title: Clinical considerations for the surgical treatment of pectoralis major muscle ruptures based on 60 cases: a prospective study and literature review.
abstract: BACKGROUND
  Early recognition of the clinical signs of ruptures of the pectoralis major muscle (PMM) in athletes by orthopaedic surgeons, physical therapists, and physical trainers may prove to be critical for patient access to surgical treatment while the injury is still in the acute phase.
  
  
  OBJECTIVE
  Total ruptures of the PMM may yield a better outcome with surgical treatment than with nonoperative treatment in athletes.
  
  
  METHODS
  Cohort study; Level of evidence, 2.
  
  
  METHODS
  A prospective study was performed on 60 patients with total ruptures of the PMM. The patients were followed from 1997 to 2012, with a physical examination every 6 months for the first 2 years and every 12 months thereafter. The patients' mean age was 31.21 years, and the mean length of follow-up was 48.25 months. The surgical treatment methods included reinsertion of the tendon in 51% of the patients and nonoperative treatment in 49% of the patients. All of the patients were evaluated using the Bak criteria.
  
  
  RESULTS
  The bench-press exercise was associated with 80% of the PMM ruptures (48 patients). Forty-one of the patients with chronic ruptures were seen after 3 months (80%). The outcomes were poor in 9 patients from the nonoperative group (31%) and in 3 patients from the surgical group (9.7%); the outcomes were fair in 12 patients from the nonoperative group and in no patients from the surgical group. Excellent results were not observed in any patient from the nonoperative group and were observed in 21 patients from the surgical group (67.7%). The isokinetic evaluation at 60 deg/s showed a decrease in strength of 41.7% in the nonsurgical group and 14.3% for the surgical group, which was significant at P < .05.
  
  
  CONCLUSIONS
  Total ruptures of the PMM exhibit better outcomes with surgical treatment than with nonoperative treatment based on the Bak criteria in athletes.
authors.affiliation: Alberto de Castro Pochini, Sports and Traumatology Center, Federal University of São Paulo (UNIFESP Rua Estado de Israel 638, São Paulo, SP, 01408000, Brazil. apochini@uol.com.br).
authors.forename: Alberto
authors.initials: A
authors.lastname: de Castro Pochini
authors.forename: Carlos Vicente
authors.initials: CV
authors.lastname: Andreoli
authors.forename: Paulo Santoro
authors.initials: PS
authors.lastname: Belangero
authors.forename: Eduardo Antonio
authors.initials: EA
authors.lastname: Figueiredo
authors.forename: Bernardo Barcellos
authors.initials: BB
authors.lastname: Terra
authors.forename: Carina
authors.initials: C
authors.lastname: Cohen
authors.forename: Marilia dos Santos
authors.initials: Mdos S
authors.lastname: Andrade
authors.forename: Moises
authors.initials: M
authors.lastname: Cohen
authors.forename: Benno
authors.initials: B
authors.lastname: Ejnisman
mesh_terms: D000328:Adult; D045930:Anabolic Agents / Q000008:administration & dosage; D001265:Athletic Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000293:injuries*; D011446:Prospective Studies; D012307:Risk Factors; D012421:Rupture / Q000601:surgery; D014891:Weight Lifting / Q000293:injuries
chemical_list: D045930:Anabolic Agents
keywords: bench press; cortical button; general; muscle injuries; pectoralis major muscle rupture; shoulder