title: Bony avulsion injury of the pectoralis major in a 19 year-old male judo athlete: a case report.
abstract: OBJECTIVE
  Bony avulsion of the pectoralis major muscle is a rare but potentially devastating injury for athletes. Pectoralis major rupture typically occurs in 20 to 39 year-old males. The shoulder region is one of the most frequently injured areas in Judo athletes. The purpose of this case report is to describe diagnosis and treatment following a pectoralis major bony avulsion due to an atypical mechanism of injury in a young Judo athlete.
  
  
  METHODS
  A 19-year-old military cadet and competitive judo athlete reported to a direct-access sports physical therapy clinic 7 weeks after incurring a shoulder injury during a judo match. He complained of shoulder pain and weakness with the inability to perform pushups. He presented with horizontal adduction weakness and visible discontinuity of the pectoralis muscle with resisted adduction.
  
  
  RESULTS
  Radiographs demonstrated a bony avulsion of the pectoralis major from its humeral attachment. The patient underwent surgical repair of the lesion the next week and was able to resume most military cadet activities within 5 months post-operation.
  
  
  CONCLUSIONS
  Bony avulsions are exceptionally rare injuries, and are even more uncommon in athletes under the age of 20. It is important for clinicians to perform a thorough history and physical examination in order to avoid missing this diagnosis. Surgery is likely the best option for a young athletic population; while conservative management may be optimal for the older, inactive population.
  
  
  METHODS
  4.
authors.affiliation: Resident, US Military-Baylor University Sports Physical Therapy Doctoral Residency, Keller Army Community Hospital, West Point, NY, 10996.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Shepard
authors.affiliation: Faculty, US Military-Baylor University Sports Physical Therapy Doctoral Residency, Keller Army Community Hospital, West Point, NY, 10996.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Westrick
authors.affiliation: Associate Professor John A. Feagin, Jr. Sports Medicine Fellowship, Orthopedic Surgery, Keller Army Community Hospital, West Point, NY, 10996.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Owens
authors.affiliation: Director, US Military-Baylor University Sports Physical Therapy Doctoral Residency, Keller Army Community Hospital, West Point, NY, 10996.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Johnson
keywords: Athlete; avulsion; martial arts; pectoralis major; rupture