Traumatische Ruptur des Musculus pectoralis major – ein Fallbericht

Zusammenfassung

Nach traumatischer Ruptur des M. pectoralis major erfolgte bei einem 49-jährigen Sportler die transossäre Reinsertion mittels Durchflechtungsnähten am Ober- und Unterrand des sternalen und klavikulären Anteils sowie zusätzlichen Mason-Allen-Nähten am lateralen Sehnenrand. Drei Wochen Gilchrist-Verband, ab der 6. Woche Krafttraining, Schwimmen, Klimmzüge und Liegestütze. Freie Beweglichkeit auf dem ursprünglichen Leistungsniveau.

Abstract

A 49-year-old male athlete sustained a complete rupture of the pectoralis major muscle while bench pressing. The inferior and the superior border of the clavicular lamina and the sternal lamina were fixed with mattress sutures. After that transosseous reinsertion via drill holes (no suture anchors). The lateral rim of both tendons was fixed with Mason-Allen sutures. Final adaption of the distal tendon stump above the reinserted tendon (doubling). Postoperative immobilisation for 3 weeks in Gilchrists sling was followed by active-assistive step-by-step mobilisation. A speedy rehabilitation was planned after 6 weeks, but at this time the patient was doing strength training, swimming, pull-ups and press-ups at his own responsibility. Normal mobility and previous sports activity were achieved in spite of the early and extremely high stress. We assume that the very strong and secure reinsertion technique with 4 mattress sutures, Mason-Allen sutures and doubling of the tendon close to the foot print region may be the reason for the good result in spite of the massive and early loading.

Ruptur des M. pectoralis major - Krafttraining - akute Ruptur - Rehabilitation - Operationstechnik

pectoralis major rupture - strength training - acute rupture - rehabilitation - operation procedure

Literatur

• 1 Kakwani R G, Matthews J J, Kumar K M et al. Rupture of the pectoralis major muscle: surgical treatment in athletes.  Int Orthop. 2007;  31 159-163
• 2 Merolla G, Campi F, Paladini P et al. Surgical approach to acute pectoralis major tendon rupture.  G Chir. 2009;  30 53-57
• 3 Ritsch M. Die Pectoralis-major-Ruptur im Kraftsport.  Sport Orthop Traumatol. 2009;  25 142-143
• 4 Antosh I J, Grassbaugh J A, Parada S A et al. Pectoralis tendon repairs in the active-duty population.  Am J Orthop. 2009;  38 26-30
• 5 Constant C R, Gerber C, Emery R J H et al. A review of the Constant score: modifications and guidelines for its use.  J Shoulder Elbow Surg. 2008;  17 355-361
• 6 Constant C R, Murley A H. A clinical method of functional assessment of the shoulder.  Clin Orthop Relat Res. 1987;  214 160-164
• 7 Habermeyer P, Magosch P, Lichtenberg S. Classifications and scores of the shoulder. Berlin, Heidelberg; Springer 2006: 199-204
• 8 Germann G, Wind G, Harth A. Der DASH-Fragebogen – Ein neues Instrument zur Beurteilung von Behandlungsergebnissen an der oberen Extremität.  Handchir Mikrochir Plast Chir. 1999;  31 149-152
• 9 Gwinn D E, Wilson K E, Sracic M et al. Use of transcutaneous electrical nerve stimulation for pectoralis major tendon repair.  Techn Shoulder Elbow Surg. 2009;  10 1-4