athletes. Overuse insertional tendinopathy of pectoralis minor is a previously undescribed cause of shoulder pain in weightlifters/sportsmen.


OBJECTIVE
To describe the clinical features, diagnostic tests and results of an overuse insertional tendinopathy of the pectoralis minor muscle. To also present a new technique of ultrasonographic evaluation and injection of the pectoralis minor muscle/tendon based on use of standard anatomical landmarks (subscapularis, coracoid process and axillary artery) as stepwise reference points for ultrasonographic orientation.


METHODS
Between 2005 and 2006, seven sportsmen presenting with this condition were diagnosed and treated at the Cape Shoulder Institute, Cape Town, South Africa.


RESULTS
In five patients, the initiating and aggravating factor was performance of the bench-press exercise (hence the term "bench-presser's shoulder"). Medial juxta-coracoid tenderness, a painful active-contraction test and bench-press manoeuvre, and decrease in pain after ultrasound-guided injection of a local anaesthetic agent into the enthesis, in the absence of any other clinically/radiologically apparent pathology, were diagnostic of pectoralis minor insertional tendinopathy. All seven patients were successfully treated with a single ultrasound-guided injection of a corticosteroid into the enthesis of pectoralis minor followed by a period of rest and stretching exercises.


CONCLUSIONS
This study describes the clinical features and management of pectoralis minor insertional tendinopathy, secondary to the bench-press type of weightlifting. A new pain site-based classification of shoulder pathology in weightlifters is suggested.
Bhatia
Deepak N
DN
Cape Shoulder Institute, Medgroup Anlin House, Plattekloof, Cape Town, South Africa. thebonesmith@gmail.com
de Beer
Joe F
JF
van Rooyen
Karin S
KS
Lam
Francis
F
du Toit
Donald F
DF
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000704:Analysis of Variance; D012090:Cumulative Trauma Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007270:Injections, Intra-Articular; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D012307:Risk Factors; D017006:Rotator Cuff / Q000187:drug effects / Q000473:pathology*; D012785:Shoulder Joint / Q000503:physiopathology; D020069:Shoulder Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D013177:Sports / Q000502:physiology; D018709:Statistics, Nonparametric; D052256:Tendinopathy / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D000305:Adrenal Cortex Hormones