Partial Pectoralis Tear Treated With Orthobiologics: A Case Report

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Reports of pectoralis major (PM) rupture have risen significantly in the last 20 yr, with more than half of all reported cases occurring in the last 10 yr (7). This is thought to be a result of increased interest in health and fitness as well as weight training (1). A missed or delayed diagnosis of a PM rupture can lead to poor outcomes or a need for an allograft reconstruction rather than direct repair (6). The PM muscle and tendon have a complex musculotendinous anatomy and historically the descriptions of PM tears have been inconsistent with the actual musculotendinous anatomy (2).
The diagnosis of a PM rupture can usually be made while taking the history from a patient. Commonly there is a sudden “pop” and sharp pain felt by the patient at the anterior medial aspect of the shoulder. This typically occurs with eccentric contraction during an activity such as a bench press. During physical examination, there may be ecchymosis and swelling over the anterior medial aspect of the shoulder. On inspection, there can be a loss of the anterior axillary fold with an asymmetric muscle outline that is retracted medially. The absence of the anterior axillary fold can be masked by significant swelling, but this defect can be accentuated by abducting the affected arm or with resisted adduction (8).
Partial tears and tears of the muscle belly can be treated nonoperatively. Nonoperative management of PM ruptures tends to be reserved for elderly patients or those who are not surgical candidates. Even with this conservative treatment of rest and physical therapy the patient can take up to 2 to 3 months to recover (5). Surgical repair is recommended for athletic individuals with complete PM ruptures. Improved clinical and functional outcomes have clearly been shown in the literature for surgical management with these types of individuals (1). However, it may take 5 to 6 months to return to full participation after surgery. PM injuries can seriously alter the course of an athlete’s season. We present a case of an in-season athlete with a partial PM that was treated nonoperatively with an injection of mesenchymal stem cells and platelet-rich plasma (PRP) to expedite return to play in 6 weeks.

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