title: Utility of the Pectoralis Major Index in the Diagnosis of Structurally Significant Pectoralis Major Tears.
abstract: BACKGROUND
  Diagnosis of pectoralis major tears early in the acute phase is important for optimizing surgical repair and outcomes. However, physical examination of pectoralis major injuries can be misleading, often resulting in a potentially detrimental delay in surgical treatment.
  
  
  OBJECTIVE
  To establish and validate a quantifiable clinical diagnostic test for structurally significant pectoralis major tears.
  
  
  METHODS
  Cohort study (diagnosis); Level of evidence, 2.
  
  
  METHODS
  A total of 50 healthy male participants (mean age, 43.3 ± 11.9 years) with normal uninjured pectoralis major anatomy were examined. Digital photographs of all participants were taken in the "military press" starting position (90° of shoulder abduction, 90° of shoulder external rotation). The length between the ipsilateral nipple and the apex of the pectoralis major muscle curvature along the anterior axillary fold, known as the pectoralis major distance, was measured bilaterally. Two orthopaedic surgeons measured all photographs on 2 separate occasions. The pectoralis major index (PMI) was calculated as a ratio of pectoralis major distance values to establish normal values. The PMI was also calculated in a cohort of 19 male patients (mean age, 33.8 ± 6.8 years) with a pectoralis major rupture to assess the diagnostic utility of this novel quantifiable physical examination technique.
  
  
  RESULTS
  Mean (± standard deviation) PMI for the uninjured group was 1.0 ± 0.07. A diagnostic threshold of a PMI <0.9 resulted in a sensitivity of 79%, specificity of 98%, and overall accuracy of 93% in identifying structurally significant pectoralis major ruptures. There was no correlation between PMI and age or activity level, including participation in sports and/or weight training. The PMI technique demonstrated good to excellent intrarater reliability (intraclass correlation coefficient [ICC] = 0.82, 0.74) and interrater reliability (ICC = 0.63, 0.76).
  
  
  CONCLUSIONS
  The PMI technique is a simple, quantifiable, and accurate clinical diagnostic test for structurally significant pectoralis major tears. Routine application of the PMI technique by clinicians may improve accurate identification of structurally significant rupture and expedite referral to a surgical specialist for optimal treatment and outcome.
authors.affiliation: Department of Orthopaedic Surgery, St. Joseph's Health Centre, Toronto, Ontario, Canada. ; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Amr W
authors.initials: AW
authors.lastname: ElMaraghy
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sacha S
authors.initials: SS
authors.lastname: Rehsia
authors.affiliation: Department of Orthopaedic Surgery, St. Joseph's Health Centre, Toronto, Ontario, Canada.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Pennings
keywords: diagnosis; pectoralis major; shoulder; tendon rupture