Surgical repair and rehabilitation of a ruptured pectoralis major muscle in a professional footballer - A case report.

BACKGROUND: Pectoralis Major ruptures normally occur in activities and sports such as powerlifting and American football or rugby. It is a rarely reported phenomena in professional footballers. Surgery is normally considered the choice of management to enable a safe return to play with conservatively managed ruptures often resulting in significant strength deficits. This case report highlights the management of a pectoralis major rupture in a professional footballer. CASE PRESENTATION: A 27-year-old professional footballer sustained a left pectoralis major rupture after falling to the floor. A subsequent MRI reported a 5cm retraction of the pectoralis major tendon from its attachment at the humerus. Following a consultation with an orthopaedic surgeon the player underwent a pectoralis major surgical repair. Following surgery, the player underwent a rehabilitation programme under the care of the club physiotherapist. Return to play testing included a handheld dynamometer test, closed kinetic chain upper extremity test and progressive falling activities. The player returned to full contact training after 87 days. CONCLUSION: This case study demonstrates a successful return to professional football following a pectoralis major rupture and supports the notion that surgical repair of these injuries produces a favourable outcome in professional athletes when returning to sport.

The effect of shoulder manipulation on rotator cuff integrity.

The use of shoulder manipulation in the treatment of frozen shoulder remains controversial. Humeral fractures and neurological damage are the risks associated with the procedure. A concern of causing a rotator cuff tear exists but the incidence of iatrogenic rotator cuff tears is not reported. The purpose of this study was to assess the effect of shoulder manipulation for frozen shoulder on the integrity of the rotator cuff. In a prospective study, 32 consecutive patients (33 shoulders) with the diagnosis of frozen shoulder underwent manipulation of the shoulder under anaesthesia (MUA), 18 female and 15 males with mean age at manipulation of 503 years (range: 42-63). The average duration of symptoms before treatment was 6.2 months (range: 2-18 months). The patients were examined prior to the manipulation and at follow-up for combined shoulder range of motion, external and internal rotation and strength. All patients had an ultrasound assessment of the rotator cuff before and at 3 weeks after manipulation of the shoulder. Mean time between manipulation and last follow-up was 133 weeks. None of the patients had ultrasound findings of a rotator cuff tear, prior to the manipulation. In all patients the rotator cuff remained undamaged on ultrasound examination at 3 weeks after the procedure. The mean improvement in motion was 81.2 degrees (from 933 degrees pre-op to 174.5 degrees at last follow-up) for forward flexion; 102.6 degrees (from 68.8 degrees pre-op to 171.4 degrees at last follow-up) for abduction, 49.4 degrees (from 8.8 degrees pre-op to 58.2 degrees at last follow-up) for external rotation and 3.5 levels of internal rotation (range: 2 to 5 levels). These gains in motion were all highly significant (p < 0.0001). No fractures, dislocations or nerve palsies were observed. In this study, manipulation of the shoulder has not been associated with rotator cuff tears. If done properly the procedure appeared to be safe and to result in a marked improvement of range of movement and function.