The long head of the biceps lhb tendon is an important pain generator in the anterior shoulder, with both sensory and sympathetic innervation, which may transmit pain signals in response to inflammatory or degenerative tendinitis, instability, partial tears, or complete rupture. Imaging evaluation with ultrasound and mr imaging can be difficult given the complex regional anatomy. The multiplanar capabilities of mri allow optimal depiction of the portions of the pectoralis major muscle and tendon involved. Acrsarspr practice parameter for the performance of. The mean duration of followup was twentyfour months.
Obl sag t2 angle perpendicular to lt c 56 formaina on axial image. The injury results from violent, eccentric contraction of the muscle and tends to present in athletes as an uncommon sports injury. Pectoralis major tears, also known as pectoralis major ruptures, are an uncommon traumatic injury of the pectoralis major. An expert panel convened by the american cancer society recommended the use. The next nearest book out there is handbook of mri technique, though this book is much more detailed in both sequences and specific anatomy areas. The purpose of this study was to use mr imaging to provide an anatomic survey of the normal pectoralis major tendon and its insertion and to compare these findings with surgically proven cases of rupture. Incomplete ruptures of the pectoralis major are most common and typically occur at the musculotendinous junction or muscle belly of the sternal head. In type 1 torn pectoral, the tendon of the pectoralis major tears directly off of the humerus the easiest to fix.
Rupture of the pectoralis major is a rare injury that was first described by patissier in 1822 in paris, followed by letenneur in 1861. Table 3 summarizes the distribution of diagnostic findings via different modalities. Our radiologists work closely with ohsu mri technologists in the art of creating. An mri scanner contains a large magnet with a tunnel through the middle where the patient lies on a movable bed.
Discusses test also called mri scan that uses a magnetic field and pulses of radio wave energy to make pictures of the shoulder. The acrin 6701 trial will assess the repeatability of the quantitative magnetic resonance imaging mri assays dynamic contrastenhanced dce mri and diffusion weighted. The sensitivity and specificity of mri with respect to arthroscopy in medial meniscal tears is 85. It can limit arm use, and may cause significant pain. He is being worked up for surgery and i thought his mri images may be helpful to some of you suffering from posterior tibial tendon problems. Mri of the pelvis is the imaging modality of choice for many clinical situations involving pelvic pathology.
When the patient enters the magnet the hydrogen atoms in the water of their body tissues line up along the magnetic field. Rupture of the pectoralis major muscle is a once rare injury that is becoming more common due to increasing numbers of intense weighttraining and highperformance athletes. Optimal brain mri protocol for new neurological complaint. Mri of complete rupture of the pectoralis major muscle. When the mri protocol begins, the patient could breathe normally. Indirect magnetic resonance arthrography of the shoulder.
In type 2 torn pectoral the tear occurred where the muscle starts transitioning into a tendon the muscletendon junction harder to fix, but still. The sensitivity and specificity of mri with respect to arthroscopy in anterior cruciate ligament tear is 87. Complete tear of the patellar tendon with interposed edema andor hemorrhage can be seen on mri figure 4. This is a great reference book that is so far unique in the collection of mri books out there as a spiralbound havenexttothescanner book. Although the injury typically occurs while lifting weights, specifically while performing a bench press, it has also been known to occur in several other sports. Stir short ti iinversion recovery sag t1w sag t2w stir gadolinium spine imaging c o n t r a s t a g e n t o n g t left axial t1w image of s1 note nerve root right gdenhanced. In addition, recent literature has redefined the anatomy of the distal pectoralis major. Previous surgery around the tendon, such as a total knee replacement or allograft for anterior cruciate ligament reconstruction, might increase the risk of a tear. Coronal t2 near complete tear at the musculotendinous junction of pectoralis major with contusionedema of the muscle and surrounding softtissues. The coronal plane is oblique, paralleling the central tendon of the supraspinatus muscle. For the evaluation of intracranial extension of sinonasal disease. What is mri what is magnetic resonance imaging mri imaging.
Physical therapy for a pectoralis major tear verywell health. This book lists out the common pulse sequences for both. Rupture of the pectoralis major muscle is a rare clinical entity. None of the 91 patients experienced any adverse events during the imra protocol. Other functions of the pectoralis major include forward flexion of the humerus by the clavicular head and dynamic stabilization of the shoulder 1,3.
Mr imaging of the shoulder after surgery request pdf. The first five chapters of the book introduce the reader to the basics of mr imaging. This required a larger field of view than a standard shoulder mri. Axial t2 blade fat sat complete tear of the left pectoralis major tendon with retraction over a length of approximately 5 cm. Mr imaging assessment of the pectoralis major myotendinous.
Mri is useful in delineating the site and extent of the rupture in relation to the musculotendinous junction, which. Injury of the pectoralis major can occur at the muscle origin, muscle belly, musculotendinous junction. A torn or ruptured pectoralis muscle can limit your ability to engage in normal work and recreational activities. Individual chapters are devoted to each major anatomic region, including the central nervous. Tears of the pectoralis major can be partial just one head or complete. Written specifically for technologists and highly illustrated, it guides the uninitiated through scanning techniques and helps more experienced technologists to improve image quality.
Capsulotenodesis healing was assessed on a computed tomography ct arthrogram n 38 or magnetic resonance image mri n 4. It outlines all sequences and protocols currently applied in our mri section. Magnetic resonance imaging mri is a noninvasive test used to diagnose medical conditions. Mri protocols for essr european society of musculoskeletal. On conventional mri, sensitivities and specificities compared with arthroscopy were as follows. Mri handbook mr physics, patient positioning, and protocols.
Mr imaging shows the normal pectoralis major myotendinous unit has low signal intensity on both t1 and t2weighted images. This protocol was designed and developed by the american college of radiology imaging. Covers why it is done such as checking for unexplained shoulder pain or torn tendons. Us and mr imaging of pectoralis major injuries radiographics. Axial t1 and pd fs use coronal loc and plane is straight horizontal if the shoulder is markedly angled, you can angle the axial images perpendicular to the glenohumeral joint. In all other patients, both noncontrast mri and imra showed a labral tear by both readers.
Straight ax t2 fat mid humeral head superiorly through soft tissue of axilla inferiorly 5. Msk mri protocol overview page 3 of 123 msk mri protocols march 2010 1. Specific changes in the program will be made by the physician as appropriate for an individual patient. This protocol provides you with general guidelines for the rehabilitation of patients following a pectoralis major repair or transfer. Because teres major muscle injury was suspected at the time of imaging, we. The pectoralis major serves as a strong adductor and internal rotator at the shoulder joint. Sensitivity of mri for detection of superior labral anterior posterior slap lesions was 90% and specificity was 100% in 67 patients in one study. Accuracy of magnetic resonance imaging in predicting the. Mri pectoralis major muscle tear sequential mris of the right pectoralis major muscle demonstrates an extensive partial thickness tear arrows commencing from the lower aspect of the muscle, almost involving its entire length. Magnetic resonance imaging mri gadolinium statpearls ncbi. Obl sag t2angle perpendicular to rt c56 foramina on axial image 6. It should be performed only for a valid medical reason. A foursequence mri protocol that includes sagittal t1 weighted images, axial t2weighted flair images, axial diffusionweighted images, and t2weighted images reliably detects nearly all nonenhancing brain mri findings in patients without a known history of a neurologic disease undergoing evaluation for a new neurologic complaint.
Scan from sternum through lateral aspect of humerus. Mri is a medical imaging technique that can produce detailed pictures of many parts of the body. A tear of the pectoralis major is a considerably uncommon injury, often occurring during forceful activity such as bench press. Occasionally, magic angle artifact can cause an increase in signal in the distal supraspinatus tendon, mimicking a tear or tendonosis. Now entering its fourth edition, the marketleading handbook of mri technique has been fully revised and updated to incorporate new technologies and developments essential to good practice. In these patients, followup mri was performed 6 months and 1 year after initiation of steroid therapy with a 1. If you have any questions regarding the progress of the patient, the physician should be contacted.
Accurate characterization of pectoralis major tears is important to guide management. If you have ruptured or torn your pectoralis major muscle in your chest, you may benefit from physical therapy pt to help you recover. Mri is unique among diagnostic modalities because it uses more than one. Mri images one of my patients recently tore his posterior tibial tendon, the most important ankle tendon for arch support. Us and mr imaging of pectoralis major injuries1 during the past 2 decades, the frequency of pectoralis major muscle injuries has increased in association with the increased popularity of bench press exercises. On mri, a tear presents as an abnormal intrameniscal signal on t2weighted or proton density mr images that unambiguously contacts the meniscal surface. Mr imaging is the optimal imaging technique to study the normal and abnormal conditions of the pectoralis major muscle and tendon unit. A recipe book presenting protocols for most major studies in mr images. Musculotendinous rupture of the sternal head and strain of the clavicular head of the pectoralis major muscle pectoralis tear. Mri of the knee provides detailed images of structures within the knee joint, including bones, cartilage, tendons, ligaments, muscles and blood vessels, from many angles. Magnetic resonance imaging mri and ultrasound us are useful radiologic.
Only few reports have discussed its mri or ct features. You may experience pain, limited shoulder motion, and difficulty using your arm normally. These injuries are most often encountered in weight lifters, with the injury occurring almost exclusively during benchpress exercise. Accuracy of magnetic resonance imaging in diagnosis of. This webpage presents the anatomical structures found on shoulder mri. Magnetic resonance imaging mri of the pelvis is a proven and useful tool for the evaluation, assessment of severity, and followup of diseases of the male and female pelvic organs. The lateral and medial pectoral nerves innervate the pectoralis major. That research showed the sensitivity for anterior and posterior labral tears to be 89% and 86% and specificity as 100% and 100%. Diagnostic accuracy in detecting tears in the proximal. A protocol for evaluating the pectoralis major in its entirety may include the acquisition of t1weighted and stir largefieldofview mr images of the affected side of the anterior chest wall in the axial and oblique coronal planes and protondensityweighted fatsaturated mr images in the axial and oblique sagittal planes through the. Mri protocol for cardiac mri patients with cardiac involvement were identified according to the criteria established by yoshida et al.
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