Shoulder muscle ruptures Flashcards
Pect major rupture Deltoid rupture triceps rupture lat dorsi ruputre
1
Q
Describe the epidemiology of pectoralis major rupture?
A
- exclusively males
- often weight lifters
- most common occurs as tendon avulsion
- mechanism
- excessive tenson on maximally eccentrically contracted muscle
- maybe iatrogenic injury caused by RC repair
2
Q
Describe the anatomy of pectoralis major ?
A
- Origin
- clavicle head, ant medial suface of medial half of clavicle. sternocostal head, ant surface of sternum, sup 6 costal cartilages
- Insertion
- lateral tip of inertubercular groove of humerus
- action
- adducts and medially rotates humerus, draws scapula anterior and inferiorly. acting alone- clavicular head flexes humerus and sternocostal head extends it.
- Innervated by lateral and medial pectoral nerves: clavicular head C5/6, sternocostal head( C7,8,T1)
- blood supply
- pectoral branch of thoracoacromial trunk
- 2 heads
- clavicular head
- sternocostal head
- one of 4 muscles connecting the upper limbto the thoracic wall others include
- pectoralis minor
- subclavius
- serratus anterior
- Biomechanics
- inferior fibres of sternal head at max stretch during final 30o of humeral extension
- position at which pectoralis major is most vunerable to rupture
3
Q
Describe the presentation of pectoralis major rupture?
A
- HX: reports a sharp tearing with resisted adduction and IR
- Pain and weakness of shoulder
O/E
-
Swelling and ecchymosis
- if localissed to anterior arm then humeral attachment rupture is more likely then musculotendinous junction rupture
- Palpable defect and deformity of the anterior axillary fold
- weakness with adduction and IR
4
Q
What imaging is useful in pectoralis major rupture?
A
- xrays normally normal
- MRI
- may show avulsion of pect major tendon from humerus
5
Q
What is the tx of pectoralis major rupture?
A
- Non operative
-
intial sling, immobilisation, rest ice NSAIDs
- for partial ruptures
- trears in muscle or musculotendinous junction
- low demand pts
-
intial sling, immobilisation, rest ice NSAIDs
- Oerative
-
open exploration and repair of tendon avulsion
- tendon avulsed from bone/ high level athletes
- http://www.orthobullets.com/video/view?id=144
-
open exploration and repair of tendon avulsion
6
Q
Describe the epidemiology of deltoid ruptures?
A
- Usually strains or partial tears
- complete tears are rare
- risk factors
- rpt corticosteriods about the shoulder
- RC tear
- Trauma
- Mechanism
- 2ary to rpt corticosteriods about the shoulder
-
Massive RC tear
- prox migration of humeral head -> compression/abrasion of deltoid by geater tuberosity
-
Iatrogenic injury
- during open RC repair
-
Trauma
- sudden deltoid contracture
- shoulder contusion
7
Q
Describe the anatomy of deltoid?
A
- origin
- lateral 1.3 rd of clavicle, acromium, and spine of scapula
- insertion
- Deltoid tuberosity
- action
- anterior part- flexes and medially rotates arm
- middle- abducts arm
- posterior- extends and laterally rotates arm
- Innervation
- axillary nerve C5/6
- Blood supply
- deltoid branch of thoracoacromial artery
8
Q
What is the presentation of deltoid rupture?
A
- shoulder pain
- inspection
- depression over deltoid
- soft tissue mass distal to depression
9
Q
What is on imaging of deltoid rupture?
A
- Xrays
- assoc cuff tear
- USS
- deltoid gap with intact surrounding fibrers
- MRI
- Differentiates partial vs completee
- find deltoid defect and assoc RC tear
10
Q
What is the tx of deltoid rupture?
A
Non operative
- Observation only
- chronic injuries in elderly
Operative
-
Early surgical repair
- complete rupture
-
Deltoplasty w mobilisation and anterior transfer of middle third of the deltoid
- iatrogenic RC injury during RC repair
11
Q
Describe the anatomy of triceps brachii?
A
- Origin
- long head - infraglenoid tubercle of scapula
- lateal head- post surface of humerus, sup to radial groove
- medial head- post surface of humerus, inf to radial groove
- Insertion
- proximal end of olecranon process of ulna and fascia of forearm
- Action
- chief extensor of forearm; long head steadies head of abducted humerus
- Innervation - Radial nerve (C6,7,8)
- Blood supply
- branches of deep brachial artery
12
Q
Describe the epidemiology of tricep rupture?
A
- Usually males
- age 30-50
- usually in
- competitive wieghtlifters
- body builders
- football players
- risk factors
- systemic illness- renal osteodystophy
- anabolic steriod use
- local steriod injecions
- flouroquiolone use
- chronic olecranon burisitis
- prev triceps surgery
- Mechanism
- usually forceful eccentric contraction
- Pathoanatomy
- rupture most common at insertion of medial /lateral head
- les frequent thru muscle belly /musculotendinous junction
13
Q
What is the presentation of triceps rupture?
A
- Pt often not a painful pop
- loss of ability to extend elbow against gravity
O/E
- May have palpable gap
- swelling, ecchymosis and pain
14
Q
What is seen on imaging of triceps rupture?
A
- xray
- lateral view may show flake sign
- MRI
- determine loation and severity
15
Q
What is the tx of triceps rupture?
A
Non operative
-
supportive tx
- partial tears and able to extend against gravity
- low demand pt with poor health
Operative
-
Primary surgical repair
- acute complete tears
- partial tears (>50%) with significant weakness
- delayed reconstruction may need tendon graft
18
Q
Describe the anatomy of latissmus dorsi?
A
- Origin
- sipinous process of inferior 6 thoracic vertebrae, thoracolumbar fascia and inferior 3/4 ribs
- Inserts
- floor of intertubercular groove of humerus
- action
- extends, adducts and medially rotates humerus, raises body toward arms during climbing
- innervation
- thoracocodorsal nerve C6,7,8
- Blood supply
- thoracodorsal artery
20
Q
What imaging is useful in latissimus dorsi rupture?
A
- MRI
- increase T2 signal and retractio of latissmus dorsi muscle
