MRI of pectoralis major tears: association between ancillary findings and tear severity

• Published in: Skeletal radiology Vol. 47; no. 8; pp. 1127 - 1135
• Main Authors: Godoy, Ivan R. B., Martinez-Salazar, Edgar L., Simeone, F. Joseph, Bredella, Miriam A., Palmer, William E., Torriani, Martin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2018; Springer; Springer Nature B.V
• Subjects: Adult; Athletic Injuries - diagnostic imaging; Athletic Injuries - etiology; Case-Control Studies; Comparative analysis; Displacement; Female; Hematoma; Hematoma - diagnostic imaging; Hematoma - etiology; Humans; Humerus; Identification methods; Imaging; Injuries; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Muscular Diseases - diagnostic imaging; Muscular Diseases - etiology; Nuclear Medicine; Orthopedics; Pathology; Pectoralis Muscles - diagnostic imaging; Pectoralis Muscles - injuries; Radiology; Reconstructive surgery; Retrospective Studies; Reviews; Rupture - diagnostic imaging; Scientific Article; Surgery; Surgery, Plastic; Tearing; Tendon Injuries - diagnostic imaging; Young Adult; Pectoralis major; Myotendinous junction; Tear; MRI; Tendon; Strain
• ISSN: 0364-2348; 1432-2161; 1432-2161
• DOI: 10.1007/s00256-018-2893-9

Objective To evaluate the significance of biceps tendon (BT) displacement and peri-bicipital hematoma on MRI in subjects with pectoralis major (PM) tears. We hypothesized that these features might be associated with tear severity at surgery. Materials and methods We retrospectively identified MRI cases with PM injury and reviewed clinical, imaging, and surgical records. MR images were reviewed independently by two musculoskeletal radiologists to determine anterior displacement of BT (BT-disp, in mm) and the presence of triangular-shaped peri-bicipital hematoma. Data were compared with an age- and sex-matched control group and correlated with surgical reports grouped by tear severity. Results We identified 46 subjects with PM injury (43 men, 3 women; mean age 34 ± 9 years), 26 of whom underwent surgical reconstruction, and 20 matched controls ( P  > 0.2). BT-disp was significantly higher in PM injury vs controls ( P  = 0.003), and in tendon vs myotendinous (MT) junction PM tears ( P  < 0.0001); however, MT junction tears vs controls were similar ( P  = 0.98). Higher BT-disp and presence of peri-bicipital hematoma correlated significantly with surgical reports describing full-thickness complete tears. BT-disp > 4.5 mm had 86% sensitivity and 75% specificity to detect the most severe tears on surgical reports, whereas the presence of peri-bicipital hematoma was the strongest predictor among both parameters. Conclusion Anterior BT displacement and peri-bicipital hematoma are helpful indicators of full-thickness complete tears at the humeral insertion.